RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY  
SEPARATION DATE:  20071102 

 
NAME:  XXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200077 
BOARD DATE:  20130205  
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty Soldier, SSG/E-6(92A/Automated Logistics Specialist), 
medically  separated  for  mechanical  low  back  pain  (LBP)  and  right  hip  pain.    The  CI  did  not 
improve  adequately  with  treatment  to  meet  the  physical  requirements  of  his  Military 
Occupational  Specialty  or  satisfy  physical  fitness  standards.    He  was  issued  a  permanent  L3 
profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded chronic right 
hip pain secondary to sciatic radiculopathy and mechanical LBP as medically unacceptable IAW 
AR 40-501 to the Informal Physical Evaluation Board (IPEB).  Five other conditions, identified in 
the rating chart below, were also identified and forwarded by the MEB as medically acceptable. 
The PEB adjudicated the mechanical LBP and right hip pain as unfitting, rating them at 10% and 
10%  respectively,  with  application  of  the  Veterans  Affairs  Schedule  for  Rating  Disabilities 
(VASRD).  The IPEB adjudicated the five other conditions as not unfitting. The CI appealed to the 
Formal PEB (FPEB), which affirmed the IPEB findings; and was then medically separated with a 
20% disability rating.  
 
 
CI  CONTENTION:    The  CI  states:  “I feel  important pieces of  information  were  not  considered 
when  the  PEB  evaluated  my  disabilities.  The  first  disability  I  want  to  discuss  is  "Mechanical 
Lower Back Pain.”  Dr.---, chief of orthopedic surgery at the time of my evaluations, stated that 
"MRI evaluation of his lumbar spine shows that he has some markedly irregular lumbar disk" 
and that the AMA Pain Rating Scale is "Moderate to severe and frequent to constant.” I also 
made my Army lawyer aware of muscle spasms I was having and to include that as evidence. 
The  second  disability,  "Chronic  Right  Hip  Pain  secondary  to  Sciatic  Radiculopathy",  was 
diagnosed by Dr.---. The PEB proceedings states this disability as "what is being called Sciatic 
Radiculopathy.”  Stating  this  condition  in  these  terms  makes  it  seem  "non-serious"  and 
"questionable" when in fact it is a very serious and disabling condition that has severely altered 
the  quality  of  my  life.  I  was  issued  a  cane  at  Darnall  Army  Hospital's  in  physical  therapy 
department in December 2006 by Dr. --- to assist me with ambulation, something I continue to 
rely  on  it  today.  All  of  these  issues  were  brought  to  the  attention  of  my  Army  lawyer  and 
although  he  thought  it  could  greatly  benefit  my  case,  he  thought  that  it  was  still  a  risk  and 
recommended that I take the settlement. I also was not allowed to finish treatment for "Sleep 
Apnea.” Diagnosis of this condition began when I brought it to the attention of Dr. --- during an 
appointment in October 2007 that I had trouble sleeping and that my wife said that I would 
stop breathing when I slept. I made PEB and MEB officials aware of this ongoing treatment and 
requested that it be evaluated also along with my other disabilities. They all declined to assist 
me.  I  was  officially  diagnosed  with  "Sleep  Apnea"  in  April  2008  and  it  has  been  "service 
connected" through Veteran Affairs with a 50% rating. I feel that if the PEB approving officials 
had  been  made  aware  of  these  issues  that  I  would  have  been  assigned  a  higher  disability 
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; and, 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 conditions eustachian tube 
dysfunction, hearing loss, knee pain, esophageal reflux, and erectile dysfunction as requested 
for  consideration  meet  the  criteria  prescribed  in  DoDI  6040.44  for  Board  purview;  and,  are 
addressed  below.    The  sleep  apnea  did  not  meet  the  criteria  prescribed  in  DoDI  6040.44 
referenced  above  for  Board  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 FPEB – Dated 20071001 
Condition 
Mechanical Low Back Pain 
Right Hip Pain / Sciatica 
Eustachian 
Dysfunction  
Hearing Loss 
Joint  Pain,  Localized 
Knee, Patellar Tendonitis 
Esophageal Reflux 
Male Erectile Disorder 

Tube 

Code 
5237 
8799-8720 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

in 

↓No Additional MEB/PEB Entries↓ 

Rating 
10% 
10% 

VA (1 Mos. Post-Separation) – All Effective Date 20071103 
Condition 
Lumbar Strain w/L Sciatica 
R Hip Bursitis / Hamstring Pain 
Eustachian Tube Dysfunction 
Hearing Loss  
Left Knee Pain  
Right Knee Pain 
Gastroesophageal Reflux  
Erectile Dysfunction 
Sleep Apnea 
Bilateral Tinnitus* 
0% X 1/ Not Service-Connected x 7 
Combined:  70% 

Code 
5237 
5019 
6201 
 
5260 
5260 
7399-7346 
7522 
6847 
6260 

Rating 
10% 
10% 
0% 
NSC 
10% 
10% 
0% 
0% 
50% 
10% 

Exam 
20071217 
20071217 
20071217 
 
20071217 
20071217 
20071217 
20071217 
20080626 
20071217 
20071217 

Combined:  20% 
*Bilateral hearing loss, NSC. Sleep Apnea added by VARD of 12/8/08, increasing combined to 70%. 
 
  
ANALYSIS SUMMARY:  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.  The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or  potential  complications  of  conditions  resulting  in  medical  separation  nor  for  conditions 
determined  to  be  service-connected  by  the  Department  of  Veterans  Affairs  (DVA)  but  not 
determined to be unfitting by the PEB.  However the 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 the degree of impairment vary over time.  The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating  determinations,  compared  to  VASRD  standards,  based  on  severity  at  the  time  of 
separation.  The Board has neither the jurisdiction nor authority to scrutinize or render opinions 
in reference to the CI’s statements in the application regarding suspected DES improprieties in 
the processing of his case. 
 
Mechanical Low Back Pain Condition.  According the MEB narrative summary (NARSUM), the CI 
experienced onset of chronic LBP since a fall in December 2004, associated with radiating pain 
into the right posterior hip and leg addressed separately below.  Magnetic resonance imaging 
(MRI) of the lumbosacral spine on 20 November 2006 was normal with normal alignment and 

normal  discs  without  bulging,  protrusion  or  herniation.    The  orthopedic  surgeon  noted  disc 
irregularity  on  the  MRI  that  was  not  reported  by  the  radiologist  on  the  MRI  report.    At  a 
7 February  2007  clinic  appointment  there  was  spinal  tenderness  with  muscle  spasm  but  gait 
and  stance  were  normal.    A  physical  therapy  examination  30  March  2007,  7  months  before 
separation, recorded flexion of 40 degrees, extension 5 degrees, left lateral bending 30 degrees, 
right  lateral  bending  35  degrees,  left  rotation  50  degrees,  right  rotation  35  degrees.    The 
physical therapist noted normal spine contour and use of a cane that was issued in November 
2006 for the right leg pain condition addressed separately below.  The orthopedic NARSUM, 
dictated  18  April  2007,  recorded  the  history  noted  above.    On  examination  there  was 
tenderness of paraspinous muscles without spasm.  Neurologic examination was intact.  The 
diagnosis  was  mechanical  low  back  pain  for  which  analgesic  medication  including  narcotic 
medication  was  prescribed.    The  CI  was  evaluated  by  the  pain  clinic  in  July  2007  and  his 
medication treatment adjusted.  The CI sought care on 21 September 2007, 2 months before 
separation, for back spasm of 2 to 3 weeks duration.  On examination, the examiner recorded 
thoracolumbar range of motion as “full” and lumbosacral spine motion as “normal.”  There was 
muscle  spasm  but posture  and  gait  were  recorded  as normal.    At the  VA  Compensation  and 
Pension  (C&P)  examination  on  17  December  2007,  a  month  after  separation,  the  range-of-
motion  (ROM)  was  significantly  improved  from  the  March  2007  PT  examination,  7  months 
before separation.  Flexion was 80 degrees (normal 90), extension 20 degrees (normal 30), left 
lateral flexion 20 degrees (normal 30), right lateral flexion 20 degrees (normal 30), left rotation 
20  degrees  (normal  30),  and  right  rotation  20  degrees  (normal  30),  with  more  pain  at  all 
extreme  ROM.    There  was  no  muscle  spasm  and  spinal  contour  was  preserved.    A  limp  was 
observed due to right hip and sciatic pain discussed below.  The C&P examination ROM was 
consistent with the September 2007 clinic examination as well as C&P examinations in March 
2009 and March 2010.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
FPEB cited the normal ROM at the time of the 21 September 2007 clinic examination in its 10% 
rating.  The VA rated the back condition 10% based on the C&P examination.  The Board noted 
that  the  ROM  at  the  time  of  the  physical  therapy  examination  7  months  before  separation 
supported a 20% rating; however a subsequent clinic examination 2 months before separation 
and the C&P examination a month after separation are consistent with the 10% rating under 
the VASRD general rating formula for diseases and injuries of the spine.  These examinations 
are also consistent with the expected severity of the condition based on the known pathology 
as reflected by the normal MRI scan.  After due deliberation, considering all of the evidence and 
mindful  of  VASRD  §4.3  (Resolution  of  Resolution  of  reasonable  doubt),  the  Board  concluded 
that  there  was  insufficient  cause  to  recommend  a  change  in  the  PEB  adjudication  for  the 
mechanical LBP condition.   
 
Right  Hip  Pain  Secondary  to  Sciatic  Radiculopathy.    The  NARSUM  records  report  of  right  hip 
pain  since  a  fall  in  December  2004.    Service  treatment  record  (STR)  entry  1  December  2005 
records  report  of  right  posterior  thigh  pain  for  3  years  that  began  while  sprinting.    On 
examination  there  was  tenderness  at  the  ischial  tuberosity  where  the  hamstring  muscle 
attaches  to  the  pelvis.    A  31  July  2006  clinic  evaluation  recorded  right  posterior  thigh 
(hamstring) pain for 3 years with re-injury since that time.  An X-ray obtained of the right hip at 
that time was normal.  An MRI scan of the right hip on 22 August 2006 was also normal.  A 
21 September 2006 clinic evaluation noted a history of pain in the right upper thigh hamstring 
for 2 years as a result of a pulled muscle while playing organized sports.  Since that time, the 
pain  was  worse  to  the  point  that  he  was  walking  with  a  limp.    The  pain  was  increased  by 
bending over.  A physical therapy examination on 22 September 2006 noted right hip pain for 2 
years that began with a cutting maneuver and feeling a pop.  On examination, active hip ROM 

was  full  and  gait  normal.    A  2  November  2006  clinic  evaluation  noted  predominant  right 
posterior thigh pain aggravated by straight leg raising (SLR).  Gait was observed to be normal.  
The  physician  thought  the  pain  might  be  due  to  sciatica  and  ordered  an  MRI  of  the  lumbar 
spine.  A cane was issued on this date as well.  The 20 November 2006 MRI was normal showing 
no  abnormality  that  would  cause  sciatica.    On  follow  up  in  the  clinic  7  December  2006,  the 
physician  noted  the  results  of  the  MRI  and  recorded  “unlikely  radiculopathy.” 
  An 
electromyogram (EMG), in January 2007 was normal (showing no evidence of radiculopathy or 
sciatica).    A  clinic  follow  up  on  7  February  2007  recorded  normal  gait.    The  CI  received  an 
injection to the right ischeal bursa by physical medicine on 12 February 2007.  An orthopedic 
examination on 18 April 2007 recorded normal hip motion with negative SLR, normal strength 
and reflexes.  The 18 April 2007 NARSUM noted intermittent radicular symptoms that were not 
well  localized.    The  NARSUM,  dated  23  May  2007,  noted  a  history  of  right  hip  pain  since 
December 2004.  At that time the right hip pain was described as a constant ache and pulling 
muscle sensation in the posterior hip with an occasional electric shock like sensation from the 
lower back and buttock down the right leg at which point he uses a cane.  On examination, 
there was tenderness of the right posterior hip.  There was hip pain with knee motion but with 
full strength.  The right hip flexed to 85 degrees, extended to 6 degrees, and abducted to 57 
degrees.  For comparison, the unaffected left hip flexion was 106, extension 12 and abduction 
52.  Clinic examinations of the hip on 13 July 2007 and 6 August 2007 recorded “FROM” (full 
range  of  motion).    A  medical  statement  to  the  PEB  8  August  2007  cited  the  right  hip  pain 
secondary to  sciatic  radiculopathy  as  medically unacceptable.   The  21  September  2007  clinic 
encounter for the back recorded the gait as normal.  At the C&P examination on 17 December 
2007,  a  month  after  separation,  the  right  hip  ROM  was  flexion  115  degrees  (normal  125), 
extension  25  degrees  (normal  20),  adduction  20  degrees  (normal  25),  abduction  30  degrees 
(normal 45), external rotation 50 degrees (normal 45), and internal rotation 35 degrees (normal 
40).    The  gait  was  observed  to  have  a  right  limp.    Laseague  sign  was  “normal” indicating no 
nerve root irritation.  On neurologic examination, strength, reflexes, and sensation were normal 
of both lower extremities.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB rated the right hip pain 10% using the 8720 code for neuralgia of the sciatic nerve noting 
the  pain  had  been  attributed  to  sciatic  radiculopathy  despite  the  negative  MRI  and  EMG 
evaluations.  The VA subsumed sciatica with the rating for the back condition and adjudicated a 
10%  rating  for  right  hip  bursitis  with  right  hamstring  pain  (coded  5019,  bursitis).    All  Board 
members agreed the right hip/thigh pain condition most nearly approximated the 10% rating 
using the VASRD code 8720 chosen by the PEB.  The Board also noted that the hip ROM was 
non-compensable under VASRD codes for limitation of motion (5251, 5252, and 5253).  Based 
on the evidence of the record, the VA choice to rate the right hip pain condition under bursitis 
was also reasonable and supported the 10% rating.  In accordance with §4.14 two ratings may 
not be assigned for the same symptomatology.  After due deliberation, considering all of the 
evidence  and  mindful  of  VASRD  §4.3  (Resolution  of  reasonable  doubt),  the  Board  concluded 
that there was insufficient cause to recommend a change in the PEB adjudication for the right 
hip pain condition.  
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were  Eustachian  tube  dysfunction,  hearing  loss,  knee  pain,  esophageal  reflux  and  erectile 
dysfunction.  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 (Resolution of reasonable doubt) standard used 
for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” 
standard.    The  CI  had  a  history  of  Eustachian  tube  dysfunction  for  several  years  for  which 

episodic treatment was provided including placement of a PE tube.  At the time of the 17 April 
2007 NARSUM, the CI had stable hearing loss in the left ear since 2005 with normal hearing in 
the  right  ear.    A  non-disqualifying  H2  profile  was  assigned.    Esophageal  reflux  and  erectile 
dysfunction  were  treated  and  had  no  impact  on  duties.    The  first  STR  for  knee  pain  was 
7 November  2005  when  the  CI  presented  for  care  of  intermittent  right  knee  pain  for  the 
preceding  year  that  occurred  “only  after  running,”  and  resolved  with  Motrin  and  icing.    The 
physical examination of both knees was normal (full painless ROM, no tenderness, swelling or 
crepitus, and no instability).  An X-ray of the right knee was normal.  After this clinic encounter, 
the  STR  fall  silent  regarding  knee  pain  or  knee  problems  until  the  MEB  history  and  physical 
examination on 9 March 2007.  At the time of the MEB history and physical examination, the CI 
reported a history of knee pain with swelling whenever he ran.  The 18 April 2007 orthopedic 
clinic note and the orthopedic NARSUM of the same day make no mention of knee pain.  The 
NARSUM  23  May  2007  makes  no  mention  of  knee  problems.    The  3  July  2007  pain  clinic 
evaluation mentions only the back and hip pain.  The 26 July 2007 warrior transition unit clinic 
evaluation  recorded  a  history  of  longstanding  bilateral  knee  pain  markedly  improved  in  the 
prior year since on a profile for the back condition.  When he was participating in unit physical 
training  he  would  get  knee  pain  the  following  day;  however,  it  never  limited  his  runs  or 
activities.    At  that  time  he  noted  occasional  soreness  with  knee  bending.    The  physical 
examination was normal except for patellar tendon tenderness.  Knee pain, patellar tendonitis 
was  referred  by  the  MEB  as  medically  acceptable.    None  of  these  conditions  were  profiled; 
none were implicated in the commander’s statement; and, none were judged to fail retention 
standards.  All were reviewed by the action officer and considered by the Board.  There was no 
indication from the record that any of these conditions significantly interfered with satisfactory 
duty  performance.    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  mechanical  LBP  condition  and  IAW  VASRD  §4.71a, the 
Board unanimously recommends no change in the PEB adjudication.  In the matter of the right 
hip  pain  due  to  sciatica  condition  and  IAW  VASRD  §4.124a,  the  Board  unanimously 
recommends no change in the PEB adjudication.  In the matter of the contended Eustachian 
tube  dysfunction,  hearing 
loss,  knee  pain,  esophageal  reflux  and  erectile  dysfunction 
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:   
 

VASRD CODE  RATING 
5237 
8799-8720 
COMBINED 

10% 
10% 
20% 

UNFITTING CONDITION 
Mechanical Low Back Pain 
Right Hip Pain Secondary to Sciatic Radiculopathy 

 

 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120122, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 
 
 

  XXXXXXXXXXXXXXXX, DAF 
  Director 
  Physical Disability Board of Review 

 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXXXX, AR20130003097 (PD201200077) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)