RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2018-00150
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20020720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Unit Supply Specialist, medically separated for “low back pain status post [s/p] T-12 compression fracture and fusion T11-L1” with a disability rating of 10%.  

CI CONTENTION:  Review requested review of the not unfitting rib removal, as well as additional conditions not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 – 20020124 (DA Form 18)	VARD - 20030204	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain S/P T12 Compression Fracture and Fusion T11-L1	5299-5295	10%	Degenerative Disc Disease  (DDD) at T12, S/P fusion and Disc Bulge at L4-5 with Radiculopathy	5293	20%	20021227	
Removal Left 11th Rib for Surgical Exposure of T12, with Chronic Pain	Not Unfit	Residuals, 11th Rib Removal with Painful Motion	5297	10%	20021227	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his back in June 2000 during a roll-over motor vehicle accident.  An August 2000 MRI demonstrated a T12 compression fracture and small disc bulge at L4-5 and L5-S1 with slight canal stenosis and S1 nerve root contact without displacement.  He underwent a T11-L1 fusion with allograft (11th rib) and Kaneda instrumentation in February 2001.  The 2 October 2001 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant back pain with an inability to perform physical activities, left leg sensation loss, and intermittent left arm numbness.  The CI was taking narcotics daily, could not perform strenuous activities, and had difficulty sleeping.  Physical findings showed a normal gait and heel-to-toe walk, and mild tenderness over the anterior aspect of the thoracic incision (rib harvest site).  While the examiner recorded decreased range of motion (ROM) of the thoracolumbar junction, actual ROM testing was not conducted as the CI was still wearing a thoracic lumbar sacral orthosis (TLSO) and awaiting further guidance since his last neurosurgery evaluation.  Deep tendon reflexes (DTRs) were normal and symmetric, and although sensation was normal in the upper extremities and intact to light touch and pinprick, there was subjective decreased sensation in the entire left leg in a glove and stocking distribution (non-dermatomal).  The diagnoses were “T12 compression fracture, status post T11 to L1 fusion” and “failed back syndrome.”  

At the 27 December 2002 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported continued lower thoracic spine pain, particularly when bending his back, as well as some anterior left thigh numbness.  Physical examination showed normal posture and gait and a scar over where the rib was removed (diagnosis indicated “no significance”).  Thoracic spine ROM testing demonstrated “pain at 60 degrees of flexion of the thoracic spine and some paraspinal tenderness in the lumbar area.”  The right knee jerk (DTR) was absent, but neurologic findings were otherwise negative.  Spine X-rays showed lumbar DDD and T11-L1 hardware in place with a compression deformity at the T12 vertebral body of approximately 30% without evidence of complication.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5299-5295 (lumbosacral strain).  The VA rated the low back condition 20%, coded 5293 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing thoracic and lumbar spine DDD, painful ROM and neurologic symptoms.  The VASRD spine criteria changed effective 23 September 2002, and both the service and VA ratings were based on the older criteria (effective the date of separation).  Panel members noted that the CI was still in a TLSO brace during the NARSUM examination and had reduced “thoracolumbar junction” ROM, which was not specified as dorsal and/or lumbar spine segments.  The post-separation VA examination documented pain onset at 60 degrees of thoracic function, but did not provide final active ROM or the normal value for the tested ROM (likely thoracolumbar).  The panel noted that there was insufficient specificity in the examinations to separately rate the dorsal (thoracic) and lumbar spine segments under ROM criteria for each segment individually.  Under the provisions of code 5285 (vertebra, fracture of, residuals), for cases with definite limited motion, a 10% should be added for demonstrable vertebral body deformity.  Panel members agreed that there was sufficient evidence of definite moderate to severe limited motion of the thoracic spine to support a 10% ROM rating under code 5291 (spine, limitation of motion of, dorsal), as well as X-ray confirmation of T-12 thoracic vertebral deformity for an added 10% under code 5285.  There was insufficient evidence of IVDS to support a rating higher than 20% for “moderate; recurring attacks.”  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 low back condition, coded 5285-5291.  

Contended PEB Condition:  Removal Left 11th Rib for Surgical Exposure of T12, with Chronic Pain.  The panel’s main charge is to assess the fairness of the US Army Physical Disability Agency (USAPDA) determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement, was not listed as a diagnosis on the NARSUM or by MEB as failing retention standards, and not noted by the original Informal PEB dated 7 November 2001.  The Formal PEB (11 December 2001) added the rib condition as unfitting (coded 5297 at 10%); however, the USAPDA adjudged that the rib condition was not unfitting as finalized on the DA Form 18 dated 24 January 2002.  There was not a preponderance of performance-based evidence from the record that the 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 low back condition, the panel recommends a disability rating of 20%, coded 5285-5291 IAW VASRD §4.71a.  In the matter of the contended rib condition, 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.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Low Back Pain S/P T12 Compression Fracture and Fusion T11-L1	5285-5291	20%	

The following documentary evidence was considered:

AR20200004704

Dear XXXXXXXXXXXXXXXXXXXXXXXXXXX:

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.