RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200946 SEPARATION DATE: 20031108 

BOARD DATE: 20130220 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (95C/RA Corrections Specialist), medically 
separated for status post (s/p) L5/S1 discectomy (low back pain), bilateral retropatellar pain 
syndrome and headaches frequent tension headaches and migraine headaches condition. The 
CI did not improve adequately with surgical and post rehabilitative treatment for the low back 
condition or conservative treatment for the remaining conditions to meet the physical 
requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. 
He was issued a permanent P3U2L3 profile and referred for a Medical Evaluation Board (MEB). 
The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The 
PEB adjudicated the low back, bilateral knee and headaches conditions as unfitting, rated 10%, 
0% and 0%, respectively, with application of Veteran’s Affairs Schedule for Rating Disabilities 
(VASRD). The CI made no appeals, and was medically separated with a 10% combined disability 
rating. 

 

 

CI CONTENTION: “I was rated for 0% for migraines that completely disable me from any work 
or activity. I was rated at 10% for degenerative arthritis, lumbar spine, which is extremely 
painful and debilitating, greatly [sic] effecting every part of my life. My back is a lot more than 
10% of my body and my life. I originally received 0% for my right and 0% for my left knees. 
With these combinations I strain to move and at times do anything at all. I struggle to work not 
only with these conditions but others that have come along the way. I cannot sleep properly 
with my back and I believe that I had incurred Sleep Apnea which does cause the migraines 
previously stated. I use a bi-pap that the VA has provided but has been denied in a 
compensation and pension review. I have bursitis in my right knee and a baker’s cyst in my left 
knee along with the constant popping, locking and giving out of both knees. I have further 
complications to these conditions now but when I was discharged in 2003 with these conditions 
I cannot believe that my head, my back and both knees were only worth 10%. I am currently 
rated at 60% and am in the progress of another compensation and pension review for an 
increase. I have included copy of letters sent for the last review and a copy of my current rating 
letter for your consideration.” sic 

 

The CI attached a 2-page statement pleading to his application along with additional letters of 
support which were reviewed by the Board and considered in its recommendations. 

 

 

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 S/P L5-S1 discectomy, 
bilateral retropatellar pain syndrome and headaches, frequent tension and migraine, conditions 
meet the criteria prescribed in DoDI 6040.44 for Board purview, and below, are accordingly 


addressed. The sleep apnea, and hip, buttock and tailbone pain requested conditions 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 IPEB – Dated 20030710 

VA (4 Mos. Post-Separation) – All Effective Date 20031109 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

S/P L5-S1 Discectomy 

5293 5299 
5295 

10% 

S/P L5-S1 Discectomy 

5243 

10%* 

Failed to 
Report* 

Bilateral Retropatellar 
Pain Syndrome 

5099 5003 

0% 

Retropatellar Pain Syndrome, 
Right Knee 

5260 

0%* 

Failed to 
Report * 

Retropatellar Pain Syndrome, 
Left Knee 

5299-5260 

0%* 

Failed to 
Report * 

Headaches, Frequent 
Tension Headaches and 
Migraine 

8100 

0% 

Migraine Headaches 

8100 

0%* 

Failed to 
Report * 

.No Additional MEB/PEB Entries. 

Surgical Scar 

7805 

0% 

Failed to 
Report * 

Not Service-Connected x 2 

Combined: 10% 

Combined: 10%* 



*Ratings increased based on C&P exam dated 20110107 for a combined 60% 

 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which his service-incurred condition continues to 
burden him. The Board also acknowledges the CI's contention suggesting that ratings should 
have been conferred for other conditions documented at the time of separation and for 
conditions not diagnosed while in the service (but later determined to be service-connected). 
While the Disability Evaluation System 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 
Department of Veterans Affairs, however, 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. 

 

Low Back Condition. The CI had a fall, slipping on a wet gym floor, and sought treatment for 
acute low back pain (LBP) with radiation into the left lower extremity. After not responding 
adequately to rest, physical therapy, chiropractic care, non-steroidal, anti-inflammatory and 
muscle relaxant medications he opted for surgery for a magnetic resonance imaging (MRI) 
confirmed large left-sided disc herniation (HNP) at L5-S1 with nerve root impingement. 
Neurosurgery documented physical exam signs consistent with an S1 radiculopathy without 
myelopathy, evidenced by a decreased ankle jerk on the left, and performed a L5-S1 discectomy 
in order to attempt to relive the radicular pain as well as possibly improve the LBP. At follow-
up with neurosurgery the CI reported the LBP had significantly improved with occasional 
tingling in the posterior aspects both legs. However, he had aggravation of pain with running, 
walking and bending which necessitated a permanent profile and referral for a MEB. The 
permanent profile documented the following limitations; no lifting above 30 lbs, unable to wear 
the 40lb backpack, alternate physical training test with the walk and push-ups, run at own pace 
and distance, march up to 5 miles, able to wear a pistol belt and the stab proof vest required 
for work in the USDB. The commander’s statement identified his back and bilateral knee 


conditions, corroborated his profile limitations and additionally documented the lifting and ruck 
marching limitations precluded him from performing in his MOS. 

 

The MEB physical exam, 6 months prior to separation, demonstrated full active range-of-
motion (ROM), normal neuromuscular findings of the lower extremities with negative straight 
leg raise (SLR) (provocative test for disc disease) and a midline surgical scar 4.5 cm (1.77 inches) 
in length in the low back consistent with history of lumbar diskectomy. A physical therapy (PT) 
examination, 17 months prior to separation, also demonstrated full active ROM; however, 
there was pain with motion. X-rays of the low back were consistent with history of lumbar 
discectomy and degenerative joint disease (DDD) of the L5-S1 level. There is no probative VA 
evidence in this case to consider, since the CI failed to present for the post separation 
scheduled VA evaluation in 2004. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB and VA chose different coding options for the condition, but this did not bear on rating. 
The PEB based their rating recommendations IAW 2002 VASRD coding and rating standards for 
the spine, which were in effect at the time of separation, were modified on 23 September 2002 
to add incapacitating episodes (5293, Intervertebral disc syndrome), and then changed to the 
current §4.71a rating standards on September 2003. The 2002 standards for rating based on 
ROM impairment were subject to the rater’s opinion regarding degree of severity, whereas the 
current standards specify rating thresholds in degrees of ROM impairment. For the reader’s 
convenience, the 2002 rating codes under discussion in this case are excerpted below. 

 

5292 Spine, limitation of motion of, lumbar: 

Severe ………………………………………………………..……….………….... 40 

Moderate …………………………………….……………….…….…………...…. 20 

Slight ………………………………………………………..…………………...….10 

 

5293 Intervertebral disc syndrome: 

Pronounced; with persistent symptoms compatible with: sciatic 

 neuropathy with characteristic pain and demonstrable muscle 

 spasm, absent ankle jerk, or other neurological findings appropriate 

 to site of diseased disc, little intermittent relief ………………..….……….….. 60 

Severe; recurring attacks, with intermittent relief ……………..…….………..….…40 

Moderate; recurring attacks ……………………………….……………............…...20 

Mild ……………………………………………………………..…………….….…10 

Postoperative, cured …………………………………….………..……………....…..0 

 

5295 Lumbosacral strain: 

Severe; with listing of whole' spine to opposite side, positive 

Goldthwaite's sign, marked limitation of forward bending in 

 standing position, loss of lateral motion with osteo-arthritic 

 changes, or narrowing or irregularity of joint space, or some 

 of the above with abnormal mobility on forced motion …………………..…... 40 

With muscle spasm on extreme forward bending, loss of lateral spine 

 motion, unilateral, in standing' position ……………...…….……..…...….….. 20 

With characteristic pain on motion ………………………………..……...…….…. 10 

With slight subjective symptoms only ……………………...…….…………...……. 0 

 

Both the MEB and the VA rated the CI’s lumbar spine condition at 10%. It is reiterated that the 
VA rating was based on the evidence. The 20% rating for 5295 is fairly specifically defined as 


noted above. The CI’s condition clearly does not meet the criteria for a rating higher than 0% 
under the 5295 code based on the MEB exam with absence of painful motion but does meet 
the 10% criteria with the PT exam 17 months prior to separation. The Board's recommendation 
may not produce a lower rating than that of the PEB. The Board also considered a rating under 
the 5292 code for limitation of spine motion. Neither the MEB nor the PT ROM’s documented 
would justify a “slight” 10% rating under that code. There is no evidence of documentation of 
incapacitating episodes to meet criteria under the 5293 code or ratable peripheral nerve 
impairment which would provide for additional or higher rating. The Board also notes the VA 
chose to assign a 10% rating code 5243 (Intervertebral disc syndrome) under the general rating 
formula for diseases and injuries of the spine rather than the formula for rating intervertebral 
disc syndrome based on incapacitating episodes which is an option with this code. 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 low back pain condition. 

 

Bilateral knee condition. While undergoing the MEB exam for the low back condition, the CI 
also reported atraumatic bilateral knee pain for the last 3 years, right worse than left, 
aggravated with ascending and descending stairways and particularly with running. The pain 
was consistent with retropatellar pain syndrome bilaterally. Prior to the MEB exam, the service 
treatment record (STR) reflected only two encounters in the year 2000 and one in 2003 when 
the CI sought care for the bilateral knee pain condition. The MEB physical exam demonstrated 
bilaterally; full active ROM, normal ligament and meniscal provocative exam findings, 
neurovascularly intact lower extremities, and pain with patellar grind. A physical therapy exam, 
9 months prior to separation, also demonstrated full active ROM. X-rays of the bilateral knees 
were normal. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB and VA chose different coding options for the condition, but this did not bear on rating. 
Both the PEB and the VA rated the CI’s bilateral knee condition at 0%. It is reiterated that the 
VA rating was based on the evidence. The Board agreed there is no X-ray evidence to support a 
10% rating or evidence of incapacitating episodes to support a 20% rating under the 5003 code. 
There is no viable approach to a higher rating for the right knee which was countenanced by 
the VASRD with normal ligament and meniscal findings. 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 bilateral knee 
condition. 

 

Headache Condition. In the STR, the CI was evaluated by neurology in 2002 for increasing 
frequency of headaches and was diagnosed with both tension headaches and migraine 
headaches. The CI reported at this time, a year prior to separation, he had 1-2 migraine 
headaches a month with the typical associated symptoms characteristic of migraines and 
tension headaches 1-2 times per week. Medications treatment included non steroidal, Midrin, 
Percocet and Imitrex, which was stopped due to side effects. There was no evidence of 
prostrating headaches that required the CI to stop work. This condition was not profiled, not 
mentioned in the commanders statement and furthermore was not evaluated in the MEB exam 
nor was there evidence of any further treatment after the neurology evaluation in 2002. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB and VA applied different VASRD codes, but were subject to the same rating criteria IAW 
§4.124a—Schedule of ratings–neurological conditions and convulsive disorders. Both the MEB 
and the VA rated the CI’s migraine headache condition at 0%. It is reiterated that the VA rating 


was based on the evidence. The VA rating decision cites the noncompensable evaluation is 
assigned due to the lack of evidence of characteristic prostrating attacks averaging one in 2 
months over the last several months for the higher rating. 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 headache 
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 low back and bilateral knee condition and IAW VASRD 
§4.71a the Board unanimously recommends no change in the PEB adjudication. In the matter 
of the headache condition and IAW VASRD §4.124a the Board unanimously recommends no 
change in the PEB adjudication. 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 

Status Post L5/S1 Discectomy 

5293-5299-5295 

10% 

Bilateral Retropatellar Pain Syndrome 

5099-5003 

0% 

Headaches 

8100 

0% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120722, 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 / xxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxx, AR20130004604 (PD201200946) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)