RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01126
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Vehicle and Equipment Maintenance Craftsman, medically separated for “chronic low back pain, with history of T12 compression fracture” with a disability rating of 10%.  

CI CONTENTION:  The CI’s condition continues to worsen and impact daily activities “My case for some reason did not warrant military retirement.”  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 on 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 - 20070911	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5235	10%	No VA Examination in Evidence 	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP) with History of T12 Compression Fracture.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in approximately 2000 without any specific injury or trauma identified.  On 14 June 2004, the CI had a baseline screening chest X-ray that showed an age-indeterminate anterior wedged compression fracture of “probably T12.”   The CI could not recall any trauma to her back.  A follow-up X-ray series performed on 30 August 2004 showed the lumbar spine with a compression fracture deformity of the superior plate of T12.  The lumbar vertebral bodies and disk spaces were normal in height.  No spondylolisthesis (when a vertebra slips forward onto the vertebra below it) was seen.  The sacroiliac (SI) joints were well-preserved and the soft tissues were unremarkable.  The CI was evaluated in July 2006 for worsening back pain especially when picking up her baby.  On 17 July 2006 X-rays of the cervical spine were negative; X-rays of the lumbar spine showed mild scoliosis and spina bifida (a congenital defect of incomplete closing of the vertebral column) of the S1 vertebra; and X-rays of the thoracic spine showed compression of T12.  Treatment consisted of piroxicam (a nonsteroidal anti-inflammatory drug) and Lortab (a combination of hydrocodone, a narcotic and acetaminophen, a pain reliever).  She was seen in consultation by a spine surgeon for pain, which she described as numbness and burning with stabbing primarily on the right side that did not radiate into her legs.  On examination she was able to forward bend 70 degrees and extend 10 degrees.  The remainder of the neurologic examination was unremarkable except she had difficulty walking on her toes and heels secondary to pain and did have back and buttock pain with straight leg raising.  

The CI was seen by physical therapy and pain management and treated with a TENS (transcutaneous electric nerve stimulation) unit.  Magnetic resonance imaging (MRI) dated 22 November 2006 demonstrated no significant spinal canal stenosis and chronic anterior wedging of T12.  On examination on 2 January 2007 she reported mid-back pain and denied lower extremity symptomatology.  She had a mild gibbus (adjacent vertebrae become wedged causing a curved spine (kyphosis-hunchback)) at T12 and was mildly tender.  She was able to forward bend 90 degrees (normal 90) and extend 15 degrees (normal 30).  She had a negative straight leg raise (to determine nerve root irritation) and “Lasègue’s sign” (test of lumbosacral nerve root irritation).  The CI had no focal motor or sensory deficits and was neurologically unchanged.  The examiner noted that the T12 stable superior endplate compression fracture was well healed.  She underwent right lumbar facet medial branch block steroid injections from L3 through L5 on 16 February 2007 with 4 days of significant relief.  A note dated 2 July 2007 indicated she had steroid injections in March and April with relief for about 3 weeks and also had a right lumbar facet radiofrequency denervation (minimally-invasive surgical procedure used to treat back pain) in April.  She was seen by a neurosurgeon and surgery was not indicated.  Because of the pain she was unable to run or walk more than a quarter of a mile, sit for prolonged periods, or do extensive lifting. 

The 2 July 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of significant back pain.  The CI was unable to walk more than one quarter mile or sit for prolonged time periods.  Physical examination revealed a “full range of motion [ROM],” no discrete tenderness, no palpable deformity (lumbar vertebrae were properly aligned), and negative straight leg raise testing.  The CI had a normal gait and balance.  Lower extremity strength was normal at 5/5.  Reflexes were symmetric at knees and ankles.  At the MEB physical therapy examination performed on 24 July 2007, 2 months prior to separation, the CI complained of lower back pain with a constant burning, numbness and stabbing pain.  ROM measurements for flexion and extension were performed with a bubble inclinometer and were 92, 100, 92 degrees and 25, 30, 30 degrees, respectively.  Side bending and rotation ROMs measured with a goniometer were normal.  Pain was noted for flexion, side bending and rotation.  No VA Compensation & Pension examination was performed proximate to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for the chronic LBP, with history of T12 compression fracture condition under the 5235 code (vertebral fracture or dislocation), citing the CI had normal strength of the lower extremities.  There was no limitation of thoracolumbar spine motion to support a minimum rating under the General Rating Formula for Diseases and Injuries of the Spine.  The physical therapy MEB examination noted pain with motion which warrants a 10% rating, but even though there was no documentation that it resulted in a loss of 50% or more of height, the CI was assigned a 10% rating on the basis of a vertebral body fracture.  There was no muscle spasm or guarding severe enough to result in an abnormal gait nor reversed lordosis to warrant a 20% rating. The Board members did consider whether the combination of the CI’s mild scoliosis of the lumbar spine and mild gibbus deformity (a structural form of kyphosis as a result of the compression fracture of T12) was sufficient to rate the disability 20%, but there were no measurements to determine the degree of curvature of the spine.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula, nor was there evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 lower back condition.  

BOARD FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20150609, w/atchs
Exhibit B.  Service Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01126.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings