RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01019
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “low back pain” with a disability rating of 20%. 

CI CONTENTION:  “The rating was unfair because at the time I didn’t know any better.  I did not realize how my injuries would affect me later in life.  I could not be a peace officer anymore...”  He also contends that the Army messed up his teeth and that he has anxiety attacks.  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 - 20060214	VARD - 20070206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5235	20%	Residual Compression Fracture T-4	5235	40%	20061209	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI initially injured his back in March 2004 when he slipped and fell during a suspect apprehension.  The CI was evaluated in the emergency room and noted to have a normal X-ray and range of motion (ROM) without neurological deficits.  He subsequently fell and hit a pole with his thoracic spine on 14 April 2005, over a year later.  An X-ray demonstrated a compression fracture of T4.  He was noted to have a normal gait, but some diffuse sensory changes and weakness.  On 18 April 2005, MRI was unremarkable and specifically noted no compression deformity.  In a primary care evaluation that day, he was exquisitely tender, but no sensory or motor deficits were present.  On 27 June 2005, X-ray studies showed unchanged T4 compression fracture.  The CI was seen in orthopedics on 5 August 2005 and noted to walk without difficulty although he wore a back brace.  A provocative test for nerve root irritation as well as hip flexion showed pain over the “entire back.”  Compression of the spine was also painful (not expected with this condition).  Tenderness was present.  The ROM was reduced with flexion at 30-40 degrees and lateral flexion 10-15 degrees.  Rotation was not possible and an X-ray showed an unchanged compression fracture.  The CI was noted to have “non-anatomical” complaints.  

During the October 2005 MEB examination (recorded on DD Forms 2807 and 2808) 5 months prior to separation, the CI reported persistent back pain.  The physical examination (PE) showed decreased ROM with forward flexion at 45 degrees (normal 90) and the neurological examination was normal.  The 7 December 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant pain.  No neurological symptoms were reported.  The PE showed flexion to 25 degrees (normal 90) and extension to 5 degrees (normal 30).  Lateral bending was reported as very limited.  Rotation was not recorded.  Tenderness of the paravertebral muscles from T4 to L2 on the right and T4 to T12 on the left was reported.  Patellar and Achilles reflexes were 1+ bilaterally.  Toe strength and foot strength were normal.  Straight leg raising produced pain in the lower to midthoracic area bilaterally.  Toe and heel walking was normal and no atrophy of the leg muscles was noted.  Sensation was reduced on the lateral aspects of both feet, but attributed to the wear of combat boots.  

The CI was seen in physical therapy for formal thoracolumbar ROM measurements on 20 January 2006, 2 months prior to separation.  Flexion was 55 degrees and the combined ROM was 165 degrees (normal 240).  All motion was limited by pain.  Tenderness of the lumbar spine was present but strength was normal.  Two (of five) signs of non-organic pain were present.  A review of the records in evidence showed the CI was placed on quarters for 24 and 48 hours at the time of the fall in April 2005, but there were no further entries for quarters found.

At the 9 December 2006 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported continued pain.  The PE of the thoracic spine (not thoracolumbar spine) showed while sitting on a table the CI could flex 25 degrees and extend 15 degrees.  Rotation to the left and right was 35 degrees.  Side bending was not recorded.  Tenderness was noted at T4 and sensation to arms and hand grip was normal.  The panel observed that at the 22 December 2008 C&P, flexion of the thoracolumbar spine was 65 degrees and the combined ROM was 165 degrees.  While this is too remote for rating purposes at separation, these values were consistent with those recorded in physical therapy a few months prior to separation and serve to increase the probative value of that examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5235 (vertebral fracture or dislocation), citing no radiculopathy or significant deformity, range of motion limited to 60 degrees of flexion with tenderness.  The VA rated the back condition 40%, coded 5235 (vertebral fracture or dislocation), based on the C&P examination 9 months after separation, citing forward flexion of the thoracolumbar spine of 30 degrees or less.  The panel considered the evidence.  Incapacitation was only noted at the time of the injury.  An abnormal gait or posture secondary to spasm or guarding were not recorded.  At the time of the orthopedic appointment in August 2005, flexion was noted to be 30-40 degrees with lateral bending of 10-15 degrees and absent rotation.  Signs of non-organic pain were present.  The MEB examination noted flexion of 45 degrees.  The NARSUM recorded flexion of 25 degrees and limitations in extension and lateral bending without recorded rotation.  The ROM values in physical therapy, the closest to separation, showed flexion of 55 degrees and a combined ROM of 165 degrees.  This is also the only examination in which 3 sets of measurements were taken.  It is accordingly assigned the highest probative value for rating at separation.  Two signs of non-organic pain were present at this examination.  The VA examination was cited for the thoracic spine rather than the thoracolumbar spine, reducing its probative value.  The panel did observe that the VA measurements obtained several years after separation were consistent with the values obtained in physical therapy for the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  Therefore, the  panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005503, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.
 
Sincerely,					      
Enclosure