RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX CASE: PD1201954 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130314 

SEPARATION DATE: 20031215 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (97E/Intelligence-Trainee) medically 
separated for cervical and lumbar spine conditions (C-spine and L-spine conditions). She 
experienced an atraumatic onset of radiating neck pain and low back pain (LBP) in 2002. She 
was diagnosed with cervical and lumbar disc disease; and, surgical options were ultimately 
deferred. She did not respond adequately to conservative measures for either spine condition 
to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy 
physical fitness standards. She was issued a permanent U4/L3 profile and referred for a 
Medical Evaluation Board (MEB). The cervical and lumbar spine conditions, characterized as 
“cervical herniated nucleus pulposus” (HNP) and “chronic low back pain,” were forwarded to 
the Physical Evaluation Board (PEB) as failing to meet retention standards IAW AR 40-501. The 
PEB adjudicated both spine conditions as unfitting, rated 10% each, with likely application of 
the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was 
medically separated with a 20% combined disability rating. 

 

 

CI CONTENTION: “Physical Therapy is outsourced from VA hospital and only allowed certain # 
of visits for therapy; example – 12 which is not sufficient. A long process is typical to take place 
IOT see the physician (primary) then get referral to Physical Therapy, then an Orthopedic 
physician examines me to determine if I need physical therapy treatments. These treatments 
have been pre-determined sessions since Hurricane Katrina and I then have out of pocket 
expense to exceed disability amount.” 

 

 

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, 
paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for 
continued military service and those conditions identified but not determined to be unfitting by 
the PEB when specifically requested by the CI. The ratings for the unfitting lumbar spine and 
cervical spine conditions are 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 respective Army Board for Correction of Military Records. The 
Board takes note of the CI’s assertions regarding her post-separation medical treatment; but, 
must clarify that its jurisdiction resides solely with the assessment of the fairness of disability 
ratings. Redress for the specific contentions elaborated in the application must be sought from 
the Department of Veterans Affairs (DAV) and/or through judiciary channels. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20030930 

VA - (2 Mos. Post-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

HNP, C6/C7 

5243 

10% 

HNP, C6/C7 

5237 

10% 

20040209 

Chronic Low Back Pain 

5237 

10% 

Lumbar Disc Disease at L3-L4 

5242 

10% 

20040209 

No Additional MEB/PEB Entries 

Other x 2 

20040918 

Combined: 20% 

Combined: 20% 




ANALYSIS SUMMARY: 

 

Cervical and Lumbar Spine Condition: The CI had an insidious onset of neck and LBP with 
radiation to the left arm and left hip, respectively. She had a motor vehicle accident prior to 
entry into service with no history or reported trauma since then. She sought care in November 
2002 with severe neck and low back pain with an intensity of anywhere from a 5-10 of 10 which 
increased while sitting in class. Multiple conservative modalities to include: physical therapy, 
nonsteroidal anti-inflammatory medications (NSAIDs), and muscle relaxers provided minimum 
relief. She underwent two separate neurosurgery evaluations whose exams corroborated the 
magnetic resonance imaging (MRI) findings of disc disease HNP at the C5-6 and C6-7 levels with 
radiculopathy and degenerative disc disease (DDD) at L3-4 level without radiculopathy. The 
neurosurgeon offered more invasive treatment modalities to include, pain management, trigger 
point injections, epidural injections for the lumbar spine and finally surgery for the C-spine. She 
opted for the more aggressive nonsurgical approaches and subsequently was referred for a 
MEB 6 months after her initial evaluation. The permanent profile limitations included no 
running, jumping or marching, no sit-ups or push-ups, no physical fitness testing and unable to 
carry a rucksack. She was only allowed to lift 20 pounds and walk, bicycle and swim at her own 
pace and distance. 

 

At the MEB exam, the CI reported pain at the base of the neck and between the shoulder 
blades, at the lower back and tailbone with radiation as noted above with associated headaches 
and sleep disturbances. The pain worsened with prolonged sitting and prolonged standing and 
was relieved with stretching, heat, traction, and sometimes physical activity. She reported 
taking the muscle relaxant Skelaxin. She additionally reported the following limitations: able to 
run 10 minutes on a treadmill, write for 15 minutes, sit in a vehicle for up to 40 minutes and 
stand for 10-15 minutes. The MEB physical exam of the C-spine demonstrated full active range-
of-motion (ROM) with pain on rotation and extension, negative Spurling’s test (provocative test 
for disc disease), 5/5 strength in all extremities however there was slight weakness of the left 
biceps compared to the right and no pathologic reflexes. The plain X-rays of the C-spine 
revealed slight loss of cervical lordosis and the MRI revealed HNP at C5-6 and C6-7. The exam 
of the L-spine revealed full lumbar ROM, tenderness to palpation of paraspinal muscles on the 
left and negative straight leg raising (SLR) bilaterally (provocative sign for disc disease). Plain X-
rays of the L-spine were negative. MRI revealed mild DDD at L3-4 with no focal disc herniation. 
The examiner diagnosed severe cervical thoracic pain with radiation and numbness and to left 
upper extremity, slight left upper extremity weakness of biceps muscle, cervical disc disease at 
C5-6 and C6-7 with C6-7 herniated nucleus pulposus and lumbar disc disease at L3-4 with 
chronic low back pain. At the VA Compensation and Pension (C&P) exam performed 2 months 
after separation, the CI reported getting physical therapy since 2002, and the symptoms were 
much improved since she started. She reported at one time she had numbness and pain in her 
upper extremities, but this was totally resolved and she was currently taking the muscle 
relaxants, Skelaxin, and Tizanidine. The C&P exam demonstrated normal posture and gait, no 
muscle spasm, mild pain on auscultating over her low neck and lower back, full painful range of 
motion of the neck and full ROM of the low back, negative SLR and otherwise normal 
neurologic findings. A neurologic specialty exam demonstrated painful neck flexion, the left 
handgrip slightly weaker but this may be due to her right handedness. The lower extremities 
revealed normal neuromuscular findings, normal gait and stance and able to walk on her heels 
and toes. X-rays of L-spine 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 C-spine condition which did not bear on 
rating; but the Board agreed that the code chosen by the MEB, 5243 (Intervertebral disc 
syndrome), is more representative of the clinical pathology related to the CI’s condition. The 
PEB and the VA achieve the same 10% rating applying the general rating formula for diseases 
and injuries of the spine for the painful motion with flexion IAW VASRD the §4.71a 5243 code 


or with VASRD §4.59 (painful motion). There is no evidence of spasm, guarding, abnormal gait, 
abnormal spinal contour, ankylosis, or incapacitating episodes to justify a higher rating than 
10%. The Board considered the VASRD formula for rating intervertebral disc syndrome based 
on incapacitating episodes and invoked the VASRD definition for incapacitating episodes which 
requires “bed rest prescribed by a physician and treatment by a physician.” There is no such 
evidence to support a higher rating under this formula. The Board considered additional rating 
for peripheral nerve involvement and notes neither the PEB nor the VA rated the objective left 
bicep weakness IAW §4.124a Schedule of ratings–neurological conditions and convulsive 
disorders. Board precedent is that a functional impairment tied to fitness is required to support 
a recommendation for addition of a peripheral nerve rating at separation. The radicular 
component in evidence in this case consisted primarily of pain, which is subsumed under the 
general spine rating formula. There is no objective evidence for functional impairment related 
to the left bicep motor deficit. Therefore, there is no evidence of ratable peripheral nerve 
impairment to justify additional rating. The Board, therefore, does not find reasonable doubt 
favoring a recommendation for additional rating. The Board finally considered the rating 
recommendation for the L-spine condition. The PEB and VA chose different coding options 
which did not bear on rating and both applied the general rating formula for diseases and 
injuries of the spine. The PEB achieved a 10% rating despite the lack of evidence for painful 
motion or limitation of motion; however the Board's recommendation may not produce a 
lower rating than that of the PEB. The VA achieved the same 10% for the painful motion of L-
spine IAW VASRD §4.71a 5242 code (degenerative arthritis of the spine) or with VASRD §4.59. 
There is no evidence of documentation 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 cervical and lumbar spine 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 cervical and lumbar spine conditions and IAW VASRD 
§4.71a, 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 

HNP, C6/C7 

5243 

10% 

Chronic Low Back Pain 

5237 

10% 

COMBINED 

20% 



 

 

 


The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20121202, 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 / XXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXX, AR20130006070 (PD201201954) 

 

 

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 XXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)