RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-04193
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20011122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Automated Logistics Specialist, medically separated for “status post burst fracture of the L4” with a disability rating of 20%.

CI CONTENTION:  “Not given sufficient counsel and VA cannot rate because of no DD 214 can be located for service.”  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - Dated 20011010	VARD	
Condition	Code	Rating	Condition	Code	Rating	
Status-Post Burst Fracture of L4	5285-5292	20%	No VA Claim Filed	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:

Status-Post Burst Fracture of L4.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented the onset of this condition with a motor vehicle accident on 25 May 2000 (18 months before separation).  This resulted in multiple orthopedic (included surgical fractures of the left tibia and fibula) and internal injuries.  Some related injuries were submitted by the MEB as other conditions, but all were found to be not unfitting and only the lumbar spine condition falls within the Board’s scope of review as above.  The lumbar injury consisted of a burst fracture of L4 (no evidence for neural damage) requiring emergent neurosurgery (posterior fusion L3-5).  The CI underwent a protracted period of hospitalization and rehabilitation which initially required a back brace.  An STR entry at the time of MEB referral (01 May 2001, 7 months before separation) documented a normal gait without brace or assistive device and normal bilateral lower extremity neurological findings (5/5 strength all groups), but estimated lumbar flexion at 35 degrees (normal 90).  There was no later outpatient STR evidence commenting on range of motion (ROM), neurological findings, or other VASRD-ratable criteria.  The MEB’s physical examination 3 weeks later estimated flexion at 45 degrees.  The improvement after surgery remained insufficient to allow unrestricted duty and the CI was referred for MEB, which in turn forwarded “posttraumatic arthritis, lumbar spine, moderate” to the PEB.

The MEB NARSUM examination on 20 August 2001 (4 months before separation) documented unquantified back pain interfering with “standing, walking, sitting, lifting and running,” and did not mention any pain radiation or neurological symptoms.  The physical examination recorded “decreased lumbar lordosis,” a well healed surgical scar, and “normal” ROM.  A neurological examination was not documented.  An addendum to the NARSUM was conducted by the same orthopedist on 05 October 2001 (2 months before separation) at the PEB’s request.  This specified measured ROM with flexion to 12 inches from the floor (approximating 80 degrees) and bilateral flexion to 30 degrees (normal); and, stated, “It is not clear whether his slight limitation of forward flexion is due to tight hamstrings or loss of motion in the lumbar segments due to his 3-level fusion.”  Additionally the addendum provided radiological details for the L4 vertebral fracture, as requested by the PEB.  The orthopedist stated that there was “40% loss of height anteriorly,” but went on to state, “These measurements are also clinically irrelevant given that he has normal height from L3 to L5 due to his instrumentation and fusion when compared to the vertebral height from L1 to L3.”  As above, there was no VA or other post-separation evidence available in this case.

The Board directed attention to its rating recommendation based on the above evidence.  In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation, which was the 2002 VASRD standards for the spine.  The PEB’s rated the lumbar spine condition 20%, analogously coded 5285-5292 (vertebra, fracture of, residuals-spine, limitation of motion of, lumbar).  

The Board agreed code 5285 (vertebra, fracture of, residuals) provides high ratings for spinal damage or requirement for a neck brace (neither present in this case); but, also stipulates, “In other cases rate in accordance with definite limited motion or muscle spasm, adding 10 percent for demonstrable deformity of vertebral body.”  Code 5285 (for lumbar ROM limitation) conferred a 10% rating for “slight,” 20% for “moderate,” and 40% for “severe” limitation.  The PEB’s DA Form 199 documented the radiological evidence and caveat opinion from the addendum, noting the 40% compression, but adding “overall height L3-5 is maintained;” and, documented the ROM evidence from the addendum; and, concluded, “Rated for loss of motion, moderate.”  Other than codes 5285 and 5285 there were no applicable codes from the VASRD in effect that would be favorable in this case.

In order to justify a recommendation higher than the PEB’s 20% rating, the Board would need to conclude that there was moderate ROM limitation and concede the 10% addition for “demonstrable deformity” of L4 as per the 5285 rating language.  With regard to the latter, it was noted that, although the 40% compression was a certainly a “demonstrable” deformity in the literal sense, it was arguably not a ratable criterion from a practical and functional standpoint.  Furthermore, with regard to the 5292 criteria, it was unclear how the near normal ROM evidence at separation justified a “moderate” rating; since, it was more reasonably aligned with “slight” limitation (as specifically characterized by the examiner himself).  This notwithstanding, members agreed that there was insufficient evidence to justify both a “moderate” characterization of the ROM limitation and concession of the 10% criterion of 5285.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the status-post burst fracture of L4 condition.

BOARD FINDINGS:  In the matter of the status-post burst fracture of L4 condition and IAW VASRD §4.71a in effect, the Board unanimously recommends no change in the PEB adjudication.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141023, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

07 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018266 (PD201404193)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA