RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04315
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Cavalry Scout, medically separated for thoracic vertebral compression fracture, with a disability rating of 10%.  

CI CONTENTION:  The CI contends for medical retirement due to blindness in one eye and an increased back rating.  The applicant’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 confined to 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 - 20070606	VARD - 20080201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Thoracic Vertebral Compression Fracture	5235	10%	Thoracic Vertebrae Fracture of T9	5235	0%	20071113	
Ischemic Optic Neuropathy	Not Unfitting	Right Eye Ischemic Optic Neuropathy	6074	30%	20071115	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Thoracic Vertebral Compression Fracture.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in November 2006 after heavy lifting.  Radiographic X-ray studies on 3 November 2006 showed a fracture of the T9 vertebra with “mild loss of vertebral body height of about 20%.”  Evaluation by orthopedics concluded with a diagnosis of “closed fracture of thoracic vertebral body.”  Surgical intervention was not discussed.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “thoracic vertebra fracture T-9” for PEB adjudication.  Further evaluations confirmed that the spine fracture was due to trauma and that there was no underlying medical condition for the fracture.  

The MEB NARSUM examination on 6 December 2006, 6 months prior to separation, noted complaints of back pain with activity, “especially bending or jumping.”  The examiner noted tenderness and “full active ROM,” but did not record a measurement for extension.  There was no swelling or spasm and the CI had normal strength, sensation, and reflexes.  There was no abnormal curvature or spinal deformity.  

At the VA Compensation and Pension (C&P) examination on 13 November 2007, performed 5 months after separation, the CI reported significant pain with heavy lifting.  He also stated that he was unable to do gardening or push a lawn mower due to his back condition.  Physical examination showed tenderness but full active ROM.  On repetition, the spine was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination.  There was no radiation of pain or presence of spasm.  Straight leg testing (for radicular symptoms) was negative bilaterally and the CI had normal gait, posture, strength, sensation, and reflexes.  The examiner stated that there was no “evidence of an intervertebral disk syndrome with nerve root involvement.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10% coded 5235 (vertebral fracture or dislocation), citing “rated for pain.”  The VA rated the back condition 0% coded 5235, based on the VA C&P examination 5 months after separation, citing full and painless ROM.  Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of tenderness, which was noted on both the NARSUM and C&P examinations.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy, but there was no evidence of lumbar nerve root involvement by neurologic examination.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 for the back condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the condition of ischemic optic neuropathy was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  “Decreased vision in right eye” was profiled as E2 [IAW AR 40-501; not significantly duty limiting, but may require some activity limitations] and the profile did not list any specific duty limitations from any eye or vision condition.  Decreased vision, or ischemic optic neuropathy, was not implicated in the commander’s statement and ischemic optic neuropathy was not judged to fail retention standards by the ophthalmologist or MEB.  The CI had acute decrease in right eye visual acuity in October 2006 along with a respiratory infection (pneumonia).  The right eye visual acuity loss was determined to be due to ischemic optic neuropathy.  In December 2006 the CI had uncorrected visual acuity of 20/400 in the right eye with normal acuity of 20/20 in the left eye.  The right eye condition was reviewed and considered by the Board.  There was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the ischemic optic neuropathy and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended ischemic optic neuropathy condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  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 20141110, 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

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for, AR20160011359 (PD201404315)

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