RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05716
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060422

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Basic Trainee, medically separated for “L1 compression fracture with adjacent degenerative disc disease [DDD], without neurologic abnormality” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20060320	VARD - 20060427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L1 Compression Fracture, with Adjacent DDD, Without Neurologic Abnormality	5235	10%	L1 Compression Fracture with Adjacent DDD	5243-5235	10%	20060203	
			Mild Laxity of Anal Sphincter	7332	10%	20060203	
			Radiculopathy, Left Lower Extremity	8599-8520	NSC	20060203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

L1 Compression Fracture, with Adjacent DDD, Without Neurologic Abnormality.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in October 2005 when he sustained an L1 compression/burst fracture after falling from an obstacle tower in basic training.  He was treated emergently with bracing (Jewett brace and hyperextension orthosis cast), and imaging on 13 January 2006 showed a stable fracture with developing osteophytes and degenerative changes between T12 and L1.  During the January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported taking Tylenol for back pain.  Physical examination revealed painful back motion.  

At the 3 February 2006 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported back pain with left leg, foot, and ankle stiffness; left leg weakness with jogging/running; and pain with position changes.  The CI reported he needed to immediately defecate when the sensation occurred as he could not hold stool for long; but he denied soiling himself.  Physical examination revealed that the CI wore a Jewett brace, and had normal posture and gait.  Back range of motion (ROM) showed forward flexion to 90 degrees (normal) and combined ROM of 240 degrees (normal), with painful motion and back tenderness, but no muscle spasm.  Rectal examination was abnormal with mild laxity of the anal sphincter.  Neurological examination of the lower extremities was normal for motor and sensory function and reflexes.  An X-ray showed a vertebral fracture with 40% loss of height.  

The 10 February 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of back pain.  Current medications listed Ibuprofen (nonsteroidal anti-inflammatory drug) with “no narcotic needed at this time.”  Physical examination showed back tenderness but no abnormal spinal contour, and flexion to 90 degrees, with a combined ROM of 225 degrees.  Motor, sensory, and reflex testing was normal, and the examiner noted the CI had “hyperreflexia of his bilateral lower extremities, but this was symmetric and normal for him.” A bulbocavernosus reflex test (for spinal shock) was negative, and rectal tone was normal.

The panel 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 combined ROM over 240 degrees and tenderness.  The VA also rated the back condition 10%, but dual coded 5243-5235 (intervertebral disc syndrome-vertebral fracture or dislocation), based on the STR and C&P examination.  Members agreed that a 10% rating, but no higher, was justified for tenderness as reported on all examinations proximate to separation; or for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Condition: Neurologic Abnormality.  The panel noted that the PEB considered neurologic abnormality in its adjudication and rendered a de facto “not unfitting” determination by stating “without neurologic abnormality” within the disability description, and the CI contended this condition.  Neurologic abnormality/radiculopathy is therefore in the panel’s scope of review and will be addressed.  There was no objective evidence of lower extremity neurologic deficit on any examination proximate to separation.  There was no complaint of incontinence or any abnormal finding of the rectal sphincter at the NARSUM examination which was closest to separation.  

A neurologic condition was not profiled or implicated in the commander’s statement, and did not failed retention standards.  There was no performance-based evidence from the record that any neurologic condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended neurologic abnormality, the panel agrees it cannot recommend it for additional disability rating.  There are 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.  

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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.