RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
SEPARATION DATE: 20030801
NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY
CASE NUMBER: PD1200489
BOARD DATE: 20130109
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty SGT/E‐5 (52C/Utilities Equipment Repairer), medically
separated for lumbosacral strain with left sciatic dysfunction. The CI first noted low back pain
(LBP) in 1997 after lifting heavy gas cylinders. He was found to have a herniated nucleus
pulposus (HNP) associated with left sciatic dysfunction. The CI did not improve adequately 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 E2 profile
and referred for a Medical Evaluation Board (MEB). The MEB forwarded lumbar spine,
herniated disc pulposus, to the Physical Evaluation Board (PEB) for adjudication. Adjustment
disorder, vision defect, intermittent retropatellar pain syndrome (RPPS) of the left knee, mild
asymptomatic pes planus, mild (bilateral) high frequency hearing loss (HFHL) and occasional
heartburn, identified in the rating chart below, were forwarded by the MEB as conditions
meeting retention standards. The PEB adjudicated the lumbosacral strain and left sciatic
dysfunction conditions as unfitting, rated 10% each, with 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 20% disability rating.
CI CONTENTION: “Conditions at time of discharge have since then developed into further
medical conditions.” The CI made no specific contention in his 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. 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 20030627
VA (<1 Mo. Pre‐Separation) – All Effective Date 20030802
Condition
Lumbosacral strain
L sciatic dysfunction
Adj disorder
RPPS L knee
Heartburn
Mild Bil HFHL
Vision defect
Mild asy pes planus
Code
5293 5299‐5295
5293‐8620
Rating
10%
10%
Not Unfitting
Not Unfitting
Not Unfitting
Not Unfitting
Not Unfitting
Not Unfitting
↓No Addi(cid:415)onal MEB/PEB Entries↓
Combined: 20%
Condition
HNP lumbar
Left sciatic dysfunction
Adjustment disorder
L knee, RPPS
Heartburn
NO VA ENTRY
NO VA ENTRY
NO VA ENTRY
R shoulder subacromial bursitis
L shoulder subacromial bursitis
Code
5293‐5292
5293‐8620
9440
5099‐5014
7399‐7319
5019
5019
0% X 4 / Not Service‐Connected x 1
Combined: 50%
Rating
20%
10%
0%
10%
NSC
10%
10%
Exam
20030718
20030718
STR
20030718
20030718
20030718
20030718
20030718
20030718
ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit
and vital fighting force. 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 DES
has neither the role nor the authority to compensate members for anticipated future severity
or potential complications of conditions resulting in medical separation nor for conditions
determined to be service‐connected by the Department of Veterans Affairs (DVA) but not
determined to be unfitting by the PEB. However the DVA, operating under a different set of
laws (Title 38, United States Code), is empowered to compensate all 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. 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 VASRD standards, based on severity at the time of
separation.
Lumbosacral strain and left sciatic dysfunction condition. The first record in evidence for LBP
was in late October 1999 when the CI presented with a 3 week history of pain after repetitive
lifting. He was referred to physical therapy (PT) where normal range‐of‐motion (ROM) and gait
were noted although his symptoms increased with ROM. He was treated with PT and
medications, but had recurrent symptoms over the next year. On 12 September 2000, he was
found to have a left lateral disc protrusion at L5S1 with left foraminal stenosis on magnetic
resonance imaging (MRI) examination. He was seen in orthopedics and given duty limitations
and referred back to PT. He continued conservative management, but had persistent pain and
was referred to Physical Medicine and Rehabilitation (PMR) on 2 April 2001. The neurological
examination and ROM were normal. He was referred to an MOS Medical Retention Board
(MMRB) and retention with duty limitations recommended. On 25 February 2003, an
orthopedist noted a normal gait and neurological examination with a positive test for nerve
root irritation and tenderness in the lumbar region. X‐rays were normal. He was issued a
permanent L3 profile and referred to MEB. On 11 April 2003, he was placed on quarters for 72
hours; this is the only record of quarters found in evidence. He was seen again in orthopedics
on 17 April 2003 and gave a history of LBP radiating to both calves. An MRI was repeated on
30 April 2003 and showed left L5S1 disc protrusion with mild lateral recess narrowing adjacent
to the left S1 nerve root and disc bulging at L3‐4 and L4‐5. At the MEB examination on 22 April
2003, the CI reported numbness and tingling in both legs and that the LBP radiated to both legs.
On examination, he had tenderness at the lumbo‐sacral junction without spasm and slightly
reduced flexion, extension as well as left lateral bend and rotation. Testing for nerve root
irritation was negative. One non‐organic sign of pain was present. Mild weakness of left ankle
dorsiflexion was noted as was diminished sensation in a S1 distribution. At an orthopedic
evaluation on 28 May 2003, obtained for the MEB, the CI reported progressive LBP since 1999
which had been treated with epidurals, PT and other conservative management without relief
of his pain. On examination, he was found to have spasm and tenderness in the lower lumbar
spine area with slight instability and a slight decrease in ROM. Testing for nerve root irritation
was slightly positive on the right. Strength and sensation were grossly normal. Reflexes were
symmetric. The narrative summary (NARSUM) dictated on 5 June 2003, 2 months prior to
separation. It noted the above and that the CI could not run, bend, twist, lift heavy objects or
stand over 30 minutes without aggravation of his pain. He was also limited to sitting no more
than an hour and walking no more than 40 minutes. It cited the both the above examinations
for objective findings. It noted that the ROM was slightly reduced in flexion, extension and left
rotation and side bend. At the VA Compensation and Pension (C&P) examination on 18 July
2003, 2 weeks prior to separation, the CI reported a lot of pain if he sat in one place over 15
minutes or drove over 30 minutes and a past history of foot drop on the left. Gait and posture
were noted to be normal without foot drop although with reversal of normal lumbar lordosis.
Episodic spasms were noted. The ROM was reduced to 70 degrees in flexion and another ten
degrees after repetition due to spasms and pain. A radiculitis at L5S1 was noted. Provocative
2 PD1200489
testing for nerve root irritation was positive on the left at 70 degrees. Some weakness at 4/5
was noted for dorsiflexion of the left great toe. X‐rays were normal.
The Board directs attention to its rating recommendation based on the above evidence. The
PEB and VA both rated the left sciatic dysfunction at 10%, coding it 5293‐8620, for
intervertebral disc syndrome and sciatic neuritis. The Board noted that both the MEB and C&P
examiners noted slight weakness of left ankle dorsiflexion, but that the orthopedist did not.
The C&P examiner specifically noted the gait to be normal without foot drop. This supports no
more than a mild disability. 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 left sciatic dysfunction condition. The
Board then considered the rating for the L5S1 HNP. The PEB coded the condition as 5293 and
5299‐5295, analogous to lumbosacral strain, and rated it 10%. The VA coded it 5293 and 5292,
limitation of motion, but rated it at 20% for moderate limitation of motion. The Board noted
that the ROM seen on the C&P examination was decreased from that seen on the two MEB
examinations, both of which showed only a slight decrease. The Board considered that the C&P
examination was more proximate to separation, but that the orthopedic examination was by a
more experienced examiner and only one month earlier and supported by the other MEB
examination. It was therefore assigned a higher probative value. 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 HNP 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 HNP and left sciatica conditions and IAW VASRD §4.71a
and 4.124, 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:
VASRD CODE
5293‐5299‐5295
5293 8620
COMBINED
RATING
10%
10%
20%
UNFITTING CONDITION
Herniated Disc Pulposus L5/S1 with some Left Sciatica
Left Sciatic Dysfunction
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20120604, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record
XXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
3 PD1200489
SFMR‐RB
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD‐ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202‐3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for
XXXXXXXXXXXXXXXXXX, AR20130000823 (PD201200489)
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
XXXXXXXXXXXX
Deputy Assistant Secretary
(Army Review Boards)
CF:
( ) DoD PDBR
( ) DVA
4 PD1200489
AF | PDBR | CY2012 | PD2012-00032
Lower Back Condition . The Board considered whether the PEB removal of an unfitting sciatica was deliberate and if additional permanent rating could be recommended under a peripheral nerve code, as conferred by the FPEB for TDRL entry, for the sciatic radiculopathy at separation. The Board concluded therefore that the left sciatic radiculopathy condition could not be recommended for additional disability rating.
AF | PDBR | CY2011 | PD2011-00707
The PEB and VA chose the same coding options for the condition, and based their rating recommendations on the 2002 VASRD coding and rating standards for the spine which were in effect at the time of CI’s separation. The PEB assigned a 10% rating coded 5293 (IDS) for mild pain with no objective painful motion. The challenge before the Board was to carefully review the C&P exam and the service treatment record (STR) for evidence of a disability meeting 40% rating criteria under the old spine...
AF | PDBR | CY2011 | PD2011-00469
The Board evaluates VA evidence proximal to separation in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness decisions and rating determinations for disability at the time of separation. Under these rating criteria, the CI’s condition could be considered either mild or moderate, recurring attacks. With the ROM limitations noted on the VA C&P examination, the CI’s limitation of motion could be considered as either slight or moderate.
AF | PDBR | CY2012 | PD2012 01790
[The CI] suffers from back pain. Additionally, under the current general rating formula for diseases and injuries of the spine, which uses ROM measurements for rating, the CI’s back pain would also be rated at 10% based on the ROM measurements documented in the NARSUM. Since no evidence of functional impairment exists in this case, the Board would not have supported a recommendation for additional rating based on peripheral nerve impairment (as opposed to the PEB’s adjudication).
AF | PDBR | CY2012 | PD-2012-00406
The MEB determined that the herniated disc in the L4‐L5 region (the Board noted that it was actually in the L5S1 region) and chronic LBP were medically unacceptable and forwarded the two conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the chronic LBP with (an) L5S1 herniated disc conditions as unfitting, rated 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). (2) is limited to those conditions which were determined by...
AF | PDBR | CY2012 | PD-2012-01020
Post-Separation) All Effective Date 20020906 Condition Code Rating Condition Code Rating Exam Chronic Low Back Pain w/out Neurologic Abnormality 5299-5295 10% Lower Back Condition with Bulging Disc at L4/L5 and Radiculopathy 5293 20% 20021010 .No Additional MEB/PEB Entries. The 2002 Veterans Administration Schedule for Rating Disabilities (VASRD) coding and rating standards for the spine, which were in effect at the time of separation, were changed in late September 2002 regarding...
AF | PDBR | CY2012 | PD2012 00808
The MEB forwarded chronic back pain and chronic neck pain as medically unacceptablefor Physical Evaluation Board (PEB) adjudication IAW AR 40-501.The PEB adjudicated the “chronic pain, neck and LBP, without neurologic abnormality” as unfitting, rated together as 10% with application of the US Army Physical Disability Agency (USAPDA) pain policy. In the matter of the “unbundled” chronic neck pain condition, the Board unanimously agrees it was not separately unfitting and that it cannot...
AF | PDBR | CY2013 | PD-2013-02301
The VA increased their radiculopathy rating, but maintained the 40% back rating until a subsequent exam in 2012 led to a decreased spine rating of 20%. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation: XXXXXXXXXXXXXXX President Physical Disability Board of Review
AF | PDBR | CY2011 | PD2011-00952
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 40% for the chronic back pain condition coded as 5292 lumbar spine degenerative disc disease. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay. Providing...
AF | PDBR | CY2013 | PD-2013-01222
The orthopedic surgeon noted that X-rays of the lumbosacral spine and the sacroiliac joints were normal. On examination, recorded on form DD Form 2808, the extremity examination only noted the sacroiliac joint pain on the right and no abnormality of the knee was recorded.There was no VA C&P examination proximate to separation (the first after separation examination was 8 September 2004, 17 months after separation).The Board first considered whether the right knee pain was unfitting when...