RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

      

 

 
                           BRANCH OF SERVICE: ARMY  
               SEPARATION DATE [ARNG]:  20080724  

 
NAME:  XXXXXXXXXXXXXXXXXXXXX                 
CASE NUMBER:  PD1101128  
 
BOARD DATE:  20121023 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  Army  National  Guard  (ARNG)  PFC/E-3  (09B10/Basic  Trainee), 
medically  separated  for  chronic  low  back  pain  (LBP)  and  chronic  left  knee  pain.    The  CI 
developed left knee pain while in basic training, documented as both secondary to the increase 
in physical activity as well as after falling.  In May 2007, the CI sought care for LBP, which was 
present on wakening the day after a two-mile hike.  Despite conservative treatment for both 
conditions, the CI was unable to perform within his Military Occupational Specialty (MOS) or 
meet physical fitness standards.  Surgery was not warranted.  He was issued a permanent L3 
profile  and  underwent  a  Medical  Evaluation  Board  (MEB).    Left  knee  pain  consistent  with 
patellofemoral  pain  syndrome  (PFPS)  and  LBP  secondary  to  ruptured  disc  at  L4-5  were 
forwarded to the  Physical  Evaluation  Board  (PEB)  as  medically  unacceptable  IAW  AR 40-501.  
Plantar fasciitis, as identified in the rating chart below, was forwarded on the MEB submission 
as  medically  acceptable.    The  PEB  adjudicated  the  chronic  LBP  and  chronic  left  knee  pain 
conditions  as  unfitting,  each  rated  10%,  with  probable  application  of  the  Veterans 
Administration  Schedule  for  Rating  Disabilities  (VASRD).    The  plantar  fasciitis  condition  was 
adjudicated to be not unfitting.  The CI made no appeals, and was medically separated with a 
20% combined disability rating. 
 
 
CI  CONTENTION:    “Condition  is  permanent  cannot  be  changed  without  surgery  which  could 
make  condition  worse.  Condition  currently  requires  almost  daily  medication  for  pain. 
Degeneration of spine cannot be stopped and is permanent.”  In the block 15 remarks section 
the CI also states “Orthodic devices for Knee and feet cause wear and tear in clothing such as 
pants and shoes. Service connected disabilities interfere with past history of physical activities 
and  way  of  life  affecting  future  of  prior  service  member  to  be  sustainable  with  existing 
permanent injuries.” 
 
 
SCOPE  OF  REVIEW:    The  Board’s  scope  of  review  is  defined  in  the  Department  of  Defense 
Instruction  (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  those  conditions 
identified but not determined to be unfitting by the PEB when specifically requested by the CI.  
The plantar fasciitis condition was determined to be within the Board’s purview in addition to 
the unfitting left knee and back conditions.  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 IPEB – Dated 20080422 

VA (Exam 20080507) – All Effective Date 20080220* 

Condition 

Chronic LBP 
Chronic Lt Knee Pain 
Plantar Fasciitis 

Code 
5237 

5099-5003 

Rating 
10% 
10% 

Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

Condition 

Code 
5243 

HNP L4-5 w/ Degenerative  
Changes & Radiculopathy 
Lt Knee PFS 
Rt Foot Plantar Fasciitis . . . .  

5299-5024 
5299-5276 
0% x 0/Not Service Connected x 2 

Rating 
40%** 
10% 
10% 

Exam 

20080507 
20080507 
20080507 
20080507 

Combined:  50% 

* Effective date is the date of CI’s application for VA benefits.**LLE radiculopathy at 10% added 20091105; back reduced to 
20% effective 20100501 

 

 

ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit 
and  vital  fighting  force.    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.  The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or  potential  complications  of  conditions  resulting  in  medical  separation  nor  for  conditions 
determined  to  be  service-connected  by  the  Department  of  Veterans’  Affairs  (DVA),  but  not 
determined to be unfitting by the PEB.  However, the DVA, operating under a different set of 
laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  all  service-connected 
conditions  and  to  periodically  re-evaluate  said  conditions  for  the  purpose  of  adjusting  the 
Veteran’s disability rating should the degree of impairment vary over time.  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.   
 
Chronic  Low  Back  Pain  Condition.    There  were  three  goniometric  range-of-motion  (ROM) 
evaluations in evidence which the Board weighed in arriving at its rating recommendation, with 
documentation of additional ratable criteria, are summarized in the chart below. 

Thoracolumbar ROM 

MEB (20071228) 

VA C&P (20080507) 

VA C&P (20091105) 

Degrees 

Flexion (90) 

Combined (240) 

 
90 
240 

 
30 
135 

 
35 
145 

Comment 

No signs of pain behavior 

No DeLuca.  Normal 
neurological exam 

 

§4.71a Rating 

10% 

40% 

20% 

 
The CI was first seen for his LBP on 8 May 2007, 14 months prior to separation from the ARNG, 
reporting that he had awoken with LBP the day after a two-mile hike, 8 days earlier.  At this 
time, he was already in the MEB process for his left knee, which had been initiated on 25 April 
2007.    He  was  noted  to  have  tenderness  of  the  sciatic  notch  and  spasm  of  the  lumbosacral 
muscles, but gait and stance were normal.  His X-rays showed mild degenerative disc disease 
(DDD).    He  was  given  medications  and  released.    He  returned  3  days  later  with  worsened 
symptoms  and  was  placed  on  quarters  for  72  hours.    He  was  seen  again  3  days  after  that 
appointment;  his  symptoms  were  improved,  but  persistent  and  he  was  again  placed  on 
quarters for 72 hours.  There are no other entries in the records available for review indicating 
placement  on  quarters  or  bed  rest  for  the  LBP.    Treatment  included  medications,  physical 
therapy  (PT)  and  chiropractic  treatment.    The  ROM  was  reduced  on  the  30  July  2007  PT 
examination to about 30% of normal, but improved with treatment until it was measured as 

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normal  on  the  MEB  examination  for  the  narrative  summary  dictated  28  December  2007 
(below).  A magnetic resonance imaging (MRI) performed on 1 August 2007 was remarkable for 
a large L4-5 paracentral disc protrusion with compression of the right anterior thecal sac which 
likely  affected  the  right  L5  and  S1  nerve  roots.    Nerve  conduction  velocity  (NCV)  and 
electromyography  (EMG)  studies  were  accomplished  on  17  September  2007.    The  EMG  was 
suggestive  of  a  mild  right  L5  root  level  lesion.    On  29  October  2007,  he  was  evaluated  by 
orthopedics.  On examination, his gait was normal and he was able to rise on his toes and heels 
demonstrating normal strength.  Sensation, strength and reflexes were documented as normal.  
There  was  no  scoliosis,  straightening  or  atrophy  of  the  spine.    Muscle  tone  was  normal  (no 
spasm).  Extension was 40 degrees and flexion brought his fingertips to four inches from the 
floor,  which  is  essentially  normal.    No  pain  was  reported  at  the  extremes  of  flexion  and 
extension.  Surgery was not indicated.  He was seen in family practice on 15 November 2007 
and noted to have a normal gait.  The examiner also documented the expectation that the CI 
would recover with time.  He continued to have chiropractic treatment; the last chiropractic 
entry  in  the  records  is  dated  13  December  2007.    The  narrative  summary  (NARSUM)  was 
dictated 28 December 2007, 7 months prior to separation.  The CI reported that the LBP began 
after a fall in November 2006; however, this is not the history documented in the initial visits 
for LBP in May 2007.  The CI noted continued LBP, rated 5/10, exacerbated by heavy lifting or 
prolonged standing.  He had tenderness of the right paraspinal region without spasm.  Strength 
and  reflexes  were  normal  as  was  the  ROM.    The  overall  examination  was  recorded  as 
“unremarkable”, implying a normal gait and stance as well as absence of spasm.  Between the 
MEB and VA exams, a family practice note, dated 13 February 2008, documented a normal gait.  
His major concern that visit was for a mild upper respiratory infection.  It was also noted that he 
had pain of 4/10, but in the right hip.  The note was silent for complaints related to the back.  At 
the VA Compensation and Pension (C&P) exam performed on 7 May 2008, 2 months prior to 
separation,  the  CI  reported  that  the  LBP  dated  from  a  fall  in  November  2006  when  another 
soldier fell upon him and that he was treated with Ibuprofen for back strain.  The Board noted 
that the 2 December 2006 treatment note documents left lower extremity pain after a series of 
“Iron Mikes,” an alternating forward lunge of the lower extremities, and that the note is silent 
for any complaint of back pain.  He  reported numbness and weakness of the right foot with 
radiation to the right thigh and leg.  He also noted that his right foot would drag on occasion.  
He stated that he had not worked since February of 2007.  He endorsed 14 days of physician 
ordered bed rest over the past year.  On examination, he was noted to rise from the lobby chair 
using both hands and to have a pronounced right limp, but did not use any assistive device.  The 
Board noted that the CI also reported pain in the right hip, left knee, and both feet.  Sensation, 
strength  and  reflexes  were  normal.   There  was right  lumbar  spasm  and  tenderness.   DeLuca 
criteria  were  absent.    Imaging  showed  mild  lumbar  scoliosis  to  the  right  with  degenerative 
changes of the facet joints at L4-5 and L5-S1.  The ROM is above.  There was a second VA C&P 
examination over one year after separation on 5 November 2009.  This is outside the 12-month 
window normally utilized for evidence; however, there is a significant deterioration between 
the MEB and initial VA examination.  On the second VA examination, the CI reported that his 
symptoms  had  worsened  and  that  he  had  an  antalgic  gait.    He  endorsed  12-14  days  of 
incapacitation and bed rest.  He used a cane.  There was no spasm, but there was paraspinal 
tenderness at L4-5 and minimal scoliosis.  Strength and reflexes were normal.  Sensation was 
reduced over the right anterior thigh, the dermatomal distribution for L2-L3.  The Board directs 
attention to its rating recommendation based on the above evidence.  The PEB rated the back 
condition at 10% and coded it 5237, lumbosacral strain.  The VA rated the back at 40%, coded 
5243,  intervertebral  disc  syndrome,  citing  the  ROM  limitation  noted  on  the  VA  C&P 
examination.  The record shows that the CI had an essentially normal ROM on both the pre-
separation orthopedic and the NARSUM examinations.  The two VA examinations documented 
an antalgic gait and reduced ROM.  The Board found no evidence in the records available for 
review which explained the deterioration between the MEB and two VA examinations.  The CI 
attributed  the 
in  symptomatology  to  the  discontinuation  of  the  chiropractic 
treatments.  However, a family practice note dated 13 February 2008, 2 months after the last 

increase 

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recorded  chiropractic  treatment,  documented  a  normal  gait  without  mention  of  LBP.    The 
second VA examination documented that the strength was normal and spasm absent despite 
the  history  of  worsened  symptoms.    The  Board  also  noted  the  inconsistencies  between  the 
histories  provided  to  the  MEB  and  VA  examiners  and  the  entries  in  the  service  treatment 
record.    The  Board  determined  that  the  MEB  examination  was  most  consistent  with  the 
underlying pathology, expected improvement in symptoms as noted by the treating physicians 
and  the  remainder  of  the  medical  record  and  assigned  it  a  higher  probative  value  for  the 
disability determination.  After due deliberation, considering all of the evidence and mindful of 
VASRD  §4.3  (reasonable  doubt),  the  Board  concluded  that  there  was  insufficient  cause  to 
recommend a change in the PEB adjudication for the back condition.   
 
Chronic Left Knee Pain Condition.  There were two goniometric ROM evaluations in evidence 
which  the  Board  weighed  in  arriving  at  its  rating  recommendation,  with  documentation  of 
additional ratable criteria, are summarized in the chart below. 

 

135 
0 

MEB (20071228) 

VA C&P (20080507) 

Comment 

§4.71a Rating 

105 
0 

10% 

Crepitus 

10% 

Flexion (140 normal) 

Extension (0) 

Left Knee ROM 

Degrees 

pain and popping at 100-105  

Swelling, warmth and tenderness; 

 
 
 
 
 
 
 
 
The first entry in the medical record for the left knee pain was on 2 December 2006 when he 
was  seen  with  the  complaint  of  left  lower  extremity  pain  after  multiple  “Iron  Mikes”  during 
basic training and thought to have tendonitis.  There were multiple visits for the left knee for 
the duration of basic training and also after he returned to home station.  An MRI of the left 
knee performed on 12 April 2007 was normal.  An orthopedic exam a week later performed on 
20 April 2007 showed normal gait and stance, full ROM and stable ligaments.  The last visit for 
the knee in the record was performed on 21 August 2007, 11 months prior to separation.  The 
gait  was  antalgic,  but  there  was  no  effusion  or  erythema.    The  MEB  (NARSUM)  was 
28 December 2007, 7 months prior to separation.  The examiner noted some crepitus, but with 
ROM  essentially  normal.    A  test  for  ligamentous  instability  was  negative.    At  the  VA  C&P 
examination performed on 7 May 2008, the CI reported pain, stiffness, swelling and instability 
on  a  daily  basis.    He  used  a  brace  for  his  knee  and  was  noted  to  have  a  right  limp.    On 
examination,  he  was  found  to  have  1+  swelling  and  2+  warmth  and  tenderness,  but  these 
findings  were  not  further  addressed  or  explained.    Although  the  examination  showed 
deterioration  from  the  MEB  examination,  it  did  not  support  a  higher  rating  than  the  PEB 
adjudicated.  The Board directed attention to its rating recommendation based on the above 
evidence.  The PEB and VA both rated the disability at 10%, coding it 5099-5003, analogous to 
degenerative  arthritis,  and  5299-5024,  analogous  to  tenosynovitis,  respectively.    The  Board 
considered  other  coding  options,  but  none  provided  an  advantage  to  the  CI.    After  due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the 
Board  concluded  that  there  was  insufficient  cause  to  recommend  a  change  in  the  PEB 
adjudication for the left knee condition.   
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
was plantar fasciitis.  The Board’s first charge with respect to this condition is an assessment of 
the  appropriateness  of  the  PEB’s  fitness  adjudication.    The  Board’s  threshold  for  countering 
fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its 
rating  recommendations,  but  remains  adherent  to  the  DoDI  6040.44  “fair  and  equitable” 
standard.  Plantar fasciitis was not profiled, implicated in the commander’s statement and was 
not judged to fail retention standards.  The last visit recorded for this condition was 24 April 
2007,  14  months prior  to  separation.   This  condition  was  reviewed  by  the  action  officer  and 

   4                                                           PD1101128 
 

  After  due  deliberation 

considered by the Board.  There was no evidence in the record that it significantly interfered 
with  satisfactory  duty  performance. 
in  consideration  of  the 
preponderance  of  the  evidence,  the  Board  concluded  that  there  was  insufficient  cause  to 
recommend  a  change  in  the PEB  fitness  determination for  the plantar  fasciitis  condition and 
therefore no additional Service disability rating is recommended. 
 
 
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 low back pain condition and IAW VASRD §4.71a, the Board 
unanimously recommends no change in the PEB adjudication.  In the matter of the left knee 
pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the 
PEB  adjudication.    In  the  matter  of  the  contended  plantar  fasciitis  condition,  the  Board 
unanimously recommends no change from the PEB determination as not unfitting.  There were 
no other conditions within the Board’s scope of review for consideration.   
______________________________________________________________________________ 
 
RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:   
 

UNFITTING CONDITION 

VASRD CODE  RATING 

5237 

5099-5003 

Not Unfitting 

COMBINED 

10% 
10% 

20% 

Chronic Low Back Pain 
Chronic Left Knee Pain 
Plantar Fasciitis 

 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111205, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans’ Affairs Treatment Record. 
 
 
 
 
 
 
 

 

 

           XXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 

   5                                                           PD1101128 
 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXXXXXX, AR20120020016 (PD201101128) 
 
 
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 and hereby deny the individual’s application.   
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 
 
 BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 

     XXXXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

   6                                                           PD1101128