RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200994 SEPARATION DATE: 20020103 

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 (96B20/Intelligence Analyst), medically 
separated for chronic pain, low back with right radicular symptoms due to L4-5, L5-S1 herniated 
disks and both knees, due to retropatellar pain syndrome. He fell off a truck in December 1999 
landing on his buttocks and knees and continued to have low back and knee pain. Despite 
epidural steroid injections, pain medication and physical therapy he could not be adequately 
rehabilitated 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 no other conditions for Physical 
Evaluation Board (PEB) adjudication. The PEB adjudicated the chronic pain of the low back and 
bilateral knees as one unfitting condition, rated 20% with application of the US Army Physical 
Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated 
with a 20% disability rating. 

 

 

CI CONTENTION: “Still face back, knee & neck pain daily & on medication still today. Not able 
to run like I once was able, deal with headaches in a regular basis due to neck pain and back 
pain and severe muscle spasms. TMJ also causes thoses as well. Still dealing with IBS and none 
of these conditions are getting any better with age. Also deal with right hip pain which runs 
down my right leg regularly. My dreams of working for the FBI will never come true to these 
disabilities which limit me in that field.” [sic] The CI also attached a 1 page memo to his 
application which was 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 back and knee conditions as requested 
for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview and are 
addressed below. The other requested conditions of temporomandibular disorders (TMJ), neck 
pain, hip pain and headaches 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 20010917 

VA (7 Mos. Pre-Separation) – All Effective Date 20020104 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Pain – Low Back w/ Rt 
Radicular Symptoms due to 
L4-5, L5-S1 Herniated Disks & 
Both Knees 

5099-5003 

20% 

Degenerative Disc Disease, L4-5, 
L5-S1 

5293 

20% 

20010618 

Lt Knee Pain 

5260 

NSC* 

20010618 

Rt Knee Pain 

5260 

NSC* 

20010618 

.No Additional MEB/PEB Entries. 

0% X 1 / Not Service-Connected (NSC) x 6 

20010618 

Combined: 20% 

Combined: 20%* 



*The VA found the knees NSC due to no diagnosable condition found at time of C&P examination; they were later rated 10% 
from 20061115. Additionally, VARD dated 20021002 added four rated conditions based on a Board of Veterans’ Appeals 
decision, with an effective date back to the date of separation, raising the combined rate to 60% from 20020104. This decision 
did not change the original NSC designation for the knees at that time. 

 

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. However 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. 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 
Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at 
the time of separation. 

 

The PEB combined the chronic low back pain (LBP) with radicular symptoms and bilateral knee 
conditions as a single unfitting condition coded analogously to 5003 and rated 10%. The 
approach by the PEB not uncommonly reflected its judgment that the constellation of 
conditions was unfitting, and there was no need for separate fitness adjudications or implied 
adjudication that each condition was separately unfitting. The Board also noted that 
“bundling,” the combining of two or more major joints is permissible under the VASRD 5003 
rating criteria, and that this approach does not compromise the VASRD §4.7 guidance to choose 
the higher of two ratings. The Board’s initial charge in this case was therefore to determine if 
the PEB’s approach of combining conditions under a single rating was justified in lieu of 
separate ratings. When the Board recommends separate fitness recommendations in this 
circumstance, its recommendations may not produce a lower combined rating than the PEB. 

 

As detailed below, the Board concluded the LBP condition was separately unfit and most 
appropriately rated 20%. The Board concluded the evidence indicated the right and left knee 
conditions were not separately unfitting and did not warrant service rating at separation. The 
Board noted that if the knees had been concluded to be separately unfitting, the totality of the 
evidence reflected a disability picture that more nearly approximated a 0% rating and thus 
provided no rating benefit to the CI. The Board therefore recommended no change to the PEB 
adjudication as no rating benefit to the CI resulted after the Board’s deliberations. 

 

Low Back Pain Condition. All Board members agreed the evidence in the service treatment 
records (STR) indicated the LBP condition was unfitting for continued military service when 
considered separately. The CI had chronic LBP beginning in 1999 associated with radiating pain. 
Magnetic resonance imaging on 28 January 2000 revealed disc protrusion at L4-5 and L5-S1. A 
transcutaneous electrical nerve stimulation (TENS) unit and epidural injections brought some 
relief, but radiating pain down the right side remained. The VA Compensation and Pension 
(C&P) examination on 18 June 2001 was 6 months prior to separation, and preceded the MEB 
narrative summary (NARSUM) examination. The CI reported LBP since a fall off a truck in 2000. 
The back pain was associated with weakness, stiffness, pain radiating into his buttocks 
bilaterally with tingling in his right leg, constant muscle spasm in his back, and pain that 


interfered with sleep and work. Physical exam revealed tenderness and muscle spasm. Flexion 
was 75 degrees, extension 20, and right lateral flexion 20, left lateral flexion 25, right and left 
rotation 35, all with pain at end range. Posture and gait were normal. Straight leg raising (SLR) 
test was positive bilaterally at 30 degrees. There was no muscle atrophy and strength, 
sensation and reflexes were within normal limits. The MEB NARSUM examination dated 
23 August 2001 noted continued back pain with running, wearing load bearing equipment and 
prolonged standing. Radiating pain was also noted. On examination there was tenderness to 
palpation. Spinal contour was normal. SLR on the right provoked radiating pain into the right 
leg, but strength, reflexes and sensation were normal. ROM was not recorded. 

 

The Board directs attention to its rating recommendation based on the above evidence. In 
accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in 
effect at the time of separation. The Board notes that the 2002 VASRD standards for the spine 
which were in effect at the time of separation were changed to the current §4.71a rating 
standards in September 2003. The Board must correlate the above clinical data with the 2002 
rating schedule (applicable diagnostic codes included: 5292 limitation of lumbar spine motion; 
5293 intervertebral disc syndrome; and 5295 Lumbosacral strain). The PEB rated the back pain 
condition and knee pain condition together with a single 20% using the USAPDA pain policy, 
coded 5099-5003. The VA assigned a 20% rating for the back condition based on intervertebral 
disc syndrome (5293), moderate recurring attacks. The Board agreed that the ROM at the time 
of the C&P examination more nearly approximated the 10% rating than the 20% rating under 
VASRD diagnostic code 5292, limitation of motion (as well as current VASRD guidelines). The 
Board also considered the rating under the code, 5295, lumbosacral strain, but concluded the 
evidence did not support a rating higher than 10%, for characteristic pain on motion. There 
was not unilateral loss of lateral spine motion to support the 20% rating. The Board noted the 
presence of muscle spasm at the time of the C&P examination but also noted that posture, 
spinal contour, and gait were normal. Board members also agreed the evidence did not 
support the 40% rating under this code. The Board next considered the rating under the 
guidelines for intervertebral syndrome, code 5293. All members agreed the condition did not 
approach 60% pronounced, or 40% severe under this code as neurologic examinations were 
normal. The Board discussed whether the condition more nearly approximated the 20%, 
moderate, or the 10%, mild, rating under 5293. Board members noted the absence of recurring 
attacks, mild limitation of motion, normal gait and normal neurologic examination. The CI was 
able to perform non-deployed, rating. After review of the STRs, all members agreed the 
evidence supported a conclusion the back pain condition more nearly approximated the 10% 
rating than the 20% rating under 5293. Board members considered the chronic pain, and 
associated limitations recorded in the NARSUM and C&P examinations. After review of the 
STRs, all members agreed the totality of the evidence supported a conclusion the back pain 
condition more nearly approximated the 20% rating than the 10% rating under 5293. The 
Board also considered if additional disability rating was justified for peripheral nerve 
impairment due to radiculopathy. The CI had disc disease with radiating pain; however, 
examinations indicated normal strength, reflexes and gait. 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. Therefore the critical decision 
was whether or not there was a significant motor weakness which would impact military 
occupation specific activities. There is no evidence in this case that motor weakness existed to 
any degree that could be described as functionally impairing. The Board therefore concluded 
that additional disability rating was not justified on this basis. 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 20% for the LBP condition, coded 5293, intervertebral 
disc syndrome. 

 

Bilateral Knee Condition. The Board considered whether the bilateral knee condition, when 
considered alone separate from the LBP condition, was unfitting for continued military service. 


Review of the STRs reflected care for bilateral knee pain beginning in December 1999 after a fall 
off of a truck. At the time of a physical therapy evaluation on 7 January 2000, the CI reported 
occasional swelling after running with a popping sensation. On examination ROM was full, and 
gait was normal. There was crepitus consistent with bilateral patellofemoral pain syndrome. A 
15 August 2000 clinic visit records a history of knee pain after running, walking long distances or 
climbing stairs. On examination, ROM was full. There was no instability, crepitus, or 
tenderness. X-rays of the knees on 15 August 2000 were reported as normal. Orthopedic 
evaluation on 14 September 2000 noted a history of right greater than left knee pain, 
particularly after prolonged activity. There was popping but no swelling. Examination 
documented full extension (0 degrees) and flexion to 130 degrees in both knees without 
effusion or instability. There was patellar grinding consistent with the diagnosis of 
patellofemoral pain syndrome. The orthopedic surgeon recommended a P2 profile. During 
follow up in the clinic on 18 September 2000, the physician noted a history of bilateral knee 
pain for 18 months and recorded CI report that he could not ruck march more than two miles 
without severe knee pain and swelling. The physician changed the profile to P3 for the knee 
pain. A clinic entry on 4 October 2000 noted the CI reported he could not fulfill duties in the 
field and the MEB was initiated. Examination noted full ROM without effusion, tenderness or 
instability, but crepitus was again present. The final permanent L3 Profile of 4 October 2000 
references chronic knee and LBP and recommends no running, jumping, marching, or climbing. 
Clinic encounters on 18 December 2000 and 19 March 2001 noted a non-antalgic gait. The MEB 
history and physical examination on 11 April 2001 (reported on the DD Form 2807 and DD Form 
2808) documented CI reporting of bilateral knee pain with locking and popping sensation, and 
swelling if he walked a lot. On examination, ROM was full associated with crepitus. Strength of 
the legs was indicated as normal. The C&P examination was 18 June 2001, 6 months prior to 
separation, and preceded the MEB NARSUM examination. At the C&P exam the CI reported 
constant knee pain worsened with excessive walking or prolonged standing, and grinding and 
aching when he stood up. On examination the appearance of the knees was normal, and ROM 
was full (extension 0 degrees, flexion 140 degrees). There was no instability, meniscus signs or 
painful motion. “There is no DeLuca issue of the knees.” Gait was normal. Lower extremity 
findings included normal motor function, sensory and reflexes, and no muscle atrophy. X-rays 
of both knees were normal. The examiner concluded there was no diagnosis of a bilateral knee 
condition because there was no evident pathology, other than the complaint of frequent knee 
pain, to diagnose. The VA coded right knee and left knee pain separately as 5260, non-service 
connected based on the C&P examination. The last STR entry mentioning the knees was 27 July 
2001, 6 months prior to separation, and noted that the CI complained that “bilateral knee pain 
swells up slightly after walking.” The MEB NARSUM on 23 August 2001, 4 months prior to 
separation, notes the CI complained of “constant bilateral knee with swelling and popping 
intermittently,” pain with walking or standing greater than 10 minutes and stiffness. The 
physical exam does not specifically reference a knee exam but indicates normal motor strength 
in all lower extremity muscles. The commander’s letter noted the CI to be performing duties 
within his MOS except for strenuous activities or field duties. The Board considered whether 
the right and left knee conditions, when considered alone and separate from the LBP condition, 
were unfitting for continued military service. The Board noted the normal examinations and 
imaging results and agreed there was not sufficient evidence to support the presence of a knee 
condition that would be considered unfitting for continued military service. The Board also 
noted that the C&P examination which was a complete examination and most proximate to 
separation, and consistent with prior examinations, supported a 0% rating for each knee which 
provided no benefit to the CI. After due deliberation in consideration of the totality of the 
evidence, the Board concluded that the evidence supported a conclusion that the bilateral knee 
condition was not separately unfitting and therefore could not be recommended for additional 
disability rating. 

 

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. As discussed above, PEB 
reliance on the USAPDA pain policy for rating low back and knee pain was operant in this case 
and the condition was adjudicated independently of that policy by the Board. In the matter of 
the chronic LBP condition, the Board unanimously concluded a determination of separately 
unfit with a disability rating of 20%, coded 5293 IAW VASRD §4.71a was appropriate. In the 
matter of the bilateral knee pain condition, the Board unanimously concluded a determination 
of not separately unfit was supported by totality of the evidence. Therefore the resulting 
combined rating would provide no benefit to the CI and no change to the combined PEB rating 
decision is warranted. 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 

Chronic Pain – Low Back w/ Rt Radicular Symptoms due to L4-5, 
L5-S1 Herniated Disks & Both Knees 

5099-5003 

20% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120607, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 XXXXXXXXXXXXXXXX, 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 
XXXXXXXXXXXXXXXXXXXXX, AR20130004074 (PD201200994) 

 

 

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 XXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)