RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: AIR FORCE 

CASE NUMBER: PD1200416 SEPARATION DATE: 20050318 

BOARD DATE: 20121204 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SSGT/E-5 (2W071/Munitions Systems Craftsman), 
medically separated for chronic low back pain (LBP). The CI stated that he injured his back from 
a fall down a flight of stairs in January 2004. Despite narcotic medications, non steroidal anti 
inflammatory drugs (NSAIDS), neurosurgery consults, physical therapy (PT) and a 
transcutaneous electrical nerve stimulation (TENS) units. The CI failed to meet the physical 
requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards. The CI was 
issued a permanent P4U4L4 profile and referred for a Medical Evaluation Board (MEB). The 
MEB forwarded right knee degenerative joint disease(DJD), painful hydrocele, hyperlipidemia, 
irritable bowel syndrome (IBS), periodic limb movements, mild obstructive sleep apnea (OSA), 
major depressive disorder (MDD) with anger management issues, benign thyroid nodules, 
history of right knee arthroscopy for medical issues, history of hypertrigliceridemia, resolved to 
the Physical Evaluation Board(PEB). The PEB adjudicated the chronic LBP condition as unfitting, 
rated 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD) and 
Department of Defense Instructions (DoDI). The PEB also adjudicated DJD Right knee, status 
post (s/p) arthroscopy surgery, post surgical hypothyroidism, IBS, and mild OSA associated with 
periodic limb movements as Category II (“Conditions that can be unfit, but not compensable or 
ratable”) and hyperlipidemia Category III (“Conditions that are not separately unfit, 
compensable or ratable”). The CI made no appeals, and was medically separated with a 10% 
disability rating. 

 

 

CI CONTENTION: “I believe the original rating of 10 % was too low. The Air Force has stated, 
according to AF form 356 OCT 95, that the only condition that was rateable (sic) was the lower 
back issues. They did not rate the Degenerative Joint Disease of right knee, and spinal injuries 
to my neck for which I still have the MRI copies). When I was discharged, I was lead believe 
that I was evaluated for my neck and lower back degenerative disk disease, but according to the 
AF 356 the neck injuries are not even listed. Both of the spinal injuries contributed to the 
inability to run which is why they said I was unfit to continue in the AF. I believe if one federal 
agency (VA) states 60% disability the other should be close to that rating.” 

 

 

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 not unfitting right knee condition as 
requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview 
and is addressed below, in addition to a review of the rating for the unfitting chronic LBP 
condition. The neck condition is 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 Air Force Board for Correction of Military 
Records. 

 

 


RATING COMPARISON: 

 

Service IPEB – Dated 20050203 

VA (2 Wks. Pre-Separation) – All Effective Date 
20050319 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic LBP 

5243 

10% 

Diffused Disc Herniation 
T-Spine 

5243 

10% 

20050301 

Right Knee DJD S/P 
Arthroscopy 

Category II 

S/P Right Knee Surgery 

5299-
5259 

0% 

20050301 

Hypothyroidism S/P 
Surgery 

Category II 

Hypothyroidism 

7903 

10% 

20050301 

IBS 

Category II 

IBS 

7319 

0% 

20050301 

Mild OSA with Limb 
Movements 

Category II 

OSA 

6847 

30% 

20050301 

Hyperlipidemia 

Category III 

No Corresponding VA Entry 

20050301 

.No Additional MEB/PEB Entries. 

Cervical Strain 

5237 

10% 

20050301 

CTS, Lt Wrist 

8515 

10% 

20050301 

CTS, Rt Wrist 

8515 

10% 

20050301 

0% X 4 (Includes Above) / Not Service-
Connected x 3 

20050301 

Combined: 10% 

Combined: 60%* 



*Original VARD 20050407 granted combined rating @30%. Charted conditions / ratings based 
on VARD 20060919 after De Novo Review by DRO. 

 

 

ANALYSIS SUMMARY: The Board acknowledges the CI's contention suggesting that ratings 
should have been conferred for other conditions documented at the time of separation, some 
of which were evaluated and determined not to be individually unfitting for continued service. 
The Board wishes to clarify that it is subject to the same laws for disability entitlements as 
those under which the Disability Evaluation System (DES) operates. 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. However the Department of Veterans Affairs (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 his degree of impairment vary 
over time. The Board notes the current DVA ratings listed by the CI for all of his service-
connected conditions, but must emphasize that its recommendations are premised on severity 
at the time of separation. The DVA ratings which it considers in that regard are those rendered 
most proximate to separation. The DES has neither the role nor the authority to compensate 
service members for anticipated future severity or potential complications of conditions 
resulting in medical separation. The Board is empowered to evaluate the fairness of fitness 
determinations, and to make recommendations for rating of conditions which it concludes 
would have independently prevented the performance of required duties (at the time of 
separation). The Board’s threshold for countering MDES 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. 

 

Chronic LBP Condition. There were two range-of-motion (ROM) evaluations 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 ~4.5 Mo. Pre-Sep 

VA C&P ~ 17 Days Pre-
Sep 

Flexion (90° Normal) 

“Limited” 

90° 

Ext (0-30) 

“Limited” 

30°* 

R Lat Flex (0-30) 

“Mild Pain” 

30° 

L Lat Flex 0-30) 

“Mild Pain” 

30° 

R Rotation (0-30) 

Not Noted 

30° 

L Rotation (0-30) 

Not Noted 

30° 

Combined (240°) 

unk 

240° 

Comment: 

MRI diffuse disc bulge, 
moderate neuro 
foraminal narrowing, mild 
central canal narrowing 
L4-5/early facet 
osteoarthritis L4-S1 

Limited ROM due to pain; 
tenderness to palpation 
(TTP); gait nml “states cannot 
do heel walking due to poor 
balance”; motor/sensory 
intact 

*Pain significant but not 
limiting ROM; Gait nml; 
no assistive device 
needed; * with DeLuca 
applied 

§4.71a Rating 

10% 

10% 



 

The CI had lumbar spine pain with TTP from L1-to S1 and left lower extremity straight leg pain 
which caused radiation through the left buttocks and thigh. A magnetic resonance imaging 
(MRI) exam performed in April 2004 demonstrated diffuse disc bulge with moderate neuro 
foraminal narrowing at L4-5 and early facet osteoarthritis at L4-S1. The Neurosurgery 
examination indicated negative exam findings and the examiner opined that there was no 
surgical intervention warranted. The MEB examination 4.5 months prior to separation noted a 
response failure to intravenous narcotics (IV Morphine) and a narcotic patch (Fentanyl); 
occasional paresthesias in the lower extremities and pain with any bending or any jarring 
movement; and pain with movement during the night. The MEB exam findings are summarized 
in the chart above. The commander’s statement indicated that the CI could not bend at the 
waist and consistently lift fifty pounds. The VA Compensation & Pension(C&P) examination 17 
days prior to separation noted functioning with the use of medication, sharp daily non-radiating 
pain, no periods of incapacitation; however there was a functional impairment of an inability to 
do any significant bending or lifting. The VA C&P exam findings are in the chart above. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB and the VA chose the same disability code 5243 (Intervertebral disc syndrome) and both 
rated at 10%. The VA initially rated the LBP condition 0%; however the September 2006 VARD 
Decision Review Officer (DRO) De Novo decision increased the disability rating to 10% with 
additional application of DeLuca criteria. The General Rating Formula for Diseases and Injuries 
of the Spine considers the CI’s pain symptoms “with or without symptoms such as pain 
(whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of 
injury or disease.” There was no evidence of fixed neurologic deficit impacting duty 
performance. All exams proximate to separation met the 10% rating criteria for “localized 
tenderness not resulting in abnormal gait or abnormal spinal contour”, or for painful motion 
IAW VASRD §4.59. 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 LBP condition. 

 

Contended PEB Conditions. The contended condition adjudicated as not unfitting by the PEB 
was right knee DJD, s/p arthroscopy surgery. 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 CI injured his right knee by twisting the knee as he was getting up from a lying to standing 
position approximately 7 years prior to separation and underwent a partial medial 


menisectomy at that time. Worsening symptoms led to a MRI documenting chondromalacia 
and indeterminate finding of a medial meniscus tear or scar. The MEB examination was prior to 
surgery and noted chronic right knee pain associated with popping and cracking. The physical 
exam findings are in the chart below (MEB exam before surgery) and the examiner indicated an 
orthopedic consult was pending. The CI subsequently underwent a second arthroscopic surgery 
with medial meniscus trimming and debridement prior to separation. Operative reports and 
follow on notes indicated an acute meniscal tear. The commander’s statement was post-
surgery and indicated that the CI missed a substantial amount of duty due to surgeries and 
recuperation time and could not lift fifty pounds consistently. 

 

Right Knee ROM 

MEB ~4.5 Mo. Pre-
Sep* 

VA C&P 17 days Pre-
Sep 

Flexion (140° 
Normal) 

Not Recorded 

140° 

Extension (0° 
Normal) 

Not Recorded 

0° 

Comment: 

Surgery 5 Mo. Pre-
Sep 

*Positive crepitus 
on patellar grind; 
mildly atrophied 
medial 
compartment 

Crepitus throughout 
ROM; no pain on 
motion 

§4.71a Rating 

10% (PEB Category 
II) 

10% (VA 0%) 



 

*MEB exam was prior to repeat surgery (although NARSUM post-dated 
surgery date). Surgery noted in NARSUM Addendum without knee 
exam. 

 

The C&P exam 17 days prior to separation noted a diagnosis of DJD right knee; a functional 
impairment of inability to perform functions that required bending the knee and a loss of 
twenty days of work due to the right knee pain. The C&P physical exam findings are noted in 
the chart above. 

 

The Board deliberated if the right knee condition was unfitting given the chronic knee pain and 
continued accomplishment of AFSC duties. The CI’s unfitting LBP condition and the knee pain 
may have exacerbated each other. Offsetting this was a significant worsening of symptoms and 
an additional knee surgery. However, it appeared that the knee condition exacerbation 
occurred during the MEB processing. Right knee surgery was noted in the NARSUM addendum, 
without a detailed exam of the knee, and the VA exam was post-surgery and pre-separation. 

 

Although there was some reasonable doubt, the evidence that the right knee was not unfitting 
upon entry into the MEB process and that the knee exam improved following surgery during 
the DES process, the preponderance of the evidence was that there was only temporary duty 
impairment with expected improvement following surgery. 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 right knee 
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. In the matter of the contended right knee condition, the Board 
unanimously recommends no change from the PEB determination 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 LBP 

5243 

10% 

COMBINED 

10% 



The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120509, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxx, DAF 

 President 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxxxxxx, AR20130006257 (PD201201416) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)