RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200723 SEPARATION DATE: 20020411 

BOARD DATE: 20130123 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SFC/E-7 (91W4V/Health Services Specialist) medically 
separated for chronic thoracic back pain with underlying condition of Scheuermann's Kyphosis. 
The CI’s mid-back pain had been present since mid-1996. His pain was probably related to an 
injury suffered when performing a parachute landing fall and after extensive evaluation he was 
diagnosed as having Scheuermann’s Kyphosis. His chronic thoracic back pain with underlying 
Scheuermann's Kyphosis could not be adequately rehabilitated to meet the physical 
requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was 
issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The MEB 
identified Scheuermann’s Kyphosis and forwarded it as the only condition for Informal Physical 
Evaluation Board (IPEB) adjudication. The IPEB adjudicated the chronic thoracic back pain 
secondary to Scheuermann's Kyphosis as unfitting, rated 10% citing characteristic pain on 
motion, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI 
appealed to the Formal PEB (FPEB) that adjudicated the condition as chronic thoracic back pain 
with underlying condition of Scheuermann's Kyphosis, and added the VASRD code for residuals 
of vertebral fractures but applied the same rating rational. The CI was medically separated with 
a 10% disability rating. 

 

 

CI CONTENTION: “I appealed the decision twice, however board was reluctant to award, 30% 
despite being rated 60% VA! Addendum for MEB was never seen or addressed; Special Forces 
Col. on Board (MEB) did not believe injuries were caused by airborne operations. He asked 
several questions not related to injuries. Did not like Rangers. MEB did not take into account 
erectile dysfunction (ED) issues with wife. The Army sent me to MEB for hearing loss as well.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings 
for unfitting conditions will be reviewed in all cases. The unfitting chronic thoracic back with 
Scheuermann's Kyphosis condition meets the criteria prescribed in DoDI 6040.44 for Board 
purview and it is addressed below. The other requested conditions, ED and hearing loss, are 
not within the Board’s purview. Any conditions or contention not requested in this application, 
or otherwise outside the Board’s defined scope of review, remain eligible for future 
consideration by the Army Board for Correction of Military Records. 

 

 

 

 

 

 


 

 

 

RATING COMPARISON: 

 

Service FPEB – Dated 20011127 

VA (~1 Mo. Post-Separation) – All Effective Date 20020412 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Thoracic Back 
Pain w/ Scheuermann's 
Kyphosis 

5285-5299 

 5295 

10% 

Scheuermann’s Disease of The 
Thoracic Spine 

5285-5291 

10%* 

20020304 

.No Additional MEB/PEB Entries. 

Lumbar Strain with Degenerative 
Joint Disease 

5292-5010 

10% 

20020304 

Cervical Spine Strain 

5290-5010 

10% 

20020304 

Tinnitus 

6260 

10% 

20020312 

Depression 

9403 

10% 

20020312 

Gastroesophageal Reflux Disease 

7346 

10% 

20030811 

0% x3/Not Service-Connected 0 

Combined: 10% 

Combined: 60% 



*changed to 20% based on VA C&P exam dated 20030811 effective 20020412 

 

 

ANALYSIS SUMMARY: The Board acknowledges the CI’s contention that suggests ratings should 
have been conferred for other conditions documented at the time of separation. The Board 
wishes to clarify that it is subject to the same laws for disability entitlements as those under 
which the Disability Evaluation System (DES) operates. While the DES considers all of the 
member's medical conditions, compensation can only be offered for those medical conditions 
that cut short a member’s career, and then only to the degree of severity present at the time of 
final disposition. However the Department of Veterans Affairs (DVA), operating under a 
different set of laws (Title 38, United States Code), is empowered to compensate all service-
connected conditions and to periodically reevaluate said conditions for the purpose of adjusting 
the Veteran’s disability rating should the degree of impairment vary over time. The Board also 
notes acknowledges the CI’s assertions that “addendum for MEB was never seen or addressed; 
Special Forces Col. on Board (MEB) did not believe injuries were caused by air borne operations. 
He asked several questions not related to injuries. Did not like Rangers.” It is noted for the 
record that the Board has neither the jurisdiction nor authority to scrutinize or render opinions 
in reference to asserted improprieties in the disposition of a case. The Board’s role is confined 
to the review of medical records and all evidence at hand to assess the fairness of PEB rating 
determinations, compared to VASRD standards, based on severity at the time of separation. It 
must also judge the fairness of PEB fitness adjudications based on the fitness consequences of 
conditions as they existed at the time of separation. 

 

Chronic Thoracic Back Pain with Scheuermann's Kyphosis Condition. There were two 
goniometric range-of-motion (ROM) evaluations in evidence, with documentation of additional 
ratable criteria, which the Board weighed in arriving at its rating recommendation; as 
summarized in the chart below. The MEB addendum prepared 5 months prior to separation 
contained ROM measurements that were requested by the PEB as the original narrative 
summary (NARSUM) did not contain any ROM measurements. These ROM measurements 
were of the thoracic spine only and were available to the FPEB. 

 

 

 


Thoracic Spine ROM 

NARSUM 10.5 Mos. Pre-Sep 
Utilized by PEB 

MEB Addendum 5.5 Mos. Pre-Sep 

Utilized by FPEB 

PT ROMs 6 Mos. Pre-Sep 

Thoracic Spine only ROMs 

VA C&P 1 Mo. Pre-Sep 

Lumbosacral Spine ROMs 

Flexion 

No ROM measurements 

10° (~50% decrease in ROM)* 

60° 

Ext 

30° (~75% decrease in ROM)* 

20° 

R Lat Flex 

20° (~25% decrease in ROM)* 

40° 

L Lat Flex 

20° (~25% decrease in ROM)* 

40° 

R Rotation 

25°(normal)* 

35° 

L Rotation 

25°(normal)* 

35° 

Combined 

- 

230° 

Comment 

Capable of bending 

Non-antalgic gait 

Sitting forward to avoid 
hyperextension of thoracic 
spine due to pain 

+ tenderness to palpation 
mid-thoracic area 

No palpable spasm 

Normal STR & DTRs 

+ Tenderness to palpation 

Kyphosis changed only 15° 

rigid deformity T6-T9 

no spasm 

non-antalgic gait 

Normal STR & DTRs 

Upright posture & steady 
gait 

No tenderness to 
palpation 

+ painful motion with flex 
& ext 

Normal STR & DTRs 

§ 4.71a (7–1–01 Edition) 

10%(painful motion-PEB) 

10% (Mod. limited motion-FPEB) 

20%(VA) 



*Percent decrease was documented by the physical therapist who obtained the ROM values 

 

The NARSUM prepared 10 months prior to separation noted that the CI had chronic mid-
thoracic back pain after he performed a parachute jump with injury in 1996. He did not report 
any adolescent back pain. He noted some abnormal positioning of his thorax and did not 
believe it has worsened with time. He reported no radicular symptoms, weakness, or bowel 
and bladder symptoms. He had no headaches, shoulder pain or paresthesias. He had been 
followed by an orthopedic surgeon and plain films revealed a mild Kyphosis with anterior 
wedging of the thoracic vertebrae, Schmorl's nodes and mild Kyphosis, over three segments. 
The radiographs also revealed endplate irregularity. All of this was consistent with 
Scheuermann's Kyphosis. Despite this, he had no history of adolescent back pain. The CI was 
teaching and prolonged standing or sitting caused severe mid-thoracic back pain. He did not 
have any pain radiating around to the front of his chest as seen if an inter-costal nerve was 
impinged. He had to avoid running, jumping, jogging and heavy lifting activities due to the pain. 
Physical exam data is summarized in the chart above. X-ray data was significant for plain film X-
rays noted that at the level of T6, 7, and 8, he had greater than 20 degrees of Kyphotic 
deformity over these three segments. These show endplate irregularity, Schmorl's nodes, 
anterior wedging and narrowing of the intervertebral disk space. The magnetic resonance 
imaging revealed a T6-7 paracentral disk bulge that did push on the cord posteriorly. This did 
not cause significant impingement. There was another bulge at T10-11 which did not appear to 
contribute to any impingement. His neural foramina were widely patent. There were Schmorl's 
nodes defects noted to the inferior endplates throughout the thoracic spine. His CT scan 
confirmed mild anterior wedge compression deformity of T7 and T8 along with the above 
abnormalities. The CI stated he had a constant ache that was seven out of 10 in his mid-
thoracic spine. At least once a week this was exacerbated with some activity that caused it to 
become 10/10 and knife-like in the same region. Any activity exacerbated his pain and the only 
thing that relieved it was lying down. The pain began immediately with the onset of running 
and increased in severity as the duration of the run increased. He was able to walk, but this 
also increased his pain. He was able to lift up to 50 pounds. He was not using any medications 
at that time. His diagnosis appeared to be Scheuermann's Kyphosis. It met the radiographic 
criteria. It was not progressive, for the entire amount of Kyphosis of the thoracic spine was 
only in the order of 50 degrees. However, it did meet the criteria for Kyphosis over 5 degrees at 


3 sequential vertebrae and could remain painful. There was no concern about progression of 
the Kyphosis, but this was a painful entity and interfered with his Army activities. The CI found 
no relief with medications. 

The MEB addendum, prepared 9 months prior to separation, was performed specifically to 
detail the functional limitations of the CI. It contained similar historical and symptomatic 
information as the NARSUM above with the following additional items. The CI had no 
symptoms as an adolescent and only during his jump status did he begin to experience these 
symptoms. His symptoms were steadily progressive throughout his jump status until they 
arrived at his present level of disability. He had not previously used narcotics as it interfered 
with his driving and teaching but at the time of this addendum, he was using narcotics 4 times a 
day for pain relief. He had to change jobs and could only teach due to the interference with his 
physical requirements of combat medic. He was unable to run due to the severity of the pain. 
He could walk only for a very short period, again 15 minutes, before the pain was excruciating 
and required him to lie down. Lying down was the only thing that relieved his pain. He was not 
experiencing radicular symptoms. When he woke in the morning, he had tremendous spasm 
from the bottom of his cervical spine down through the interscapular area. His rhomboid 
muscles had to be stretched with a shoulder, chest and neck stretch. This pain could be rated 
as severe as it had significantly limited his activities of daily living. He had tremendously 
changed his recreational activities due to the limitations this pain caused. It interfered with 
sleep every night and required him to take a muscle relaxer to relieve the muscle spasm. 

 

An additional MEB addendum, prepared 5 months prior to separation, was utilized by the FPEB. 
The CI appeared in front of the FPEB who then recessed Board proceedings to obtain additional 
information. The addendum was requested specifically to obtain formal ROM measurements 
of the thoracic spine along with documenting the presence of paraspinal muscle spasm. It 
detailed a similar history to the NARSUM and the physical exam findings are also summarized in 
the chart above. This addendum contained the following significant additional comments: the 
spine specialist did remark that Scheuermann's disease is not painful in and of itself and it was 
believed that the CI’s airborne status was the reason for his pain. There was a study that did 
report that patients with Scheuermann's Kyphosis had more intense back pain, their jobs 
tended to have lower requirements for activity and they did have less ROM with extension. The 
examiner opined that Scheuermann’s Kyphosis in and of itself can become painful, but the CI 
did not have any pain, by his own report, and there is none documented until well after his 
airborne activities, which would certainly have increased the axial load of the entire spine and 
could contribute to his spinal pain. 

 

At the MEB exam accomplished 2 months prior to separation, the CI reported difficulty with 
breathing deeply during flare-ups of his back pain. He also reported “Arthritis, thoracic spine; 
compression fracture thoracic spine; numbness in both hands during back flare up and spine 
pain.” The MEB physical exam noted decreased ROM in the lumbosacral spine spine, decreased 
flexion and increased spasm in the lumbosacral area. 

 

At the VA Compensation and Pension performed a month prior to separation, the CI reported 
upper back pain that began in 1996; during an airborne jump. He stated that he had an aching 
in his upper back and was seen by a physician who prescribed Motrin. He did not have any X-
rays until 1997. He reported that there was an aching in his upper back with standing for more 
than 20 minutes or with running and he currently used muscle relaxants on an as-needed basis. 
The physical examination findings are summarized in the chart above. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB disability description was chronic mid-back pain secondary to Scheuermann’s Kyphosis; it 


applied the analogous code of 5299-5295 and rated the disability at 10%. The FPEB adjudicated 
this condition as chronic thoracic back pain with underlying Scheuermann’s Kyphosis, coded it 
analogously as 5285-5299-5295 and rated it 10% based on lumbosacral strain with 
characteristic pain on motion. This analogous coding and rating scheme was not optimal as the 
VASRD in effect at the time of adjudication had coding and rating options specifically for the 
dorsal (thoracic) spine which was the spinal segment responsible for the CI’s disability. It would 
be more accurate to use VASRD code 5291 for limitations in motion of the dorsal spine as seen 
in this case. The rating guidelines for the 5291 code include the subjective designations of mild, 
0%, and moderate or severe, either resulting in a 10% evaluation. The Board agrees with the 
FPEB’s adjudication of a moderate limitation in thoracic spine flexion. The FPEB’s use of VASRD 
code 5285 (Vertebra, fracture of, residuals), did identify a ratable condition, but the final 10% 
disability rating did not reflect the proper application of VASRD guidelines for that code. The 
rating guidelines for VASRD code 5285 states, “In other cases rate in accordance with definite 
limited motion or muscle spasm, adding 10% for demonstrable deformity of vertebral body.” 
The VA applied the analogous code of 5285-5291 for Scheuermann’s disease of the thoracic 
spine and initially rated it 10% citing moderate or severely limited motion of the dorsal spine or 
residuals of compression fracture to include painful and limited motion. The VA rating was 
later changed to 20% with the same effective date for a moderate loss of motion, a 10% rating, 
plus an additional 10% rating for the residual compression deformity of the thoracic spine as 
required by VASRD code 5285. This rating change by the VA reflected a refinement of their 
rating as opposed to a worsening of the CI’s condition. The CI had a definite limitation in 
motion of his thoracic spine as evidenced by the MEB addendum’s thoracic spine ROM values. 
The physical therapist who documented these ROM values also documented the percent 
decrease from the normal thoracic spine ROM as summarized in the ROM chart above. The CI 
did not have any palpable spasm. He did have mild anterior wedge compression deformity of 
two thoracic vertebral bodies warranting application of VASRD code 5285, thus adding 10% to 
the 10% rating for the moderately limited thoracic spine ROM. After due deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the 
Board recommends a disability rating of 20% for the chronic thoracic back pain with underlying 
Scheuermann's Kyphosis 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 back pain with underlying Scheuermann's 
Kyphosis condition, the Board unanimously recommends a disability rating of 20%, coded 5285-
5291 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: 

 

UNFITTING CONDITION 

VASRD 
CODE 

RATING 

Chronic Thoracic Back Pain with underlying Scheuermann's Kyphosis 

5285-5291 

20% 

COMBINED 

20% 



 


 

 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120607, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

XXXXXXXXXXXXXXXXXXX, DAF 

Acting Director 

Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for XXXXXXXXXXXXXXXXXXX, AR20130003829 (PD201200723) 

 

 

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 

 

 XXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)