RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00353
BRANCH OF SERVICE:  Army 	Sepatation Date:  20040115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Signal Intelligence Analyst, medically separated for “chronic upper and low back pain secondary to an L1 compression fracture,” with a disability rating of 10%.  

CI CONTENTION: The applicant makes no specific contention in his application.  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 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 - 20030912	VARD - 20040810	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Upper Low Back Pain Secondary to L1 Compression Fracture	5292	10%	Compression Fracture, L1	5235	0%	20040624	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA:  10%	

ANALYSIS SUMMARY:  

Chronic Upper and Low Back Pain Secondary to a L1 Compression Fracture Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in October 2001 after a parachute landing fall.  Radiographic studies in January 2003 showed an old compression fracture of a lumbar vertebra (with anterior height “about 1/3 of the posterior height”) with degenerative changes T12-L1.  Treatment notes documented back discomfort with forward flexion and problems assuming the prone firing position while wearing gear.  There were no reported radicular signs or symptoms.  Surgical fusion of L1 was suggested, but reasonably declined.  

At the time of the physical therapy clinic appointment on 7 April 2003, the CI reported pain at 6/10 and 8/10 with aggravation.  The examiner recorded the “BROM WNL” (bilateral range-of-motion [ROM] within normal limits) with pain on forward flexion.  At the NARSUM examination on 7 April 2003, performed 9 months before separation the CI reported 3-8/10 constant dull and sharp pain radiating only regionally in a circular pattern adjacent to L1.  The CI denied loss of sensation or weakness.  The ROM was 60 degrees of forward flexion, 15 degrees extension, and 25 degrees of left and right lateral flexion as measured with a bubble goniometer.  Motor, sensory and reflex testing was normal.  At the MEB examination (recorded on DD Form 2808) on 1 July 2003, performed 7 months prior to separation, the examiner recorded tenderness to palpitation with a “full ROM.”  On examination the spinal contours were significant for a left convex curvature of the thoracolumbar junction.  There was tenderness to palpitation at L1, L2 and L3.  No other physical examination abnormalities were reported.  

At the VA Compensation and Pension (C&P) examination on 24 June 2004, performed 5 months after separation, the CI reported he could no longer run, but he could walk on a treadmill and had done some upper body weights.  Physical examination showed a ROM of forward flexion 90 degrees (90 normal) with a combined ROM of 240 degree (240 normal).  After repetitions there was no evidence of pain, fatigability, incoordination or significant loss of ROM.  The CI was able to walk on his heels and toes, and had a normal sensory examination.  Patellar reflex was slightly decreased on the left (1/4 vice 2/4 on the opposite side) and Achilles reflexes were normal and symmetric.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10% coded 5292 (limitation of lumbar spine motion), indicating “rated as limitation of ROM” with text indicating flexion of 60 degrees with a normal of 80 degrees.  Code 5292 is from the older VASRD which was revised on 26 September 2003 to the current spine rating criteria.  The VASRD revision was after the date of the PEB, but prior to the CI’s date of separation.  The VA rated the back condition 0% coded 5235 (vertebral fracture or dislocation), based on the VA C&P examination 5 months after separation, citing a non-compensable ROM without functional loss.  In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation.  The older VASRD did not specify normal ROM limits and rated based on narratives of limited motion of the spine (slight, moderate, or severe) with the lumbar spine and thoracic spine considered as separate ratable segments while the VASRD in effect at separation rates the thoracolumbar spine as a unit with specified ROM criteria.  

The Board deliberated on the interpretation and probative value of the examinations in evidence.  The VA examination was closest to the date of separation and more closely aligned with the disability picture in the remainder of the record.  The NARSUM examination used a bubble goniometer, did not include all axis of back ROM, and was bracketed by examinations indicating less restrictive ROM findings.  The Board majority agreed that a 10% rating, but no higher, was justified for limitation of ROM, tenderness, or painful motion documented on the bulk of the examinations in evidence.  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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB’s 10% disability rating for the back condition.  

BOARD FINDINGS:  In the matter of the back condition, the Board majority recommends a disability rating of 10%, with a changed coded to 5235 IAW VASRD §4.71a.  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 20150527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX AR20160014876 (PD201500353)

1.  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, accept the Board’s recommendation to modify the individual’s disability description without modification of the combined rating or re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA