RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200935 SEPARATION DATE: 20031031 

BOARD DATE: 20130125 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a Reserve SGT/E-5 (31U20/Signal Support Systems Specialist), 
medically separated for chronic low back pain (LBP). The condition began in December 2001 as 
a consequence of heavy lifting. He did not respond adequately to operative and rehabilitative 
treatment and was unable to meet the physical requirements of his Military Occupational 
Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and 
referred for a Medical Evaluation Board (MEB). The MEB forwarded chronic LBP with left lower 
extremity radiculitis to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 
40-501. No other conditions appeared on the MEB’s submission. The PEB adjudicated the 
chronic LBP post L4-5 discectomy condition as unfitting, rated 10% with application of the 
Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI non-concurred the 
determination, but waived a formal appeal. The United States Army Physical Disability Agency 
(USAPDA) concluded the case was properly adjudicated, and administratively corrected the 
DA Form 199. The CI was then medically separated with a 10% disability rating. 

 

 

CI CONTENTION: “Because I Received surgery also release Naval Doctor said I needed. LOD 
Report and I was on Med Hold with a T-3 profile. A 20% rating was rendered, severance pay 
was issued. I was medically discharged not retired. I feel I should have been retired.” 

 

 

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 chronic LBP post L4-5 discectomy 
condition as requested for consideration meets the criteria prescribed in DoDI 6040.44 for 
Board purview, and is addressed below. The remaining conditions rated by the VA at 
separation 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 Admin PEB – Dated 20030827 

VA (~4 Mos. Post-Separation) – All Effective Date 20031101 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Low Back Pain 
Post L4/L5 Discectomy 

5293-5299- 

5295 

10% 

Herniated Nucleus Pulposus L4-5 

5299-5243 

20%* 

20040220 

Degenerative Disc Disease L3-5 

5242 

10% 

20040220 

.No Additional MEB/PEB Entries. 

Degenerative Changes, Cervical 
Spine 

5242 

10% 

20040220 

Bilateral Pes Planus 

5276 

10% 

20040220 

Right Wrist Carpal Tunnel Release 

8515 

10% 

20040220 

0% X 2 

20040220 

Combined: 10% 

Combined: 50%** 



*Rating increased to 100% effective 20040517, code changed to 5242; decreased to 20% effective 20040801, then increased to 
40% effective 20051110. **Final combined rating 60% from 20050110 includes non-PEB conditions. 


ANALYSIS SUMMARY: 

 

Chronic Low Back Pain Condition. Subsequent to the injury in December 2001, discovery of a 
herniated nucleus pulposus (HNP) led to L4-5 microdiscectomy in April 2002. Post-operatively, 
lower back pain continued despite physical therapy, epidural steroid injections (ESI) and 
narcotic pain medication. Magnetic resonance imaging (MRI) showed degenerative disc disease 
(DDD) of L3 through S1, slight thickening of the left L5 nerve root (possibly indicating mild 
radiculitis), and mild facet hypertrophy and mild bilateral foraminal stenosis at L4-5. There was 
no evidence of recurrent disc protrusion. There were three 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. 

 

Thoracolumbar ROM 

Neurosurg ~12 Mos. Pre-Sep 

Ortho ~2 Mos. Pre-Sep 

VA C&P ~4 Mos. Post-Sep 

Flexion (90° Normal) 

60° 

30° 

“Declined” 

Ext (0-30) 

“Full” 

-- 

10° 

R Lat Flex (0-30) 

“Reduced” 

15° 

L Lat Flex 0-30) 

15° 

R Rotation (0-30) 

-- 

L Rotation (0-30) 

-- 

Combined (240°) 

-- 

-- 

-- 

Comment 

Ambulates forward flexed 

+Tenderness 

+Painful motion 

§4.71a Rating 

20% 

40% 

20% or 40% (VA 20% + 10%) 



 

An evaluation by a neurosurgeon on 8 October 2002, over 12 months prior to separation and 6 
months after surgery, reported back pain of 4-5 severity on a 10 point scale. He complained of 
significant residual numbness and intermittent radiating pain in the left lower extremity. 
Physical exam revealed normal lower extremity muscle strength but diminished sensation in 
the left lower extremity. Straight leg raise (SLR) was negative for radiculopathy. An orthopedic 
examiner approximately 6 months prior to separation reported that 60% of the CI’s pain was in 
the left leg and 40% in the back. He was observed to be in moderate distress and listed to the 
side while standing. Decreased flexion and lateral bending were present. Multiple areas of 
tenderness were also noted. An orthopedic follow-up 5 days later observed a normal gait. 
Paravertebral lumbar muscle tenderness and spasm were present. Conflicting examination 
findings included a negative distracted SLR, LBP on axial loading, pain with hip rotation, 
exaggerated response to light touch and inconsistent paravertebral muscle tenderness. Lower 
extremity strength, sensation and deep tendon reflexes (DTR) was normal. At the narrative 
summary (NARSUM) exam 5 months prior to separation, the CI denied lower extremity 
paresthesias or weakness. Physical examination revealed a normal gait and spinal contour. 
There was mild paravertebral muscle tenderness and spasm. Lower extremity strength, 
sensation and DTRs were normal. ROM was not mentioned. SLR testing was inconsistently 
positive. At the MEB exam, the CI reported an inability to bend, stand longer than 15 minutes 
or lie down due to lower back problems. At a primary care evaluation on 22 May 2003, the CI 
complained of back pain radiating to the left leg, and leg numbness and weakness. The CI 
appeared uncomfortable. A normal gait and stance were present, and there was no lumbar 
spine tenderness or muscle spasm. Neurologic examination of the lower extremities was 
normal. At a clinic visit for refill of narcotic pain medication 3 months prior to separation, the 
examiner noted an “altered gait.” A final orthopedic follow-up examination 2 months prior to 
separation noted the CI to be in moderate distress with generalized tenderness throughout the 
lower lumbar spine. At the VA Compensation and Pension (C&P) exam 4 months after 
separation, the CI reported pain that radiated down the left leg. Left leg weakness occurred “at 
times.” Difficulty bending occurred “sometimes.” He could walk a half mile, and had to stop 
due to foot pain. He could not run. Physical examination revealed an antalgic gait, although it 
was not specified if this was due to foot or back pain. He was able to tandem walk. The CI 
needed assistance removing socks. A well-healed lumbar surgical scar was present. Spinal 
contour, tenderness and spasm were not mentioned. The CI declined to perform forward 


flexion because pain was “too severe.” Left hip flexion was full and extension was to 45 
degrees (normal to 20 degrees). Right hip motion was present but documented in an unclear 
manner. SLR testing was negative for radiculopathy, but caused pain in the lower back; 
neurologic testing of the lower extremities was normal. Another C&P examiner on the same 
date observed a normal gait and posture. 

 

The Board directs attention to its rating recommendation based on the above evidence. It is 
noted in this case that the PEB's adjudication was IAW VASRD §4.71a criteria in effect at the 
time of those proceedings; but, a change to the current §4.71a criteria (General Rating Formula 
for Diseases and Injuries of the Spine) occurred on 26 September 2003, in advance of the date 
of separation. The Board, IAW DoDI 6040.44, must apply the latter criteria to its 
recommendation. The PEB assigned a 10% rating under the old 5295 code (lumbosacral strain) 
combined with a 5293 code (intervertebral disc syndrome). Conversely, the VA assigned a 20% 
rating under the new intervertebral disc syndrome code (5243) and a separate 10% rating 
under the 5242 code (degenerative arthritis of the spine). The 60 degrees of flexion supported 
a 20% rating (i.e. flexion greater than 30 degrees but not greater than 60 degrees), but this 
exam was a year prior to separation. The 30 degrees of flexion two months prior to separation 
supported a 40% rating (i.e. flexion of 30 degrees or less), but this measurement and the 
absence of flexion measurement at the VA exam were considered in the context of conflicting 
data. For example, the VA examiner reported an antalgic gait and the need to assist with 
removal of socks, yet another VA exam on the very same day reported a normal gait and 
posture. The ability to walk a half mile, and the findings of hip flexion and ability to tolerate an 
SLR test also seemed inconsistent with a complete inability to flex the lumbar spine. The Board 
also debated the findings by the orthopedic examiner 6 months prior to separation and by the 
NARSUM examiner suggestive of non-physiologic pain. The Board therefore agreed that the 
evidence presented is not consistent with the 40% rating criteria, and furthermore concluded 
that under the new spine rules (that are grounded in ROM measurements), a 10% rating is not 
supportable. Board members ultimately agreed that the clinical picture at the time of 
separation most closely approximated the 20% rating. The Board also concluded that assigning 
two separate ratings for the lumbar condition is prohibited under §4.14 (avoidance of 
pyramiding). The Board further deliberated if additional disability was justified for the history 
of left lower extremity pain and numbness. Except for one exam showing diminished sensation, 
all examinations otherwise recorded normal neurologic findings, including muscle strength. 
The presence of functional impairment with a direct impact on fitness is the key determinant in 
the Board’s decision to recommend any condition for rating as additionally unfitting. There is 
no evidence in this case of functional impairment attributable to peripheral neuropathy. While 
the CI experienced radiating pain, this is subsumed under the general spine rating criteria, 
which specifically states “with or without symptoms such as pain (whether or not it radiates).” 
The Board therefore concludes that additional disability was not justified on this basis. The 
Board finally considered whether a higher rating could be achieved under the formula for rating 
intervertebral disc disease based on incapacitating episodes. However, there was no evidence 
that the minimum rating under that formula was met. 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 chronic low back pain condition, coded 5243 under the new VASRD spine 
rules. 

 

 

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 LBP condition, the Board unanimously 


recommends a disability rating of 20%, coded 5243 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 Low Back Pain 

5243 

20% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120613, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting President 

 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 xxxxxxxxxxxxxxxxxx, AR20130006040 (PD201200935) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)