RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200062 SEPARATION DATE: 20090621 

BOARD DATE: 20130314 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a National Guard SGT/E-5 (13F/Fire Support Specialist), medically 
separated for intervertebral disc syndrome. The CI developed back pain after a humvee 
accident while deployed in Iraq in June 2005. Despite physical therapy (PT), pain medications, 
epidural steroid injections (ESI), chiropractic care, transcutaneous electrical nerve stimulation 
(TENS) unit, and a facet injection, the CI failed 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 chronic low 
back pain (LBP) secondary to degenerative disc disease (DDD) and herniated disc at L5-S1 
condition on DA Form 3947 as medically unacceptable IAW AR 40-501. The MEB also identified 
and forwarded headaches, bipolar disorder, chronic posttraumatic stress disorder (PTSD), 
tinnitus, right shoulder pain, alcohol dependence in remission, hypertension (HTN), and 
hyperlipidemia as medically acceptable to the Physical Evaluation Board (PEB). The PEB 
adjudicated the intervertebral disc syndrome L4-5 with facet arthrosis but no significant canal 
or neural foraminal stenosis condition as unfitting rated 10% with likely application of the 
Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were 
determined to be not unfitting. The CI made no appeals, and was medically separated with a 
10% disability rating. 

 

 

CI CONTENTION: “The board listed my bipolar, PTSD and Sleep problems as medically 
acceptable as well as tinnitus and cluster headaches.” 

 

 

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 conditions bipolar disorder, chronic 
PTSD, tinnitus, and headaches as requested for consideration meet the criteria prescribed in 
DoDI 6040.44 for Board purview and are addressed below, in addition to a review of the ratings 
for the unfitting intervertebral disc syndrome condition. 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 20090323 

VA 4 Mos Post-Separation) – All Effective Date 20090622 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Intervertebral Disc Syndrome 

5243 

10% 

Lumbar Disk Disease at L4-L5 and L5-S1 

5243 

10% 

20091015 

Headaches 

Not Unfitting 

Cluster Headache 

8100 

10% 

20091002 

Bipolar Disorder 

Not Unfitting 

PTSD with History of Bipolar Disorder, 
Anxiety Disorder, Depression, and 
Insomnia 

9411 

30%* 

20091015 

Chronic PTSD 

Not Unfitting 

Tinnitus 

Not Unfitting 

Tinnitus 

6260 

10% 

20091015 

Right Shoulder Pain 

Not Unfitting 

NO VA ENTRY 

Hypertension 

Not Unfitting 

Essential Hypertension 

7101 

0% 

20091015 

Hyperlipidemia 

Not Unfitting 

NSC 

Alcohol Dependence 

Not a Disability 

NO VA ENTRY 

.No Additional MEB/PEB Entries. 

0% X 2 / Not Service-Connected x 2 Others 

20091015 

Combined: 10% 

Combined: 50% 



*PTSD increased to 70% effective 20110118 (Combined 80%) 

 

 

ANALYSIS SUMMARY: The Board notes the current VA ratings listed by the CI for all of his 
service-connected conditions, but must emphasize that its recommendations are premised on 
severity at the time of separation. The VA ratings which it considers in that regard are those 
rendered most proximate to separation. The Disability Evaluation System has neither the role 
nor the authority to compensate members for anticipated future severity or potential 
complications of conditions resulting in medical separation. That role and authority is granted 
by Congress to the Department of Veterans Affairs. 

 

Intervertebral Disc Syndrome Condition. There were 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 

PT ~4 Mo. Pre-Sep 

MEB ~4.5 Mo. Pre-Sep 

VA C&P ~3.90 Mo. Post-Sep 

Flexion (90° Normal) 

70°* 

80° 

80° 

Ext (0-30) 

 

15° 

30° 

R Lat Flex (0-30) 

25° 

30° 

L Lat Flex 0-30) 

20° 

30° 

R Rotation (0-30) 

30° 

25° 

L Rotation (0-30) 

30° 

20° 

Combined (240°) 

200° 

215° 

Comment 

 

*Limited by pain in back 
progressing to left buttock; 
hypomobility with lumbar 
Spring testing; straight leg 
raise(SLR) + at 45° on left; 
Tender to palpation (TTP) 
laterally on left-reproduces 
radiating buttock pain; 
sensation intact to light touch 
bilateral lower extremities 

Decreased ROM due to pain; 
no change in ROM with 
repetition; gait and stance 
normal; mild TTP lumbar 
paraspinal muscles; no spasm 
or guarding; positive SLR on 
left, negative on right; negative 
Waddell’s; motor 5/5 bilateral 
lower extremities; sensation 
intact; reflexes normal 

Painful motion with flexion, 
extension, and lateral 
flexion but not with 
rotation; no additional 
limitation with repetition; 
barely perceptible antalgic 
gait; moves stiffly; 

§4.71a Rating 

10% 

10% 

10% 



 

The CI initially injured his low back while moving a refrigerator in October 1995 however after 
medication and exercise the pain resolved. In October 2005, the CI injured his back in a 
humvee accident in Iraq and continued to have chronic back pain afterwards. A lumbar spine X-
ray approximately a year after the accident was negative; however, a lumbosacral spine 
magnetic resonance imaging (MRI) exam performed at the same time revealed an L5-S1 central 
disc herniation and L4-5 mild facet hypertrophy. The CI continued to have low back pain (LBP) 
and a repeat MRI approximately 2 years later demonstrated a new L4-5 left foraminal disc 
herniation and an unchanged biforaminal disc herniations at L5-S1. It also showed bilateral 


degenerative facet changes at L3-5 and mild loss of disc height at L5-S1. An orthopedics 
evaluation at that time showed a normal motor exam and reflexes. A standing anterior 
posterior lateral lumbar spine X-ray was negative. The CI continued with PT and chiropractic 
care. A third MRI approximately 4 months later documented a new small disc bulge at L3-4 
without central canal or foraminal stenosis. The L4-5 disc bulge was now accompanied by a 
mild to moderate left inferior neuroforaminal narrowing and the L5-S1 disc bulge was central 
with mild bilateral lateral recess narrowing but no neuroforaminal or central canal stenosis. 
This study also showed continuing mild disc disease and facet arthrosis. An ESI brought relief 
for a week. The CI was placed on a permanent L3 Profile for chronic LBP due to DDD and 
herniated disc L5-S1. The commander’s letter noted that the CI was unable to perform his 
duties due to his LBP and had problems standing for periods of time. The MEB narrative 
summary (NARSUM) examination approximately 4 months prior to separation indicated 
increased pain with most physical activity, prolonged sitting or standing without shifting 
position, and an inability to wear interceptor body armor (IBA), battle gear, lifting or carrying 
weight greater than ten pounds. The MEB NARSUM physical exam findings are summarized in 
the chart above. The VA Compensation and Pension (C&P) examination approximately 4 
months after separation, documented chronic constant LBP that varied in severity with 
increased levels of activity. The examiner further documented flare-ups a “couple of times per 
week” which required relief by TENS unit, ice pack, medications and rest and three episodes of 
weeklong prescribed bed rest periods. The C&P physical exam findings are summarized in the 
chart above. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB and the VA chose the same disability code 5243 intervertebral disc syndrome and both 
rated at 10%. The General Rating Formula for Diseases and Injuries of the Spine considers the 
CI’s pain symptoms “With or without symptoms such as pain (whether or not it radiates), 
stiffness or aching in the area of the spine affected by residuals of injury or disease.” All exams 
proximate to separation met the 10% rating criteria for forward flexion of the thoracolumbar 
spine greater than 60 degrees but not greater than 85 degrees. 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 intervertebral disc syndrome condition. 

 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
were headaches, bipolar disorder, chronic PTSD, and tinnitus. 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, the only condition profiled was the intervertebral disc syndrome; none were 
implicated in the commander’s statement; and, none were judged to fail retention standards. 
Treatment records document relief of headaches with medication. The CI was in treatment for 
bipolar disorder and PTSD but there is no evidence of any negative occupational or social 
effects. While no military psychiatric narrative summary was prepared for the PEB, the C&P 
examination completed approximately 4 months after separation noted a Global Assessment of 
Functioning (GAF) of 78. None of these conditions led to functional limitations that would 
prevent the CI from performing the tasks required of his MOS. 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 headaches, bipolar disorder, chronic PTSD and tinnitus 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. In the matter of the intervertebral disc syndrome condition and IAW VASRD 
§4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter 
of the contended headaches, bipolar disorder, chronic PTSD and tinnitus 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, therefore, recommends that there be no re-characterization 
of the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Intervertebral Disc Syndrome 

5243 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120118, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxxxxxxx, AR20130007443 (PD201200062) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)