RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200970 SEPARATION DATE: 20020404 

BOARD DATE: 20130131 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (77F/Petroleum Supply Specialist), medically 
separated for back pain. The CI reported initial onset of back pain while walking in December 
1997. Back pain persisted for 4 years despite physical therapy (PT) or medications. The CI’s 
back pain condition could not be adequately rehabilitated and the CI did not improve with 
treatment to meet the physical requirements of her Military Occupational Specialty (MOS) or 
satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a 
Medical Evaluation Board (MEB). The MEB identified left sacroiliac joint dysfunction, mild 
degenerative disc disease (DDD) of L4-L5 level and mild spinal canal stenosis from ligmentum 
hypertrophy and mild facet arthropathy at two levels and possible palindromic rheumatism 
conditions and forwarded these conditions to the Physical Evaluation Board (PEB). The PEB 
adjudicated back pain as unfitting back pain condition (from MEB diagnoses 1 and 2), rated 0%, 
with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The possible 
palindromic rheumatism (MEB diagnosis 3) condition was determined to be not unfitting and 
therefore, not ratable. The CI made no appeals, and was medically separated with a 0% 
disability rating. 

 

 

CI CONTENTION: The CI elaborated no specific contention in her application. 

 

 

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 condition left sacroiliac joint 
dysfunction; and mild DDD of L4-L5 level, mild spinal canal stenosis from ligmentum 
hypertrophy and mild facet arthropathy at two levels conditions as a single unfitting back pain 
condition meets the criteria prescribed in DoDI 6040.44 for Board purview and is accordingly 
addressed below. 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 PEB – Dated 20011121 

VA (4 Mos. Post-Separation) – All Effective Date 20020405 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Back Pain 

5299-5295 

0% 

DDD L4-L5 with Spinal Stenosis 
and Chronic L/Sacroiliac Joint 
Dysfunction 

5293-5294 

10% 

20021119 

Palindromic Rheumatism 

Not Unfitting 

Palindromic Rheumatism 

6350 

NSC 

20021119 

.No Additional MEB/PEB Entries. 

0% X 1/ Not Service-Connected x 2 

 

Combined: 0% 

Combined: 10% 



 


ANALYSIS SUMMARY: The 2002 VASRD coding and rating standards for the spine, which were 
in effect at the time of separation, were changed to an interim §4.71a rating standard effective 
23 September 2002. The 2002 standards for rating are based on the rater’s interpretation and 
opinion of range-of-motion (ROM) impairment regarding degree of severity, whereas the 
current standards specify rating thresholds in degrees of ROM impairment measured with an 
instrument. Of special note in this case is that the VA spine normal ROMs were not codified in 
the VASRD until September 2003 (Plate V) and “normal” was considered what the examiner 
indicated. ROM exam templates from that timeframe often indicated normal ROMs with 
greater values for extension, lateral bending and rotation than current VASRD normal limits. 
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 

5294 Sacro-iliac injury and weakness: 

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 osteoarthritic 

 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 

 

Back Condition. Service treatment records (STR) show the narrative summary (NARSUM) of 
10 June 2001, NARSUM notes the CI developed lower back pain, usually associated with lifting, 
on the left side her body in December 1997. She underwent unremarkable lumber X-rays and 
PT pelvic traction treatments without sacroiliac exercise or pelvic belt at that time. A 
lumbosacral computerized tomography (CT) scan in May 1999 showed DDD at L4-5, 
ligamentum flavum hypertrophy, with mild facet arthropathy, mild spinal canal stenosis and 
mild L5-S1 facet arthropathy. The STR shows she was referred for “SI joint stabilization 
exercises” and an “SI belt” during a permanent P3 profile in December 1999. In February of 
2000, she was evaluated by physical medicine for SI joint dysfunction and treated for this 
condition. She was permanently profiled L3 in April 2000 and restricted from lifting, two mile 
run, and sit-ups. In March 2001, a rheumatologist noted possible palindromic rheumatism of 
the hands, of 3 months duration every 2 weeks, but no formal diagnosis was made, and the 
record then fell silent for further episodes. The rheumatologist also noted her lab workup was 
only positive for an anti-nuclear antibody (ANA) at 1:320, without sufficient clinical proof of 
systemic lupus erythematosis, discounting inflammatory arthritis as a cause for her condition. 
Per her commander’s letter in July 2001, she could not perform her primary MOS as an aircraft 
refueler, nor participate in the Army fitness program, and her case was adjudicated. However, 
her actual profile dated 20000413 indicated that the CI could take part in the Army fitness 
program with alternate events such and swimming and walking. 

 


There were two 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. 

 

Lumbar ROM 

MEB ~5 Mos. Pre-Sep 

VA C&P ~7 Mos. Post-Sep 

Flexion 

60° 

105° 

Ext 

20° 

35° 

R Lat Flex 

40° 

35° 

L Lat Flex 

40° 

35° 

R Rotation 

25° 

- 

L Rotation 

30° 

- 

Combined 

215° 

- 

Comment: 

No tenderness 

No tenderness or spasm; no 
limp; noted radiating pain 

§4.71a Rating 

10% (PEB 0%) 

0%-10% (VA 10%) 



 

At the MEB exam, the CI reported left upper lumbar lifting pain and radiating pain to the left 
buttock. The MEB physical exam noted positive Faber’s test bilaterally which radiated to the 
left SI joint and positive Gaenslen’s test on the left that was consistent with the chronic left 
sacroiliac dysfunction. “Back” ROMs are summarized above. At the VA Compensation and 
Pension (C&P) exam, 7 months after separation, the CI comments are surmised above. The VA 
examiner noted Deluca negative ranges of lumbar motion above, and normal curvature to the 
spine, no tenderness or spasm. Motor strength and neurological exam were normal. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
Board noted that page one of the C&P exams was missing from the STR; two attempts to 
retrieve this information were made. On careful analysis, the Board opined that the PEB exam 
carried more probative value with its closer proximity to the date of separation than the C&P 
exam, and that the missing page one was not required to adjudicate the CI’s case, and 
furthermore, delay of the case was not warranted. The PEB combined the left sacroiliac joint 
dysfunction, mild DDD of L4-L5 level, mild spinal canal stenosis from ligmentum hypertrophy 
and mild facet arthropathy at two levels condition as a single unfitting condition coded 
analogously to 5299-5295 (lumbosacral strain), and rated 0% (with slight subjective symptoms 
only). The symptoms and potential disability of each of the MEB diagnoses is appropriately 
combined for coding IAW VASRD rules. The VA coded analogously to 5294 (sacro-iliac injury 
and weakness), modified with 5293 (Intervertebral disc syndrome) characteristics for the DDD 
L4-5 with spinal stenosis and chronic left sacroiliac joint dysfunction and rated 10% disability. 
The Board opined that the PEB exam had more probative value with its closer proximity to the 
date of separation and noted findings of positive Faber and Gaenslen’s tests, as well as slight 
limitation of “back” ROM that reflected the CI’s complaints and condition. Next the Board 
considered the application of the VASRD criteria operant at the time of separation and found 
that the CI best fit a rating of 10% for characteristic pain on motion or for slightly limited ROM. 
The Board could not find evidence of muscle spasm on extreme forward bending, loss of lateral 
spine motion, unilateral, in standing position to elevate the disability to 20%. Given the lack of 
specific “back ROM” normal values or details on measurement techniques (goniometer or 
inclinometer) for the ROM exam, there was insufficient evidence for limitation of ROM beyond 
slight as flexion normal ROMs could range from 60 degrees to 95 degrees from the literature at 
the time. The Board considered the CI’s clinical presentation and record and opined that the 
code 5293-5294 sacro-iliac injury and weakness, modified with 5293 Intervertebral disc 
syndrome best fit the galaxy of symptoms that rendered the CI unfit for further service. 

 

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 10% for the left sacroiliac joint 
dysfunction, mild degenerative disc disease of L4-L5 level, mild spinal canal stenosis from 
ligmentum hypertrophy and mild facet arthropathy at two levels condition, coded 5293-5294. 


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. In the matter of the back 
pain condition (including left sacroiliac joint dysfunction, mild DDD of L4-L5 level, mild spinal 
canal stenosis from ligmentum hypertrophy and mild facet arthropathy at two levels), the 
Board unanimously recommends a disability rating of 10%, coded 5293-5294 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 her prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Back Pain Condition 

5293-5294 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120602, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for XXXXXXXXXXXXXXXX, AR20130003990 (PD201200970) 

 

 

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 10% 
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 XXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)