RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXX CASE: PD1201770
BRANCH OF SERVICE: ARMY BOARD DATE: 20130319
SEPARATION DATE: 20020906
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty SGT/E-5 (91W/Health Care Specialist) medically
separated for a lumbar spine condition. He developed radiating low back pain (LBP) 4 years
prior to separation; was diagnosed with lumbar disc disease; and, underwent surgical
intervention in 2002. His back and radicular pain did not respond adequately to surgery to
meet the 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 lumbar disc condition was forwarded to the Physical Evaluation Board (PEB)
as two diagnoses (failed back syndrome and status post L4-5 laminotomies and
diskectomies) characterized as medically unacceptable IAW AR 40-501. Two additional
conditions, as identified in the rating chart below, were addressed by the MEB and forwarded
as medically acceptable. The PEB appropriately combined the separate lumbar diagnoses as a
single unfitting condition (chronic back pain, status post L4-5 laminotomies and discectomy,
without neurologic abnormality) rated 10%; citing criteria of the Veterans Administration
Schedule for Rating Disabilities (VASRD), but also referencing Department of Defense
Instruction (DoDI) 1332.39 and Army Regulation (AR) 635-40. The CI made no appeals, and was
medically separated with a 10% disability rating.
CI CONTENTION: The application states simply, Chronic insomnia due to back pain & tinnitus
back pain & tinnitus have worsened substantially The CI does not elaborate further or specify
a request for Board consideration of any additional conditions.
SCOPE OF REVIEW: The Boards scope of review is defined in DoDI 6040.44, Enclosure 3,
paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for
continued military service and those conditions identified but not determined to be unfitting by
the PEB when specifically requested by the CI. The rating for the unfitting lumbar spine
condition is addressed below. The requested insomnia and tinnitus conditions were not
identified by the PEB, and thus are not within the DoDI 6040.44 defined purview of the Board.
The lipid and hypertension conditions, identified as not unfitting by the PEB, were not
requested for review and are thus not within the defined scope. Those, and any other
conditions or contention not requested in this application, remain eligible for future
consideration by the Army Board for Correction of Military Records. The Board acknowledges
the CIs information regarding the significant impairment with which his service-connected
conditions continue to burden him; but, must emphasize that the Disability Evaluation System
(DES) has neither the role nor the authority to compensate members for anticipated future
severity of conditions resulting in medical separation. That role and authority is granted by
Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.
Post-separation evidence is probative to the Boards recommendations only to the extent that
it reasonably reflects the disability at the time of separation.
RATING COMPARISON:
Service IPEB Dated 20020819
VA - (6 Weeks Pre-Separation)
Condition
Code
Rating
Condition
Code
Rating
Exam
Chronic Back Pain
5299-5295
10%
Degenerative Disc Disease, Lumbar
5293
10%
20020729
Hyperlipidemia
Not Unfitting
No VA Entry
Hypertension
Not Unfitting
Hypertension
7101
0%
20020729
No Additional MEB/PEB Entries
Other x 0
20020729
Combined: 10%
Combined: 10%
VARD 20020909 (most proximate to Date of Separation) noted 5 conditions as not service connected and deferred one
condition. Deferred condition (hearing) was awarded 0% by 20030624 VARD.
ANALYSIS SUMMARY:
Chronic Back Pain, Status Post L4-5 Laminotomies and Disectomy. The 2002 Veteran
Administration Schedule for Rating Disabilities (VASRD) coding and rating standards for the
spine, which were in effect at the time of permanent separation, were changed to the current
§4.71a rating standards on 26 September 2003, following the CIs permanent disability
disposition. The older ratings were based on a judgment as to whether the disability was mild,
moderate or severe. The current standards are grounded in range-of-motion (ROM)
measurements. IAW DoDI 6040.44, this Board must consider the appropriate rating for the CIs
back condition at separation based on the VASRD standards in effect at the time of separation.
The CI underwent surgery in January 2002 for symptoms of LBP and pain that radiated to the
buttocks and lower extremities caused by an L4-5 disc bulge and bilateral foraminal narrowing.
X-rays of the lumbar spine in April 2002 showed no abnormalities. A magnetic resonance
imaging (MRI) in May 2002 showed no evidence of recurrent disc protrusion, although the
radiologist opined that the S1 nerve root was possibly displaced due to granulation tissue
resulting from the surgery. At the narrative summary (NARSUM) exam in June 2002, 3 months
prior to separation, the CI reported alleviation of his pre-surgical leg pain and intermittent
buttock pain, but back pain was severe; the buttock pain was increased when standing for more
than 5-10 minutes. The examiner noted ROM limited to less than 90 [degrees], with normal
strength, sensation, and reflexes. At the VA Compensation and Pension (C&P) exam in July
2002, 6 weeks prior to separation, the CI reported buttock, hip, and lower back pain, with
improvement of numbness and tingling in his buttocks, hip, and right lower extremity. Back
pain severity was 6 on a 1-10 severity scale and buttock pain 2-3/10. He described subjective
guarding when lifting greater than 20-25 pounds. The examiner noted tenderness over T10-L5.
Gait and posture were normal, and muscle strength was normal throughout. The straight leg
test was negative for radicular pain bilaterally. ROM was "full throughout" except for
extension, which was limited to 10 degrees (30 degrees is normal by current standards).
Lumbar X-rays were normal. The examiner noted a new history of episodic difficulty
maintaining an erection and no objective exam findings.
The Board directs attention to its rating recommendation based on the above evidence. The
PEB assigned a 10% rating under analogous code 5299-5295 (lumbar strain; mild characteristic
pain on motion). The VAs 10% rating was based on the 5293 code (intervertebral disc
syndrome) for "mild" symptoms. The Board agreed that criteria for the next higher 20% rating
were not in evidence under the 5292 (spine, limitation of motion, lumbar), 5293 or 5295 codes.
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 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. As discussed above, PEB
reliance on DoDI 1332.39 for rating 5295 was operant in this case and the condition was
adjudicated independently of that instruction by the Board. In the matter of the chronic back
pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the
PEB adjudication.
RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of
the CIs disability and separation determination, as follows:
UNFITTING CONDITION
VASRD CODE
RATING
Chronic Back Pain
5299-5295
10%
COMBINED
10%
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20120929, 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
xxxxxxxxxxxxxxxxxxxxxxxxx, AR20130007489 (PD201201770)
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 Boards
recommendation and hereby deny the individuals 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)
AF | PDBR | CY2012 | PD2012 00936
The case was reviewed by the US Army Physical Disability Agency who upheld the FPEB’s decision and the CI was separated with that disability rating. He still had pain towards the end of the day, with some activities, he was not able to sit for more than 2 hours and his mornings were “reasonably comfortable.” The intervertebral disc syndrome rating criteria are copied below: The CI had muscle spasm and pain with motion as required for the 20% rating and did not demonstrate findings...
AF | PDBR | CY2012 | PD2012 01457
The CI requested a reconsideration of the IPEB findings after which the IPEB found the CI unfit for his low back condition, rated 10%. Subsequent multiple VA physical therapy records ranging to the end of 2002,within the 12-month window specified in DoDI 6040.44 regarding VA evaluations for Board consideration, did not demonstrate any deterioration in the CI’s condition, although the Board noted that the CI continued to have ongoing low back pain that was being treated with non-steroidal...
AF | PDBR | CY2012 | PD 2012 01409
The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB rated the chronic mechanical LBP 10% under the VASRD code for lumbar strain in effect at the time citing characteristic pain on motion without neurologic abnormality or documented chronic paravertebral muscle spasms on repeated examinations. Service Treatment Record Exhibit C. Department of Veterans Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability...
AF | PDBR | CY2012 | PD-2012-00761
RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200761 SEPARATION DATE: 20020116 BOARD DATE: 20121218 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard Soldier, SGT/E‐5 (45E, assigned to a Hull Systems Mechanic slot, 63E), medically separated for chronic low back pain (LBP) accompanied by neck pain with degenerative disc disease (DDD) at...
AF | PDBR | CY2013 | PD2013 00108
The back condition, characterized as “herniated nucleus pulposus [HNP]” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 as medically unacceptable.The MEB also identified and forwarded tinnitus as medically acceptable.The PEB adjudicated “chronic low back pain, with L4-5 herniated nucleus pulposus”as unfitting, rated 10%, using the Department of Defense Instruction (DoDI) 1332.39, and theVeterans Affairs Schedule for Rating Disabilities (VASRD). CI CONTENTION : The CI...
AF | PDBR | CY2012 | PD2012-00708
The PEB rated the condition 10% based on pain on forward motion under the 5295 code for lumbosacral strain. The VA reported 90 degrees of lumbar forward flexion and ROMs were consistent with near-normal ROMs from the AMA guidelines in effect at the time, and the Board adjudged these as slight limitation (IAW 5292, Spine, limitation of lumbar motion). Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXX, DAF Director Physical Disability...
AF | PDBR | CY2012 | PD2012 01515
The following day the CI presented to clinic with report of burning/sharp pain in right hip/buttocks. Treatment records recorded three entries documenting full range-of-motion (ROM), three entries recorded decreases in ROM: two of them indeterminate, the other recorded flexion of 60 degrees, both recorded 2 months prior to separation. 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...
AF | PDBR | CY2012 | PD 2012 00284
The rating for the unfitting low back pain with radiculopathy (which includesany associated sciatic nerve pain) is addressed below;no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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...
AF | PDBR | CY2012 | PD2012 01498
The lumbar and right shoulder conditions, characterized as “lumbar three-four disk disease with right sciatica,”“status post three epidural steroid injections” and “impingement right shoulder,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The PEBadjudicated “lumbar three-four disk disease with right sciatica” and “impingement right shoulder” as unfitting, rated 10% and 10%, with likely application of theVeterans Affairs Schedule for Rating Disabilities...
AF | PDBR | CY2012 | PD-2012-01020
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. 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...