RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201245 SEPARATION DATE: 20061021 

BOARD DATE: 20130307 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a Reserve SSG/E-6 (41L/Administrative Sergeant), medically 
separated for chronic low back pain (LBP) which could not be adequately rehabilitated for the 
CI to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy 
physical fitness standards. She was issued a permanent U2/L3 profile and referred for a 
Medical Evaluation Board (MEB). The MEB forwarded seven additional conditions, as identified 
in the rating chart below, for Informal Physical Evaluation Board (IPEB) adjudication. The IPEB 
adjudicated the LBP as a prior to service condition exacerbated, but not permanently 
aggravated, by service and therefore not ratable. The CI appealed to the Formal PEB (FPEB) 
which did determine permanent aggravation and adjudicated the chronic LBP condition as 
unfitting and rated it 0% with application of the Veteran’s Affairs Schedule for Rating 
Disabilities (VASRD). The remaining conditions were determined to be not unfitting. 

 

 

CI CONTENTION: “Prior to mobilization, I was a Reservist stationed at the 63rd Regional 
Command Center, in Los Alamitos, CA, and transferred into the 394th AG Company. I was a 
Secretary for the Los Angeles City Planning Department performing administrative duties and 
restrictions for lifting no more than 30 pounds. As a Reservist, I had a profile for right shoulder 
impingement syndrome and carefully monitored my limitations for this injury. During 
mobilization, I began rigorous training and my lower back and right shoulder pain/problems 
recurred. I was deployed to Camp Anaconda, Iraq, February 13, 2005, as a Postal Supervisor. 
The duties required lifting over 30 pounds, prolonged standing, pulling, reaching overhead, 
stooping, constant bending and turning. Performing these physically demanding and repetitive 
activities caused aggravation and made the pre-existing back and shoulder injuries impossible 
to continue to wear protective gear and perform the duties expected of my position as NCOIC 
of Postal Operations. During my deployment, I was placed on several profiles which prevented 
the wearing of body armor. I was released from active duty early because of this and 
transferred to Medical Hold at Ft. Lewis, WA. A VA Orthopedic Dr. recommended that I have 
surgery (Attach 1). I had arthroscopy with subacromial decompression and excision of the 
distal clavicle surgery on the right shoulder July 2008 (Attach 2). It was believed that I was a 
Postal Worker since I injured my back picking up a heavy mail bag. However, during my Board 
Hearing, I explained that I had been a Secretary for 30 years with the City, and not a Postal 
Worker. After the Board discovered what my actual career was, the decision was changed to 
recognize the lower back injury as exacerbation from the deployment. Since the lower back 
injury was the only injury listed as unfitting, the Board only dealt with that one issue. 
Therefore, I respectfully request this Board to reconsider the items listed below as "service-
connected" or "permanently aggravated by military service. I am respectfully requesting review 
of the following: 0% rating for low back and disabilities that were not found unfitting: 

Low back pain secondary to multilevel lumbar degenerative joint and degenerative disk disease 
- prevented wear of body armor/protective gear, etc. Right Shoulder bursitis - chronic pain, 
weakness and instability prevented wear of body armor/protective gear, etc. Degenerative disk 
disease of the cervical spine - prevented the proper wearing of kevlar, military gear, etc. 
Bilateral knee osteoarthritis - chronic pain and impaired walking, marching, running, jumping, 
etc. Plantar Fasciitis - prevented the proper wearing of military footwear and impaired walking, 
marching, running, jumping, standing, etc. Pes Planus - prevented the proper wearing of 


military footwear and impaired walking, marching, running, jumping, standing, etc. All of these 
issues prevented me from satisfactorily performing my duties as a Soldier” 

 

 

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 condition, LBP, will be reviewed. The additional conditions deemed not 
unfitting by the PEB and requested for consideration by the CI (right foot pain secondary to pes 
planus, plantar fasciitis, fractured fourth phalanx; right shoulder bursitis; bilateral knee 
osteoarthritis; degenerative disk disease of the cervical spine) also meet the criteria prescribed 
in DoDI 6040.44 for Board purview and are 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 FPEB – Dated 20060822 

VA (12 Mos. Post-Separation) – All Effective Date 20061022 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Low Back Pain 

5237 

0% 

DDD and Facet Joint Arthritis L5-
S1 

5243 

NSC 

20071022 

Right Foot Pain Secondary 
to Pes Planus, Plantar 
Fasciitis and Fractured 4th 
Phalanx 

Not Unfitting 

Left/Right Plantar Fasciitis 
(claimed as Bilateral Feet Pain) 

5099-5020 

0% 

20071022 

Menopausal Symptoms 

Not Unfitting 

NO VA ENTRY 

Right Shoulder Bursitis 

Not Unfitting 

Right Shoulder Condition 

5201 

NSC 

20071022 

Bilateral Knee 
Osteoarthritis 

Not Unfitting 

Early Osteoarthritis of the 
Bilateral Knees 

5010 

10% 

20071022 

Hypothyroidism 

Not Unfitting 

Hypothyroidism 

7903 

10% 

20071022 

Hyperlipidemia 

Not Unfitting 

Hyperlipidemia 

7099-7005 

NSC 

20071022 

DDD of the Cervical Spine 

Not Unfitting 

Minimal …w/ Cervical DDD 

5237 

10% 

20071022 

.No Additional MEB/PEB Entries. 

Varicose Veins, Left Leg 

7120 

10% 

20071022 

Varicose Veins, Right Leg 

7120 

10% 

20071022 

0% X 5 / Not Service-Connected x 11 

20071022 

Combined: 0% 

Combined: 40%* 



*Rating increased to 50% effective 20061022 with addition of Left Shoulder Impingement condition at 10% (see 20090625 
VARD pg 220 of CPF) 

 

 

ANALYSIS SUMMARY: 

 

Chronic Low Back Pain Condition. There was one goniometric range-of-motion (ROM) 
evaluation 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 

MEB ~ 6 months Pre-Sep 

VA C&P ~12 Mos. Post-Sep 

Flexion (90 Normal) 

forward flexion at hip by 
reaching to her knees 

40 

Combined (240) 

 

180 

Comment 

mild TTP paraspinal 
lumbar muscles; nml gait 

ROM not affected by pain. 
Posture and gait WNL. 

§4.71a Rating 

10% 

20% 



 

According to the MEB narrative summary (NARSUM), dated 17 May 2006, the CI injured her 
back in 1998 while working as a civilian for the city of Los Angeles. A VA Compensation and 


Pension examination (C&P), performed on 15 October 2007, documented that she had a 
Workman’s Compensation claim against the city of Los Angeles pending at the time of 
activation. The claim was for shoulder and back injuries secondary to a fall on the job. She also 
stated that she had a P3 profile at the time of activation which was on 4 November 2004. She 
was seen for several times for shoulder and back pain prior to deployment in February 2005. 
She continued to have LBP which was aggravated by the wear of combat gear. While back in 
the United States, she had a civilian magnetic resonance imaging (MRI) exam which showed 
minimal disc bulging at L4-5 and L5-S1 with degenerative disc disease (DDD) at L3-4; the action 
officer noted that this is not unusual for someone her age. She was evaluated by neurosurgery 
on 9 August 2005 and noted to have an essentially normal examination and to not be a surgical 
candidate. She returned to the theater of operations where her pain continued. On or about 
6 December 2005, she was returned 2 months early to her home station for consideration of an 
MEB. On 19 December 2005, she underwent another MRI for LBP and right greater than left 
hip pain; this MRI noted the additional findings of degenerative joint disease (DJD) L3-S1 and 
mild disc protrusion with foraminal narrowing at L5-S1 compared to the prior study. She was 
referred for an orthopedic examination, but the record of this appointment is not in evidence. 
On 07 March 2006, the CI underwent an evaluation and testing by a neurologist. 
Electrodiagnostic testing was normal without evidence of neurological compromise. At the 
MEB orthopedic evaluation on 12 April 2006 (6 months prior to separation), the CI reported 
that she had an 8 year history of LBP which she developed after lifting heavy boxes as an office 
worker and had managed conservatively with significant pain relief. Her LBP was aggravated 
while deployed due to the wear of body armor and lifting heavy objects. On examination, she 
was noted to be obese. Her strength, reflexes, and sensation were normal as were her gait, 
heel-walk, and toe-walk. Bilateral straight leg raise (SLR), a provocative test for nerve root 
irritation, was negative. She had mild tenderness to palpation in the lower back muscles, but 
there was no comment regarding spasm. She could perform forward flexion at the hip by 
reaching approximately to her knees and she could extend to approximately 10-15 degrees. No 
comment was made on whether the limitation was secondary to pain or mechanical limitations, 
such as body habitus; however, this is consistent with flexion which ranges from a slight 
reduction to normal. At the general MEB NARSUM on 17 May 2006 (5 months prior to 
separation), the CI provided no new history from above. The examination showed that she was 
68 inches and 196 pounds. The lumbar spine showed no tenderness to palpation and full active 
ROM. The CI had no radiculopathy with normal reflexes, sensation, and strength. Bilateral SLRs 
were negative. There was no comment regarding gait or back spasm. No signs of non-organic 
pain were present. She was noted to be able to perform all of her duties as an administrative 
specialist in garrison. No incapacitation was documented. The C&P examination on 22 October 
2007 (12 months post-separation), the CI reported that she was unable to garden, vacuum or 
push a lawn mower secondary to her knee and back pain. On examination, she was 68 inches 
tall and 232 pounds. Posture and gait were normal and she used no assistive devices. The 
neurological examination was normal. The ROM was notable for flexion limited to 40 degrees, 
but without DeLuca criteria present. Again, no comment was made regarding the cause of the 
limitation. The Board noted a 36 pound weight gain since the NARSUM examination. There 
was no mention of spasm. Repeat X-rays of the lumbar spine on 22 October 2007 noted no 
notable progression of the lower back disc disease. The VA examination was just outside of the 
12 month window utilized by the Board. In addition, the examiner did not specifically evaluate 
the back and the ROM values were obtained as an addendum. Both of these factors reduce the 
probative value of the examination. Under the discussion for the cervical spine it was 
documented that there were no signs of intervertebral syndrome. The CI did undergo a second 
C&P examination on 25 February 2008, 16 months after separation, which was not specific for 
the back. However, it noted that she ambulated without the use of an assistive device and that 
she could sit up from a supine position and transfer from a chair to the examination table 
without major difficulty. Her gait was normal and she could stand on both her toes and heels, 
taking a few steps. There was no evidence of limitation in standing or walking. The action 


 

The Board directs attention to its rating recommendation based on the above evidence. It 
determined that the NARSUM general examination, which documented a normal ROM and 
neurological examination, was most consistent with the predominance of other evidence. It 
also noted that the CI had a Workman’s Compensation claim for back pain pending at the time 
of activation and that the VA determined the condition to not be service-connected as it existed 
prior to service (EPTS). However, the PEB determined that there had been permanent service 
aggravation and rated the condition at 0%. The Board considered the findings. There was no 
history of incapacitation in the service treatment record. The NARSUM documented a normal 
neurological examination and ROM. Neither painful motion nor spasm was documented. 
There were minimal degenerative changes on X-rays and the MRIs showed DDD typical for the 
age of the CI. The Board considered the various coding options available for the back condition. 
None provided a route to a rating higher than the 0% adjudicated by 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. 

 

Contended PEB Conditions. The conditions adjudicated as not unfitting by the PEB and that 
were also contended by the CI are right foot pain secondary to pes planus, plantar fasciitis, and 
fractured 4th phalanx, right shoulder bursitis, bilateral knee osteoarthritis, and DDD of the 
cervical spine. 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. 
The Board must demonstrate that by a preponderance of the evidence, the above contended 
conditions were each separately unfitting. 

 

Right Foot pain Secondary to Pes Planus, Plantar Fasciitis, and a Fractured 4th Phalanx. 

An MEB podiatry consult for plantar fasciitis on 1 March 2006 notes that the CI had intermittent 
right heel pain for over a year and also had painful right 5th hammertoe. The examiner also 
noted the CI had trauma to right 4th toe on 10 February 2006. The examiner additionally wrote 
that "Pt notes it is her back, not her feet, which keep her from performing duties." An X-ray at 
the time revealed a minimally displaced fracture of the toe and pes planus. She was treated 
with taping of the affected toe. The examiner noted that the prognosis is good and that the CI 
met retention standards. Serial X-rays of the toe showed healing and the expected prognosis 
was normal. The CI was given a temporary profile that cited her right chronic foot pain and 4th 
toe fracture that expired 30 days later without renewal. The MEB examiner determined that 
the CI met retention standards as did the MEB. The commander specifically stated that 
although the CI's chronic foot pain and 4th toe fracture of the right foot precluded the CI from 
performing work in a field or tactical environment, she was able to perform her duties (in 
garrison) within the limits of her profile. After due deliberation in consideration of the 
preponderance of the above cited evidence, the Board concluded that there was insufficient 
cause to recommend a change in the PEB determination of the right foot pain secondary to pes 
planus, plantar fasciitis, and fractured 4th phalanx as being not unfitting. 

 

Right Shoulder Bursitis: The CI had an 8 year history of right shoulder problems and had a 
Workman’s compensation claim pending at activation. A right shoulder MRI on 19 December 
2005 showed tendinopathy and mild bursitis of the right shoulder. The CI was treated non-
surgically with PT. A MEB orthopedic consult on 1 March 2006 (7 months prior to separation) 
noted the CI had pain with movement at the shoulder and decreased abduction. The examiner 
noted that the right shoulder bursitis is anticipated to continue to improve and concluded that 
the CI met retention standards. The MEB NARSUM also concluded that the right shoulder 


bursitis condition met retention standards. The CI was given temporary profiles for the 
shoulder and on 8 June 2006 (4 months prior to separation), she was given a permanent U2 
profile related to the right shoulder. The commander’s letter made no specific mention of the 
shoulder condition. After due deliberation in consideration of the preponderance of the 
evidence, the Board concluded that while the CI was receiving ongoing treatment for her right 
shoulder condition, this condition was not separately unfitting at the time of separation. 

 

Bilateral Knee Osteoarthritis: The CI fell and hurt her right knee in March 2005 and was treated 
conservatively. X-rays on 1 March 2006 were normal. An MRI on 9 Apr 2006 revealed some 
thinning of the lateral collateral ligament. At the MEB orthopedic consult, the CI stated that the 
pain did not occur daily and increased with activity. On examination, she had minimal swelling 
of the right knee, but diffuse tenderness was present. Her knee was stable with full ROM. The 
examiner concluded her prognosis is good and that she met retention standards. There is 
limited information regarding the left knee. An MRI of the left knee on 8 May 2006 (2 months 
prior to separation) was normal. The MEB orthopedic consult made no mention of a left knee 
problem. The MEB NARSUM noted no abnormalities the knees on examination and concluded 
that the bilateral knee osteoarthritis condition met retention standards. There was only one 
temporary profile, dated 16 May 2006, that mentioned a diagnosis of "knee pain" without 
specifying the right or left knee. A subsequent permanent profile signed 8 June 2006 did not 
mention any knee pain as basis for limitations. The commander’s letter made no mention of a 
knee problem. 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 
determination of the bilateral knee osteoarthritis condition as being not unfitting. 

 

DDD of the Cervical Spine: The CI had an MRI of the cervical spine on 7 June 2006 on referral 
from urology during an evaluation for loss of bladder control. The MRI showed disk herniations 
and degenerative changes at several levels in the cervical spine. The CI was evaluated by 
physical therapy and had no functional impairment related to this condition. She had normal 
ROM and was without radicular symptoms; she did have subjective complaints of pain. She was 
treated conservatively with cervical traction. There was no cervical tenderness or spasm. The 
MEB concluded that the DDD of the cervical spine met retention standards. The CI was never 
profiled for the cervical spine condition. The commander’s letter made no mention of the 
cervical spine. 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 
determination of the cervical spine condition as being not unfitting. 

 

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 any of the contended 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 chronic low back condition and IAW VASRD §4.71a, the 
Board unanimously recommends no change in the PEB adjudication. In the matter of the 
contended right foot pain secondary to pes planus, plantar fasciitis, and fractured 4th phalanx; 
right shoulder bursitis; bilateral knee osteoarthritis; and, DDD of the cervical spine 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 recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic Low Back Pain 

5237 

0% 

COMBINED 

0% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120822, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, 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, AR20130006147 (PD201201245) 

 

 

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 xxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)