RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200805 SEPARATION DATE: 20020322 

BOARD DATE: 20130315 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Soldier, SGT/E-5 (71L/Administrative Specialist), 
medically separated for pain; low back, right wrist, and left foot. The CI was initially seen for his 
back pain in 1997 when he felt a pop with a sharp pain after bending over to pick up his 
children’s toys. He was diagnosed with plantar fasciitis of his left foot and seen by podiatry in 
September 2000. There was no indication of how the wrist pain developed other than it 
recurred intermittently. The CI did not improve adequately with treatment to meet the 
minimal 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 slight constant low back pain (LBP), minimal; frequent right 
wrist pain; and minimal constant left foot pain as medically unacceptable IAW AR 40-501. The 
MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB 
bundled the three MEB conditions and adjudicated the single condition of “pain; low back, right 
wrist, and left foot” as unfitting, rated 10%, with cited application of the US Army Physical 
Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated 
with a 10% disability rating. 

 

 

CI CONTENTION: The CI writes: “Degenerative disc disease, lumbar spine, with muscle spasms; 
left varicocele; diabetes mellitus; carpal tunnel syndrome, right hand.” 

 

 

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 
the unfitting conditions of low back, right wrist, and left foot will be reviewed. The two other 
requested conditions, left varicocele and diabetes mellitus (DM), 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 20011206 

VA (4 Mos. Post-Separation) – All Effective Date 20020323 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Pain; Low Back, Right 
Wrist, and Left Foot 

5099-5003 

10% 

DDD, L-Spine 

5293* 

10% 

20020711 

R Carpal Tunnel Syndrome 

8599-8515 

10% 

20020711 

Plantar Fasciitis, L Foot 

5099-5020 

0% 

20020711 

.No Additional MEB/PEB Entries. 

Left Varicocele 

7599-7529 

20% 

20020711 

Diabetes Mellitus 

7913 

10% 

20020711 

0% X 0 / Not Service-Connected x 1 

20020711 

Combined: 10% 

Combined: 40%* 



*Changed code to 5242 by VARD of 4/27/06 with no change in rating level. Combined increased to 60% in 2006 due to 
neuropathies related to 7913 (DM); 80% in 2008, and 90% in 2010. 


ANALYSIS SUMMARY: The PEB combined the low back, right wrist, and left foot conditions 
under a single disability rating, coded analogously to 5003. Although VASRD §4.71a permits 
combined ratings of two or more joints under 5003, it allows separate ratings for separately 
compensable joints. IAW DoDI 6040.44 the Board must follow suit if the PEB combined 
adjudication is not compliant with the latter stipulation, provided that each ‘unbundled’ 
condition can be reasonably justified as separately unfitting in order to remain eligible for 
service rating. If the members judge that separately ratable conditions are justified by 
performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), 
separate ratings are recommended; with the stipulation that the result may not be lower than 
the overall combined rating from the PEB. The Board’s initial charge in this case was therefore 
directed at determining if the PEB’s combined adjudication was justified in lieu of separate 
ratings. 

 

Pain; Low Back, Right Wrist, and Left Foot Conditions. The CI was right-handed. The narrative 
summary (NARSUM) indicated that the CI had chronic LBP, chronic left foot pain and recurrent 
right wrist pain. He was given conservative treatment for mechanical LBP. He had no bladder 
or bowel dysfunction, no radicular symptoms, no weakness, no paresthesias, and no 
incapacitating episodes. Back pain led to difficulty with push-ups, sit-ups, and flutter kicks. 
Radiographs of the lumbar spine showed partial lumbarization of the S1 segment and was 
considered a normal variant. Medications such as muscle relaxants, nonsteroidal anti-
inflammatory drugs, and narcotics provided mild relief. The CI was also diagnosed with left foot 
plantar fasciitis, evaluated by Podiatry and prescribed pads for his feet due to an increased arch 
of his left foot. The CI was placed on L3 profile for chronic back pain, foot pain and right wrist 
pain with “restricted to no flutter kicks, no sit-ups, no push-ups, and no running. He was able to 
march up to one mile and lift up to 40 pounds as well as able to wear a shoe of comfort for 
both his feet. Podiatry performed steroid injections into his left foot in October of 2000 due to 
the chronic foot pain. His right wrist, left foot, and back pain remain recurrent intermittently. 
He is unable to meet minimal Army standards due to his recurrent condition.” The 
commander’s statement indicated duty interference “due to chronic back injury, is having 
difficulty maintaining standards for weight control. The CI’s back does not prevent him from 
doing his job in a capable manner, however, his debilitating pain and recurring numbness 
requires regular medication … part of the problem preventing him from meeting the Army 
weight control standards.” The SF 88 noted “bending at the waist to touch toes fairly easily … 
positive subjective positive Tinel’s region left wrist … and normal feet.” 

 

VA Compensation and Pension (C&P) exam, 4 months after separation, indicated chronic back 
pain since 1996 with spasm, stiffness and pain; right wrist carpal tunnel syndrome since 1995 
with tingling and numbness of the two middle fingers and thumb, with weakness of the fingers; 
and plantar fasciitis since September 2000 with symptoms of pain, stiffness and swelling. 

 

Low Back Pain. Physical Therapy (PT) treatments and the VA exam (4 months post-separation) 
documented painful motion, and tenderness was documented on most exams. Most treatment 
notes also indicated complaint of radiating pain. Gait was normal. The single exam 
documenting more than slight limited ROM was 6 months prior to separation with both the 
MEB exam (4 months prior to separation) and the VA exam closer to the date of separation and 
indicating full active ROM with either tenderness or pain, and normal lower extremity motor 
and sensory findings. The Board first considered if the low back condition met the above 
criteria for separate rating. The lumbar spine condition history is noted above. It was the 
principle condition noted in the commander’s statement, had multiple temporary profiles, was 
undergoing treatment and was noted on duty restrictions. Members agreed, therefore, that 
the LBP condition was reasonably justified as separately unfitting and that it met VASRD §4.71a 
criteria for separate rating. Accordingly, it should be afforded separate disability rating. The 
Board directs attention to its rating recommendation based on the above evidence. The 2002 
VASRD coding and rating standards for the spine, which must be applied to the Board’s 


recommendation IAW DoDI 6040.44, differ significantly from the current §4.71a general rating 
formula for the spine. The applicable coding options for this case are excerpted below. 

 

5292 Spine, limitation of motion of, lumbar 

Severe ...................................................................................................................................... 40 

Moderate ................................................................................................................................. 20 

Slight ........................................................................................................................................ 10 

 5293 Intervertebral disc syndrome: 

Pronounced; with persistent symptoms compatible with: sciatic neuropathy with 

 characteristic pain and demonstrable muscle spasm, absent ankle jerk, or other 

 neurological findings appropriate to site of diseased disc, little intermittent relief .............. 60 

Severe; recurring attacks, with intermittent relief .................................................................. 40 

Moderate; recurring attacks .................................................................................................... 20 

Mild .......................................................................................................................................... 10 

Postoperative, cured ................................................................................................................. 0 

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 

 

The record supported rating at 10% under 5295 (lumbosacral strain) for characteristic pain on 
motion or at 10% under 5293 (Intervertebral disc syndrome) for mild symptoms. Ideal coding 
would be 5099-5293 at 10%. 

 

Right Wrist. The CI was right hand dominant. The right wrist condition history as noted above 
was chronic since 1995 with the NARSUM indicating right wrist pain was noted to “remain 
recurrent intermittently.” The NARSUM exam indicated subjective numbness/tingling with 
minor decrease ROM (dorsiflexion 70 degrees of 75 degrees and palmar flexion 60 degrees of 
75 degrees); and “decreased bilateral grip strength (>20% difference in trials suspicions of 
suboptimal effort).” The profile listed right wrist pain as part of the L3 profile with U1 noted. 
The CI could carry and fire a rifle and lift up to 40 pounds. The commander’s statement did not 
specify any hand condition, but did reference unspecified recurrent numbness. The VA exam 
indicated full active ROM with normal strength exam and “middle two fingers and thumb 
showed some decreased sensation.” Reflexes were normal and Tinel's and Phalen's signs were 
absent. The VA diagnosis was carpal tunnel syndrome. The Board first considered if the right 
wrist condition met the above criteria for separate rating. The Board adjudged that there was 
no fixed motor weakness of the right hand and that the sensory component of the wrist/hand 
condition did not significantly impact duty performance. Members agreed, therefore, that the 
right wrist condition was not reasonably justified as separately unfitting; and, accordingly, it 
cannot be recommended for separate disability rating. 

 

Left Foot. At the MEB exam, the CI reported recurrent intermittent left foot pain not relieved 
following a steroid injection for chronic pain. The MEB physical exam noted an increased arch 
with medial calcaneal tenderness. There was no pain with lateral compression. Diagnosis was 
left foot pain. The foot condition was part of the CI’s L3 profile, but did not include “wear a 
shoe of comfort” as prior temporary profiles had included. There was no mention of a foot 
condition in the commander’s statement as limiting duty performance; however there may 
have been overlap from the back restrictions to the foot. At the post-separation C&P exam, the 
CI reported symptoms of pain, stiffness and swelling with an exam documenting tenderness of 
the sole of the foot with no objective painful motion. Gait was normal. The final profile 
restriction did not include restriction from military footwear. Although there was a possibility 
that the impairment of the left foot was overshadowed by those of the back condition, there 
was insufficient evidence to indicate that the left foot condition was unfitting. Members 


agreed therefore, that the left foot condition was not reasonably justified as separately 
unfitting; and, accordingly, it cannot be recommended for separate disability rating. 

 

Rating Consideration for Pain; Low Back, Right Wrist, and Left Foot Conditions. The Board 
deliberated if the PEB’s original 10% rating for chronic pain as 5099-5003, absent the separately 
unfitting low back condition, should remain for the not separately unfitting foot and wrist 
conditions. The evidentiary standard was considered to be reasonable doubt, verses 
preponderance of the evidence. The Board considered that absent the low back condition, 
there was insufficient evidence of duty impairment from the combined foot and wrist 
conditions for continuation of the PEB 10% 5099-5003 rating in addition to a 10% rating for the 
back condition. Although ideal coding in this case would be an unfitting low back condition 
coded 5099-5293 at 10% with not unfitting/not compensable right wrist and left foot 
conditions, the PEB rating of 10% under 5099-5003 provides the equivalent rating level and 
there is no benefit to the CI for any coding change. 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’s 10% adjudication for the pain; low 
back, right wrist, and left foot condition(s). 

 

 

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 all conditions was operant in this case and the 
conditions were adjudicated independently of that policy by the Board. In the matter of the 
pain; low back, right wrist, and left foot condition, 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 

Pain; Low Back, Right Wrist, and Left Foot 

5099-5003 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120614, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130007733 (PD201200805) 

 

 

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)