RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200949 SEPARATION DATE: 20031003 

BOARD DATE: 20130220 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SGT/E-5 (67R/Attack Helicopter Repairer), medically 
separated for chronic low back pain (LBP) and chronic bilateral knee pain. The CI could not be 
adequately rehabilitated with conservative treatment 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). Seven conditions, 
identified in the rating chart below, were also identified and forwarded by the MEB. The 
Physical Evaluation Board (PEB) adjudicated the chronic LBP and chronic bilateral knee pain 
conditions as unfitting, rated 10% and 0%, respectively, with application of the Department of 
Defense Instruction (DoDI) 1332.39 and US Army Physical Disability Agency (USAPDA) pain 
policy, respectively. The remaining conditions were determined to be not unfitting. The CI 
made no appeals, and was medically separated with a 10% combined disability rating. 

 

 

CI CONTENTION: “All of the condition I was rated for are conditions that get worse as time 
passes. I did think I was not correctly rated at the time, but when you are active duty they 
pretty much tell you not to bother. I am now on daily pain medcation during the day and 
flexoral at bed time. I now have to use an inhailer twice a day and have difficult time even 
walking without knee and hip pain. Climbing stairs has become difficult as one of my knees will 
inevitably give out on me with sharp pain. I carried a P2 and P3 profile for my knees for 9 or 10 
years, that should have indicated to them there was a bigger issue than they were allowing. My 
dosage of blood pressure medication has now doubled. I am guessing from the way the 9 years 
has gone since my separation, that in 9 more years it is going to be much worse.” 

 

 

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 hypertension and pulmonary 
conditions requested for consideration and the unfitting bilateral knee and low back conditions 
meet the criteria prescribed in DoDI 6040.44 for Board purview, and are accordingly addressed 
below. The other 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 20030620 

VA (1 Mos. Post-Separation) – All Effective Date 20031001 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Low Back Pain 

5299-5295 

10% 

Lumbosacral Strain and Left 
Sacroiliac Degenerative Disc and 
Joint Disease 

5236-5237 

10% 

20031126 

Chronic Bilateral Knee 
Pain 

5099-5003 

0% 

Left Knee Condition 

5260 

0% 

20031126 

Right Knee Condition 

5260 

0% 

20031126 

Not Addressed 

Right Shoulder Tendonitis 
(Major) 

5099-5024 

10% 

20031126 

Hypertension 

Not Unfitting 

Hypertension 

7101 

0% 

20031126 

Chronic Sinusitis 

Not Unfitting 

Sinusitis 

6511 

0% 

20031126 

Gastroesophageal Reflux 
Disease 

Not Unfitting 

Gastroesophageal Reflux 
Disease 

7399-7346 

10% 

20031126 

High Frequency 
Sensoneural Hearing Loss 

Not Unfitting 

Bilateral Hearing Loss 

6100 

0% 

20031114 

Early Chronic Obstructive 
Pulmonary Disease 

Not Unfitting 

NSC 

 

 

20031120 

Nicotine Addiction 

Not Unfitting 

NSC 

 

 

20031126 

.No Additional MEB/PEB Entries. 

0% X 5 / Not Service-Connected x 5 

20031126 

Combined: 10% 

Combined: 30% 



 

 

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. It is a fact, however, that the Disability Evaluation System (DES) has neither the 
role nor the authority to compensate members for anticipated future severity or potential 
complications of conditions resulting in medical separation. This role and authority is granted 
by Congress to the Department of Veterans Affairs (DVA). 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 by the DVA). 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 DVA, however, is empowered to compensate 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. 

 

Chronic Low Back Pain Condition. The CI sought care for atraumatic LBP intermittently, at least 
yearly from 1997 up to 2002, and was diagnosed and treated conservatively for low back strain. 
In 2002 he sought care for worsening pain and was diagnosed and conservatively treated for 
mild degenerative disc disease (DDD) of L5-S1 confirmed on plain radiographs. He reported 
that the nonsteroidal anti-inflammatory medication, Piroxicam, was helping and he was seeing 
physical therapy but still was unable to participate in full physical training as this increased his 
pain at times to 7 of 10 in intensity. The permanent profile limitations included; no running, 
jumping, climbing, crawling, standing or sitting for prolonged periods over 15 minutes without 
changing positions, no bicycling, sit-ups, lifting over 20 pounds, overhead lifting, climbing, wear 
of kevlar helmet and load bearing equipment, or lifting of heavy materials required of the MOS. 
The commander’s statement corroborated the chronic back and knee pain conditions, the 
profile limitations and additionally documented the CI was unable to pickup or carry his toolbox 
to the aircraft, climb on or around the aircraft which were some of the duties as an attack 
helicopter repairer. 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. 

 

 

 


 

Thoracolumbar ROM 

MEB ~6 Mo. Pre-Sep 

VA C&P ~1 Mo. Post-Sep 

Flexion (90° Normal) 

45 

90 

Ext (0-30) 

20 

30 

R Lat Flex (0-30) 

 

30 

L Lat Flex 0-30) 

 

30 

R Rotation (0-30) 

 

30 

L Rotation (0-30) 

 

30 

Combined (240°) 

 

240 

Comment 

altered gait, +SLR 

painful motion with extension 

§4.71a Rating 

10% vs. 20% 

10%* 



*conceding §4.59 painful motion 

 

The MEB physical exam demonstrated moderate distress with altered gait and the inability to 
sit in one position for prolonged period of time without movement. Neurovascular findings and 
Waddell sign’s were negative. X-ray revealed minimal lower lumbar DDD with mild narrowing 
at L5-S1. The examiner opined the pain rating for the low back was minimal and frequent. At 
the VA Compensation and Pension (C&P) exam after separation the CI additionally reported low 
back pain flare-ups that occurred 3-4 times a year which required muscle relaxant and non- 
steroidal anti-inflammatory medications and he would rest in bed for up to a week. The VA 
C&P exam demonstrated; a non tender low back with full ROM, pain with re extension from 
flexion, slight decrease of the lumbar lordosis, negative straight leg raise (SLR) bilaterally 
(provocative test for disc disease), normal squat and rise, normal heel-and –toe walk and 
negative Waddell signs. X-rays of the lumbar spine revealed decreased L5-S1 disc space with 
anterior osteophytes. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
Board notes that both the MEB and VA exams were complete, well documented and however 
were not similar in terms of ROM ratable data; yet both assigned the same rating of 10%. The 
Board thus carefully reviewed the service file for corroborating flexion ROM evidence in the 12-
month period prior to separation and could not find any. Members agreed the disparate ROM 
data likely reflects the waxing and waning impairments due to the pathology of DDD. Therefore 
the Board agreed to carefully considering the whole record IAW VASRD §4.2 (Interpretation of 
examination reports) in order to develop a consistent picture of the CI’s back pain. The PEB 
based their rating recommendations IAW 2002 VASRD coding and rating standards for the spine 
that were modified on 23 September 2002 to add incapacitating episodes (5293, Intervertebral 
disc syndrome) which were in effect at the time of separation. These standards were then 
changed to the current §4.71a rating standards on 26 September 2003 which the VA used for 
coding. 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 

 

The PEB’s DA Form 199 reflected application of the DODI 1332.39 and AR 635-40, Appendix B-
39 for rating, but its 10% determination was consistent with §4.71a standards. 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 10% under the 5295 code based on the MEB exam. The 
Board also considered a rating under the 5292 code for limitation of spine motion. The 
impaired flexion ROM documented by the MEB exam justifies a “slight” 10% rating under that 
code but also could be considered as meeting the “moderate”20%, however would not justify a 
“severe” 40% rating. The Board notes there are no service treatment record (STR) entries for 
treatment of back pain after June 2002, there is no documentation of narcotic pain medication 
or other pain modifier medications typically used for moderate to severe pain, furthermore the 
documented spasms and altered gait are intermittent. The action officer also opines that the 
pathology and X-ray in evidence do not correlate with an anticipated limitation of ROM 
appropriately characterized as ‘moderate.’ Therefore, IAW VASRD §4.2 and based on all 
evidence and associated conclusions just elaborated, members agreed the low back condition 
does not rise to the level of moderate limitation of motion. There is no evidence of 
incapacitating episodes or ratable peripheral nerve impairment which would provide for 
additional or 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 chronic LBP condition. 

 

Chronic Bilateral Knee Pain Condition: The CI had atraumatic chronic knee pain diagnosed as 
retropatellar pain syndrome (RPPS) for many years that required a P2 profile. He ultimately 
required a P3 for persistent pain despite use of the non-steroidal anti-inflammatory medication, 
Piroxicam, physical therapy and injections by orthopedics. The bilateral knee pain was 
aggravated with stair climbing and the pain was reported to increase at times to 7 of 10 in 
intensity. The profile and commander statements reviewed under the low back condition were 
also considered for the bilateral knee condition. 

 

The MEB physical exam did not demonstrate a right or left knee exam. An orthopedic exam 12 
months prior to separation demonstrated bilateral patella grind was silent to ROM and 
otherwise negative bilateral exam for appearance, ligament, and meniscal findings. An aviation 
exam, 14 months prior to separation, demonstrated bilateral full ROM, no apparent knee 
deformities and the examiner diagnosed chronic RPS. X-rays of both knees revealed 
osteophytes on the patella otherwise were unremarkable. At the VA Compensation and 
Pension (C&P) exam separation, the CI additionally reported no locking or buckling, no use of 
braces or cane or other assistive devices, was able to swim, and bicycle ride, and that he was 
fully independent in self care. The C&P bilateral knee exam demonstrated; normal ligament 
and meniscal findings, no patellar crepitus, apprehension or ballottement and normal full ROM. 
X-rays of knees were normal. 

 


The Board directs attention to its rating recommendation based on the above evidence. This 
rating includes consideration of functional loss lAW VASRD §4.10 (functional impairment), §4.40 
(functional loss), §4.45 (DeLuca), and §4.59 (painful motion). The PEB and VA chose different 
coding options for the condition, but this did not bear on rating. The PEB’s DA Form 199 
reflected application of the USAPDA pain policy for rating and its 0% determination coded 
analogous to 5003 (arthritis, degenerative) for the chronic bilateral knee pain condition was 
inconsistent with §4.71a standards. The 5003 code specifies “when however, the limitation of 
motion of the specific joint or joints involved is non compensable under the appropriate 
diagnostic codes, a rating of 10% is for application for each such major joint or group of minor 
joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. 
In the absence of limitation of motion, rate as below: With X-ray evidence of involvement of 2 
or more major joints or 2 or more minor joint groups 10%.” The Board agreed the evidence 
does not support limitation of motion for separate knee 10% ratings however there is X-ray 
evidence, at the time of the PEB, to consider the 10% rating for two or more joints with this 
code. The VA achieved separate 0% non compensable ratings coded to 5260 (Leg, limitation of 
flexion of) for no evidence of pain limited motion and normal X-rays. There are no other viable 
approaches to a higher rating which is 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 majority recommends a disability rating of 10% for the 
chronic bilateral knee pain condition. 

 

Contended PEB Conditions. The conditions adjudicated as not unfitting by the PEB were 
hypertension and early chronic obstructive pulmonary disease (COPD). The Board’s first charge 
with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness 
adjudications. 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. None of these conditions were 
profiled; none were implicated in the commander’s statement; and, and only the early COPD 
was judged to fail retention standards. All were reviewed by the action officer and considered 
by the Board. There was no indication from the record that any of these conditions significantly 
interfered with satisfactory duty performance. After due deliberation 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 any of the contended PEB 
conditions and, therefore, no additional disability ratings can be 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. As discussed above, PEB reliance on the DoDI 1332.39, AR 635-40 and the 
USAPDA pain policy for rating low back and bilateral knee conditions was operant in this case 
and the conditions were adjudicated independently of that policy by the Board. In the matter 
of the chronic LBP and IAW VASRD §4.71a, the Board unanimously recommends no change in 
the PEB adjudication. In the matter of the chronic bilateral knee pain condition, the Board by a 
vote of 2:1 recommends a rating of 10% coded 5099-5003 IAW VASRD §4.71a. The single voter 
for dissent (who recommended no recharacterization) did not elect to submit a minority 
opinion. In the matter of the contended pulmonary and hypertension conditions, the Board 
unanimously recommends no change from the PEB determinations as not unfitting. 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 

5299-5295 

10% 

Chronic Bilateral Knee Pain 

5099-5003 

10% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120618, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxx, AR20130006036 (PD201200949) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)