RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201020 SEPARATION DATE: 20020905 

BOARD DATE: 20130130 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SGT/E-5 (77F20/Petroleum Supply Specialist), 
medically separated for chronic low back(LBP) pain without neurologic abnormality or 
documented chronic paravertebral muscle spasms. Her back pain began in March of 2000 
without any traumatic event. It has persisted as a constant dull pain without radiation, 
weakness or numbness. Despite physical therapy (PT), non-steroidal anti-inflammatory drugs 
(NSAIDs) and muscle relaxers the CI could not be adequately rehabilitated to meet the physical 
requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. 
She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The 
MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB 
adjudicated the LBP condition as unfitting, rated 10% with specified application of Department 
of Defense Instruction (DoDI) 1332.39 and AR 635-40. The CI made no appeals, and was 
medically separated with a 10% disability rating. 

 

 

CI CONTENTION: “It should be checked for errors, accuracy & fairness.” 

 

 

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 CIs chronic LBP condition as requested 
for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview; and is 
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 
Army Board for Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20020703 

VA (1 Mos. 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. 

Residuals Scar S/P 
Bunionectomy, 1st Metatarsal Lt 
Foot 

7804 

10% 

20021010 

Bunion 1st Metatarsal Lt Foot 
S/P Bunionectomy, Long Arm 
Chevron 

5299-5280 

10% 

20021010 

Not Service-Connected x 2 

20021010 

Combined: 10% 

Combined: 40% 



VARDs in 2006, 2010 and 2011 continued 5293 rating at 20%. 

 

 

 


ANALYSIS SUMMARY: 

 

Chronic Low Back Pain Condition. 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 criteria for code 5293 
(intervertebral disc syndrome), and then to the current §4.71a rating standards in September 
2003. The applicable 2002 standards in this case for code 5293 included radicular pain rather 
than incapacitating episodes. The older spine ratings were based on range-of-motion (ROM) 
impairment which was subject to the rater’s opinion regarding degree of severity, whereas the 
current standards specify rating thresholds in degrees of ROM impairment. The older spine 
ratings also did not have the general spine rating formula provision of including pain (whether 
or not it radiates). 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 

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 

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 osteoarthritic 

 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 

 

The CI suffered from chronic LBP which began about 30 months prior to separation and was 
treated conservatively. X-rays of the lumbosacral spine were normal. Magnetic resonance 
imaging (MRI) of the LS spine showed a minimal broad based disc bulge with associated central 
protrusion (L5), without significant displacement of the thecal sac, neural foraminal narrowing 
or nerve root impingement evident. Service treatment records (STRs) indicated diagnoses 
during treatment of lumbosacral strain, chronic LBP prior to MRI, but chronic LBP secondary to 
herniated nucleus pulposus (HNP) (herniated disc) after MRI. A pain specialist assessment 
stated “Lumbar radiculopathy” and “positive findings of a bulge on the MRI (L4-L5).” STRs 
contain PT notes that documented some episodes of back pain with muscle spasm, as well as 
acute care visits for back pain for which the CI was prescribed muscle relaxants. The CI had an 
epidural injection for back pain. A neurosurgical opinion did not recommend surgery. A repeat 
MRI was done about a year prior to separation which was unchanged from the first MRI. A 
permanent profile was issued when there was no improvement despite recommended 
treatments of medication, PT, referral to a pain specialist and epidural injection. 

 


At the MEB exam, about 4 months prior to separation, the CI reported a constant, dull LBP with 
radiation and tingling in both lower extremities. The MEB exam noted “the back demonstrates 
full range of motion, flexion and extension”. Other exam findings were no tilt; slow gait, but no 
limp; tenderness to palpation of the lumbar spine; normal strength and sensation in all four 
extremities; and negative straight leg raise (SLR) bilaterally. The narrative summary (NARSUM) 
stated “Further evaluation included…MRIs of the lumbar spine in May 2001 and September 
2001 which failed to show any disk herniation.” MRI impression was “minimal broad-based 
bulge with associated central protrusion at the L5 level.” The NARSUM also noted that there 
was an electromyogram (EMG) (electrophysiological test) performed “without any evidence of 
radiculopathy by exam.” The present condition and functional status noted “Pain is also 
aggravated by intercourse, running, bending, stooping, lifting grocery bags, lifting her 2-year-
old child or rotational motion to her low back.” The diagnosis was chronic LBP and the 
examiner gave a “Pain Rating: Pain according to pain rating scale is constant and moderate.” 

 

At the VA Compensation and Pension (C&P) exam, about a month after separation, the CI 
reported constant LBP with numbness and tingling in her legs, mainly the right leg. The history 
states that “Both of the magnetic resonance imaging scans show a bulging disk at L4-L5.” She 
was not taking any medication. The exam demonstrated normal spinal curvature without 
spasms. The examiner stated “She has knee buckling tenderness to very light palpation of the 
low lumbar region in the midline and to the right.” The lumbosacral spine had extension to 35 
degrees, flexion to 85 degrees, left lateral bending to 35 degrees, and right lateral bending of 30 
degrees, with pain. Muscle strength and deep tendon reflexes (DTRs) were normal and straight 
leg testing (SLR) was negative bilaterally. Sensation was noted as “subjective sense of 
decreased sensation circumferentially in a stocking distribution involving the entire right leg.” 
The examiner noted that the CI had a herniated disc by history with radiculopathy which was 
non-physiologic. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB rated “chronic low back pain without neurologic abnormality or documented chronic 
paravertebral muscle spasms on repeated examinations, with characteristic pain on motion” as 
code 5299-5295 (lumbosacral strain) at 10%. The VA rated lower back condition with bulging 
disc at L4-L5 and radiculopathy as 5293 (intervertebral disc syndrome) at 20%. Based on the 
evidence in the STRs the CI had chronic LBP that had recurrent episodes. At times there was 
muscle spasm noted, at other times there was mild evidence of neurological involvement 
(radiculopathy). At the MEB exam there was constant pain noted. At the VA exam constant 
pain and pain on motion was noted. Neither of these exams noted muscle spasm. The VA 
exam included subjective complaints of paresthesis in the both legs worse on the right. There 
were no fixed peripheral nerve deficits on exam, although there were numerous treatment 
record entries and complaints of radicular pain and paresthesias. The CIs back pain behaved 
clinically like an intervertebral disc syndrome, with chronic back pain with acute exacerbations 
involving muscle spasm and lower extremity paresthesias at times. The Board therefore 
considered rating analogously to 5293 (intervertebral disc syndrome) and deliberated on if the 
record more closely approximated moderate recurring attacks (20%) or mild symptoms (10%). 

 

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), the Board majority recommends that the CIs chronic LBP is appropriately rated as code 
5299-5293 (intervertebral disc syndrome) at 20%. 

 

 

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 DODI 1332.39 and AR 635-40 for rating the chronic LBP condition was operant in 


this case and the condition was adjudicated independently of that policy by the Board. In the 
matter of the chronic LBP condition, the Board by a vote of 2:1 recommends a disability rating 
of 20%, coded 5299-5293 IAW VASRD §4.71a. The dissenting voter (who recommended no 
change in the PEB’s 10% rating coded 5299-5295) did not elect to submit a minority opinion. 
There were no other conditions within the Board’s scope of review for consideration. 

 

 

RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of her prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic Low Back Pain 

5299-5293 

20% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120722, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxxx, AR20130007444 (PD201201020) 

 

 

1. 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 to modify the individual’s disability rating to 20% 
without recharacterization of the individual’s separation. This decision is final. 

 

2. I direct that all the Department of the Army records of the individual concerned be 
corrected accordingly no later than 120 days from the date of this memorandum. 

 

3. I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 
shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)