RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxx 	CASE:  PD-2017-00426
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070913

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard, Basic Trainee, medically separated for “chronic thoracolumbar back pain” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel 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, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070824	VARD - 20080115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Thoracolumbar Back Pain 	5299-5237	10%	Scoliosis with Thoracic Developmental Abnormalities and L5-S1 Developmental Anomaly with L5-S1 Anterolisthesis	5299-5239	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Thoracolumbar Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s thoracolumbar back pain condition began in April 2007 after falling from the top bunk while in basic training. The CI was taken to the emergency room on 13 April 2007 where X-rays showed a suspicious compression fracture T12 and T11 with a questionable congenital or post-surgical abnormality at the L5 vertebra.  A CT scan showed a complex congenital fusion anomaly from L4-5 and L5-S1 including a hypoplastic left L5-S1 facet, incomplete fusion of the posterior elements at L5-S1, an abnormally enlarged and doubly articulating lamina that extended from the L4-5 facet inferiorly to form an L5-S1 facet on the right, which was associated with bony sclerosis and facet arthropathy.  The lamina was partially fragmented at the L4-L5 level with no soft tissue swelling.  The CI also had a Grade 1 anterolisthesis (sliding forward of one vertebra over the one below it) of L5-S1. 

The CI was thought mainly to have sustained a compression fracture T10-T11 of the spine of an unknown age, and was released from the ER.  At follow-up on 17 April 2007 further consultation was obtained with orthopedics by his primary care physician, and an MRI was ordered.  The MRI showed disc desiccation with focal narrowing of the thecal sac, but no disc extrusion or protrusion. There was no stenosis or neuroforaminal narrowing.  At a 24 April 2007 clinic examination, the examiner obtained scoliosis X-rays and an EMG (electromyogram).  The scoliosis screen demonstrated "in the thoracic spine there is an approximately 9 degree dextrocurvature (curvature to the right) as measured from the top of T5 through the top of T9.  The apex is at the C6-7 interspace.”  “A compensatory levocurvature (curvature of the left) was present in the thoracolumbar spine from T11-L4 measuring 8 degrees.” The impression was a thoracolumbar “S” shaped curvature.  The examiner stated there seemed to be developmental processes resulting in decreased height of the thoracic spine; and with the lumbar deformity, and there was increased kyphosis and pelvic tilt.  At a clinic visit on 8 May 2007, electrodiagnostic studies were normal and showed no evidence of neuropathy derived from the spine, and peripheral nerves were normal.  The scoliosis series demonstrated a well-balanced curve of no concern for progression.  No further testing or medical treatment was offered.  

The 5 June 2007 MEB examination (recorded on DD Forms 2807-1 and 2808) and MEB NARSUM examination were both performed by the same examiner, 3 months prior to separation, and both noted complaints of some discomfort with certain movement and stresses. Pain occurred only when getting up, bending, and standing up.  However, walking around, sitting, or sedentary activities did not bother the CI.  Physical examination showed balance and coordination were normal.  There was a deformity with decreased height compared to the length of the extremities, and there was moderate increased thoracic kyphosis associated with marked pelvic tilt, left lower than right.  The examiner opined there was probable limb length inequality.  There was decreased sensation at the L5 and S1 dermatomes on the left and tension signs were negative, but reproduced pain was in in area of mild to moderate spasm where the injury happened.  There were no cauda equina or long track signs (bowel or bladder dysfunction or motor or sensory deficits).  Further observation showed no direct tenderness over the lumbar sacral area.  The area of pain and tenderness was in the mid thoracic spine area.  Thoracolumbar range of motion (ROM) showed flexion of 75 degrees (normal 90) with pain and combined ROM of 190 degrees (normal 240).  Pain was rated 6/10 with ROM maneuvers.  There was no VA examination proximate to separation in evidence. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the thoracolumbar back pain condition 10%, analogously coded as 5237 (lumbar spine strain), citing forward flexion of 75 degrees, total combined ROM limited by pain, spasm and tenderness present in the thoracic spine.  Also cited was that the impairment existed prior to service, was subsequently aggravated and the injury was considered beyond natural progression.  The VA also rated the thoracolumbar back pain condition 10%, analogously coded as 5299-5239 (spondylolisthesis or segmental instability), based on the STR, citing that information from [the CI’s] service medical records only [would] be used for this rating decision and then cited the NARSUM’s flexion of 75 degrees and combined ROM.  

The panel noted that muscle spasm associated with an abnormal spinal contour was present on the MEB/NARSUM examinations and concluded that was a sufficient basis for a 20% rating (i.e. for muscle spasm or guarding severe enough to result in abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis).  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic thoracolumbar back pain condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the chronic thoracolumbar back pain condition, the panel recommends a disability rating of 20%, coded 5299-5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Thoracolumbar Back Pain	5299-5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170211, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

	

AR20190008806,  

Dear XXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.