RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200564 SEPARATION DATE: 20030807 

BOARD DATE: 20130226 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a Reserve SPC/E-4 (92A/Automated Logistical Specialist), medically 
separated for chronic low back pain (LBP). The CI injured her back in 1990 during her initial 
enlistment. She remained in the Individual Ready Reserves until 1997 when she returned to 
drill status. Her pain continued and she underwent an L5-S1 Discectomy in November of 2000. 
She remained under profile until she was mobilized in January of 2003. Her chronic LBP 
condition did not improve adequately and she was unable to meet the physical requirements of 
her MOS or satisfy physical fitness standards. She was issued a L4 Profile and referred for a 
Medical Evaluation Board (MEB). Left ankle pain and migraine headache conditions, identified 
in the rating chart below, were also identified and forwarded by the MEB. The Physical 
Evaluation Board (PEB) adjudicated the chronic LBP condition as unfitting, rated 10% with 
application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD) under the old spine 
rules effective 1 July 2003. Although the remaining left ankle pain and migraine headache 
conditions were listed as existing prior to service (EPTS), they were reviewed by the PEB and 
determined to be not unfitting. The CI made no appeals, and was medically separated with a 
10% disability rating. 

 

 

CI CONTENTION: “I initially injured my back during basic training. I now am on SSD for lower 
back and mental health. I have filed a claim for PTSD which is pending”. 

 

 

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 rated chronic LBP condition requested 
for consideration is the only condition that meets the criteria prescribed in DoDI 6040.44 for 
Board purview; and, is addressed below. The other requested condition mental 
health/posttraumatic stress disorder (PTSD) and any peripheral nerve or radiculopathy 
condition 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 PEB – Dated 20030702 

VA (1 Mos. Post-Separation) – All Effective Date 20030808 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Low Back Pain 

5299-5295 

10% 

Lumbar Spine DDD 

5243 

NSC 

20030925 

Left Ankle Pain, 
Posttraumatic Arthritis 

Not Unfitting 

Left Ankle, S/P ORIF 

5271 

NSC 

20030925 

Migraine Headaches 

Not Unfitting 

Migraine Headaches 

8100 

NSC 

20030925 

.No Additional MEB/PEB Entries. 

Chronic Right Rhomboid 
Spasm 

5201 

0% 

20030925 

Combined: 10% 

Combined: 0%* 



*VARD dated 20040812 (~1 year post-separation) adjudicated condition(s) as NSC (Not Service Connected, Not Incurred/Caused 
by Service). No change in combined rating until 2011 

 

 

ANALYSIS SUMMARY: The 2002 Veterans’ Administration Schedule for Rating Disabilities 
(VASRD) coding and rating standards for the spine were changed to an interim §4.71a rating 
standard effective 23 September 2002 and were in effect at the time of the CI’s separation. 
Seven weeks after her separation, the current VASRD rating standards came into effect on 26 
September 2003, including a plate for normal thoracolumbar range-of-motion (ROM), and were 
used by the VA to adjudicate her case. The 2002 standards for rating are based on the rater’s 
interpretation and opinion of ROM impairment regarding degree of severity, whereas the 
current standards specify rating thresholds in degrees of ROM impairment measured with an 
instrument and following a table. 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: 

With incapacitating episodes having a total duration 

 of at least six weeks during the past 12 months .................................................................................60 

With incapacitating episodes having a total duration of at least four weeks but less than six 

 weeks during the past 12 months .......................................................................................................40 

With incapacitating episodes having a total duration of at least two weeks but less than four 

 weeks during the past 12 months .......................................................................................................20 

With incapacitating episodes having a total duration of at least one week but less than two 

 weeks during the past 12 months .......................................................................................................10 

Note (1): For purposes of evaluations under 5293, an incapacitating episode is a period of acute signs and symptoms 
due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 

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 osteo-arthritic 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 

 

Chronic Low Back Pain Condition. The narrative summary (NARSUM) notes the CI had LBP that 
was exacerbated with activity, impact on duty was significant and the CI was unable to perform 
any vigorous activities. She was unable to pass an Army Physical Fitness Test (APFT) to include 
the alternative aerobic event of walking. The CI could not carry any weight on her back as this 
caused excruciating pain. She stated that any deep knee bending or forward-flexion with 
repetition caused her to be unable to walk the following day. Her Commander’s performance 


statement indicated profile restrictions and “lack in physical ability” impacting duty 
performance. 

 

The back evaluations in evidence, with documentation of additional ratable criteria, which the 
Board weighed in arriving at its rating recommendation, are summarized in the chart below. 

 

Lumbar ROM* 

Neurologist ~4 Mo. Pre-Sep 

NARSUM ~2 Mo. Pre-Sep 

VA C&P ~1 Mo. Post-Sep 

Flexion 

 

70° 

30° 

Ext 

 

5-10° 

10° 

R Lat Flex 

 

30° 

10° 

L Lat Flex 

 

30° 

10° 

R Rotation 

 

30° 

10° 

L Rotation 

 

30° 

10° 

Combined 

 

---° 

80° 

Comment: 

Antalgic gait; foot drop 
Right LE radicular 

No tenderness to 
palpation, normal 
strength, normal reflexes 

Once a month pain 10/10, 3-5 
days “in bed”, R leg radicular 
symptoms, no spasm or change 
in curvature 

§4.71a Rating 

20% ~guard/gait 

10% 

20%-40% (VA NSC) 



*Under the old spine rules the spine was separated into Lumbar and Thoracic segments and the current Plate V ROM normal 
values are for combined thoracolumbar ROM. The old spine rules normal values were what the examiner stated. Absent stated 
values, the references of the day ~2002 varied from forward flexion of 60° to 90° depending on measurement techniques, etc. 

 

At the MEB exam, 2 months prior to separation, the CI reported no specific complaints except 
those comments on the DD Form 2807, that she was on Percocet, morphine (narcotic pain 
medications) and methacarbamol as need for her back, and “severe lower back down right leg 
pain limited range of motion.” The examiner also documented that she gave a history that her 
“right leg will go out due to sciatic nerve damage.” 

 

The MEB physical examiner noted that the low back exam was non-tender, with ROM as 
summarized above, with decreased sensation over the dorsal aspect of the left foot (normal 
right foot), normal reflexes, normal muscle strength and normal hip flexion. Four months prior 
to separation the neurologist consultant to the MEB stated the CI had 4-/5 strength in the right 
hip flexor, right foot dorsi-flexor and right foot external rotators.” The neurologist noted 
positive right straight leg raising, with deep tendon reflexes reduced to ¼ in the right patellar, 
trace out of 4 in the right Achilles, with antalgic gait with right hip circumduction to compensate 
for a subtle foot drop. Furthermore, the neurologist stated the CI was not able to heel walk on 
the right, but toe walk was normal. Stress gait was not tolerated secondary to pain, and the 
neurologist recorded “patient with compromised ability to conduct tandem gait secondary to 
low back pain and foot drop.” The Board acknowledged a chiropractic note within two weeks 
after the MEB in the record, but found the name on the note did not match the CI’s name and 
excluded the evidence. At the VA Compensation and Pension (C&P) exam a month after 
separation, the CI reported that she continued to have daily pain, stated to be 3 on a scale of 0-
10, 10 being the worst pain. Furthermore, the examiner recorded history that the CI stated “at 
last (least) once a month the pain will go up into the ten-range” and “with this she has (is) 
having to miss work because she is unable to get out of bed. These episodes can last 3 to 5 
days. She states that she is incapacitated with these episodes. She has not been prescribed 
bed rest, however, by a physician. Lifting is limited to essentially none. She has radicular 
symptoms going down into the right lower extremity intermittently. With the flare-ups her 
range of motion decreases by 100%. She is immobile. She uses a cane daily in the mornings. 
During the day she uses a cane only when she is having a flare up.” The VA examiner noted 
“gait is normal”, and the above ROM chart entries. The VA examiner stated “all this is done 
with significant discomfort. Repetitive range of motion testing does not reduce the range of 


motion, however it does increase the pain.” Motor and sensory exam was normal in the right 
leg, and reflexes were normal. 

 

The Board directed attention to its rating recommendation based on the above evidence. The 
PEB coded analogously to 5295, lumbosacral strain, and rated 10% for characteristic pain on 
motion. The VA coded 5243, intervertebral disc syndrome, and deferred rating awaiting the CI 
to supply new medical evidence. The Board examined the ROMs, noting that the Army and the 
VA were each using different versions of the VASRD in effect at their respective evaluations. It 
is obvious that there is a clear disparity between the MEB and VA examinations, with very 
significant implications regarding the Board's rating recommendation. The Board thus carefully 
deliberated the probative value assignment to these conflicting evaluations, and carefully 
reviewed the service file for corroborating evidence from the period preceding separation. 
Although the CI complained of incapacitation, there was no documentation of physician 
prescribed bed-rest for coding under 5293 (Intervertebral disc syndrome), nor comparative 
complaints or entries in the pre-separation record. Without evidence of interval injury the 
Board could not resolve the decreased ROM in the more proximal VA exam, found more 
probative value in the MEB exam, and noted the neurologist’s findings. The Board considered 
other coding possibilities, but could not find a coding that fit the disability better than the 
choice of the PEB. 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 chronic low back pain 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. In the matter of the 
chronic LBP condition 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 

Chronic Low Back Pain Condition 

5299-5295 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120530, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxx, AR20130006863 (PD201200564) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)