RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02268
BRANCH OF SERVICE:  Army	BOARD DATE:  20150318
SEPARATION DATE:  20051022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Petroleum Supply Specialist) medically separated for chronic thoracic spine pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty but he was authorized to perform an alternate physical fitness test (per PROFILE).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic thoracic spine pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB. The Informal PEB adjudicated “chronic thoracic spine pain, without neurologic abnormality…” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “The condition of my disability has not improved and have become more painful to deal with as the years have past [sic] since the accident.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited 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 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/Naval 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 confined to review of medical records and all available evidence for application of the 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:

IPEB – Dated 20050810	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Thoracic Spine Pain…	5299-5237	10%	Thoracic Spine Injury	5237	20%	20051207	
Other x 0 	Other x 5	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20060228 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Thoracic Spine.  The record shows that the CI was first evaluated for lower and upper back pain in August of 1998.  He was treated with medications and duty restrictions with apparent resolution over several weeks.  He was next seen in August of 2000 for recurrent pain and noted a motor vehicle accident (MVA) 7 years earlier.  Subsequently, the CI was the passenger in a second MVA in April 2002.  The records for this are scant, but by report, he was admitted to a local civilian hospital.  He returned to duty and was next seen for back pain in July 2003 when he re-injured his back setting up a tent (medium size GP).  X-rays were normal.  He was treated conservatively with medications and light duty, but had persistent pain.  A magnetic resonance imaging (MRI) on 15 August 2003 showed mild disc height loss at T9-10, but was otherwise normal.  He again aggravated his back with heavy lifting on 23 May 2004 and was again treated conservatively.  However, his pain persisted.  A CT scan on 27 May 2004 of the lower thoracic spine was without bony abnormalities (normal).  

A pain clinic evaluation on 23 July 2004 recorded a normal range-of-motion (ROM), gait and neurological examination with pain (elicited from one maneuver not expected to be painful).  A repeat MRI on 17 October 2004 showed changes at T5 and T6 possibly secondary to an impact injury.  This was also seen on a CT scan on 4 November 2004.  A trial of steroid injections and also of a nerve stabilizer (to reduce pain) had been unsuccessful.  A fitness for duty evaluation on 15 April 2005 documented good ROM of the back, but painful motion and tenderness over the mid-thoracic vertebrae.  No spasm was documented.  An L3 profile was issued.  Repeat X-rays on 18 May 2005 were normal.  An orthopedic evaluation the same day noted a normal neurological examination, gait, and stance.  At the MEB examination on 5 July 2005, 4 months prior to separation, the CI reported back pain since the MVA in 2002.  The examiner noted thoracic tenderness along the spine but not the muscles.  The ROM was 80-90% of normal.  The neurological examination was normal.  The narrative summary (NARSUM) noted that the CI was not a surgical candidate.  On examination, the ROM was reduced and painful.  The neurological examination and gait were normal.  Severe spasm was present bilaterally at T8-10.  

At the VA Compensation and Pension exam performed 2 months after separation on 7 December 2005, the CI reported back pain aggravated by lifting and walking.  He used a back brace as needed, but did not use other assistive devices.  He endorsed incapacitation five to six times over the previous 12 months, but the duration was not recorded.  He was working as a truck driver, but was concerned that he might not be able to continue this due to the back pain.  On examination, his gait was normal.  His posture was slouched in the waiting area, but upright in the examination room.  His ROM was limited on formal testing as charted below, but he demonstrated flexion greater than 80 degrees when dressing and undressing.  This reduces the probative value of the actual measured ROM as was noted by the examiner.  Spasm was present in the lower back, but the neurological examination was again normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back at 10% using the analogous code 5299-5237 (lumbosacral strain).  The VA also rated the back at 20% using the 5237 code.  The ROM on the NARSUM supports a 20% rating.  The Board found no route to a higher rating for the back condition.  The evidence does not support the presence of an unfitting radiculopathy at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the back condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chronic thoracic spine pain condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Thoracic Spine Pain 	5237	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131104, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXX, AR20150012449 (PD201302268)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						    XXXXXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA