RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:   ARMY 
SEPARATION DATE:  20090323 

 
NAME:  XXXXXXXXXXXXXX                                                             
CASE NUMBER:  PD1200078 
BOARD DATE:  20121129 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was a National Guard SFC/E-4 (92Y40/Unit Supply Specialist), medically 
separated  for  spinal  fusion  L5-S1  in  2007  due  to  chronic  back  pain  from  degenerative  disc 
disease (DDD), and for left knee pain.  He sustained an initial back injury in 1992 and underwent 
an L5-S1 fusion as stated.  He also has a history of four left knee surgeries between 2001 and 
2006.    Despite  rehabilitation,  he  could  not  meet  the  physical  requirements  of  his  Military 
Occupational Specialty (MOS) or satisfy physical fitness standards.  The CI first met a Medical 
Evaluation  Board  (MEB)  in  November  2006  and  was  returned  to  duty  with  limitations.    In 
November  2008,  he  was  issued  a  permanent  P2L3S2  profile  and  referred  for  a  second  MEB.  
The  low  back  pain  (LBP)  and  left  knee  pain  did  not  meet  retention  standards  and  were 
forwarded  to  the  Physical  Evaluation  Board  (PEB).    Idiopathic  hypersomnia,  history  left 
(inguinal)  hernia  (LIH)  repair,  history  of  spermatocele  surgery  and  major  depressive  disorder 
(MDD) conditions, were also forwarded to the PEB by the MEB as meeting retention standards.  
The  PEB  adjudicated  the  back  and  left  knee  conditions  as  unfitting,  rated  10%  each,  with 
application  of  the  Veteran’s  Affairs  Schedule  for  Rating  Disabilities  (VASRD).    The  remaining 
conditions were determined to be not unfitting and not ratable.  The CI made no appeals and 
was medically separated with a 20% disability rating.   
 
 
CI CONTENTION:  The CI elaborated no specific contention in his application.   
 
 
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.    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 20081204 

Condition 

Code 

Spinal Fusion L5-S1…DDD 

5241 

Rating 

10% 

Lt Knee Pain … 
Idiopathic Hypersomnia 
Hx Lt Hernia Repair 
Hx Spermatocele Surgery 
Maj Depressive Disorder 

5099-5003 

10% 

Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

VA (7 Mos. Post-Separation) – All Effective Date 20090324 

Condition 

L-Spine DDD, S/P L5/S1…Fusion 
Mild Sensory Neuropathy, LLE 
Mild Sensory Neuropathy RLE 
Lt Knee DJD  
CFS w/ Idiopathic Hypersomnia 
LIH, S/P Mesh Repair 
Lt Spermatocelectomy 
PTSD 
Rt Knee Mild DJD 
Lt Shoulder Rotator Cuff Repair 
Rt Shoulder Rotator Cuff Repair 
C-Spine Mild DDD 

Code 
5241 
8520 
8520 
5003 
6354 
7338 

9411 
5003 
5024 
5024 
5242 

7599-7523 

0% X 10 / Not Service-Connected x 2 

Combined:  80% 

Rating 
20% 
10% 
10%  
10% 
10% 
0% 
0% 
30% 
10% 
10% 
10%  
10% 

Exam 

20091031 
20091031 
20091031 
20091031 
20091031 
20091031 
20091031 
20091026 
20091031 
20091031 
20091031 
20091031 
20091031 

Combined:  20% 

 
 
ANALYSIS SUMMARY:   
 
Low  Back  Condition.    There  were  three  goniometric  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 

Degrees 

Flexion (90 Normal) 

Combined (240) 

Comment 

§4.71a Rating 

MEB ~5 Mo. Pre-Sep 

Consult ~4 Mo. Pre-Sep 

VA C&P ~7 Mo. Post-Sep 

Limitation only from pain 
Noted to be a typical day 

90 
>180 

10% 

~90-110 

>130 

+ Moderate LS spasm 

10% 

+ No paraspinal spasms or 

60⁰ 
160⁰ 

guarding 

20% 

 
The CI was first seen for LBP in 1992 after a motor vehicle accident.  He was next seen in 1996 
after lifting a heavy object and then, over the next few years, he was seen occasionally until 
2006 when he was evaluated for chronic LBP with radiation into the right lower extremity (RLE).  
A magnetic resonance imaging (MRI) exam performed on 10 May 2006 showed a protruding 
disc at L5-S1.  Over the next year, he was treated in pain management with medications, duty 
limitations, chiropractic manipulation, physical therapy (PT) and epidural steroid injections (ESI) 
without  resolution.    On  2  May  2007  he  underwent  a  L5-S1  posterior  fusion  with  left 
transforaminal lumbar interbody fusion.  His post-operative recovery was complicated by a left 
L5 radiculopathy manifested by numbness and weakness in extension of the left great toe.  The 
sensory loss resolved by hospital discharge and great toe extension was normal at a 6 month 
post-operative check.  The CI continued to have LBP and was treated with duty modification, 
medications and additional ESI with some improvement in his symptoms.  A PT examination on 
28 January 2008 noted a mildly antalgic gait, normal ROM and reduced girth of the left thigh as 
well as reduced strength in the left lower extremity (LLE).  A pain management appointment 
performed  on  18  March  2008  also  noted  a  normal  ROM.    Radio  frequency  ablation  of  left 
lumbar facet nerves also provided some relief as did trigger point injections.  At a 21 April 2008 
neurosurgical follow-up visit, he had a normal gait with normal sensation, strength (including 
the LLE) and reflexes.  A solid fusion was noted on X-ray.  His pain persisted though.  An MRI 
performed on 8 January 2009 showed material within the left foramen at L5-S1 which abutted 
the nerve root.  The narrative summary (NARSUM) was dictated 15 October 2008, 5 months 
prior to  separation.    The  CI  reported  some  residual  LLE  numbness.    On  examination,  he  was 

noted to have normal gait and heel to toe walk.  Sensation, strength and reflexes were normal.  
Muscle bulk was normal and symmetric in his legs.  The ROM was normal although the values 
for rotation were not included.  The CI was seen in the neurology clinic a month later for his 
back pain and other medical issues.  The ROM is above and showed normal flexion, but reduced 
lateral bending.  He had a bilaterally positive test for nerve root irritation at 60 degrees.  Muscle 
mass was symmetric in tone, strength and bulk.  There was some possible atrophy of the left 
calf and quadriceps.  Sensation and reflexes were normal.  Gait was normal.  It was thought that 
he could not meet his MOS requirements due to the persistent pain unless there was a problem 
which  was  surgically  correctable.    At  a  20  April  2009  neurology  evaluation,  he  was  noted to 
have  slight  atrophy  of  the  left  thigh  and  calf,  but  with  strength  normal  or  near  normal.    An 
electromyogram  was  significant  for  a  mild  sensory  neuropathy  consistent  with  the  previous 
surgery and not consistent with a radiculopathy.  At the VA Compensation and Pension (C&P) 
exam performed on 31 October 2009, 7 months after separation, the CI reported that he was 
limited in walking to less than a mile and had persistent pain.  No assistive devices were in use 
and his  gait  was normal.    He  had no  spasm or guarding  and the  alignment  of  the  spine  was 
neutral.  There was a sensory loss in a non-dermatomal pattern thought to be secondary to the 
previous surgery.  Strength was reduced at 4/5 on the LLE and some atrophy was noted of the 
left calf.  Reflexes were normal.  His ROM was reduced and is above.  The Board noted that the 
other examinations in the record following recovery from the fusion did not show a limitation in 
lumbosacral  flexion.    The  CI  endorsed  pain  with  repetitive  motion,  but  no  additional  loss  of 
ROM.    No  incapacitating  episodes  were  recorded.    The  Board  directs  attention  to  its  rating 
recommendation based on the above evidence.  The PEB rated the back condition at 10% and 
coded it 5241, spinal fusion.  The VA also coded the back condition as 5241, but rated it at 20% 
citing the reduced flexion noted on the VA C&P examination.  The Board determined that this 
was an outlier from the remainder of the record and assigned it a lower probative value.  The 
other  examinations  support  no  more  than  a  10%  rating  for  either  limitation  in  flexion  or 
combined ROM.  The Board also noted that the VA awarded 10% each for left and right lower 
extremity sensory loss, both coded 8520.  Board precedent is that a functional impairment tied 
to fitness is required to support a recommendation for addition of a peripheral nerve rating at 
separation.  The pain component of a radiculopathy is subsumed under the general spine rating 
as specified in §4.71a.  The sensory component in this case has no functional implications.  The 
motor  impairment  was  relatively  minor  when  present  and  cannot  be  linked  to  significant 
physical impairment.  Since no evidence of functional impairment exists in this case, the Board 
cannot support a recommendation for additional rating based on peripheral nerve impairment.  
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 back condition.   
 
Left  Knee  Condition.    There  were  three  goniometric  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.   
 

Left Knee ROM 

Flexion (140 Normal) 
Extension (0 Normal) 

Comment 

§4.71a Rating 

Ortho ~17 Mo. Pre-Sep 

 

130 
0 

Crepitus 

10% 

MEB ~5 Mo. Pre-Sep 

VA C&P ~7 Mo. Post-Sep 

115 
- 

Symmetric with right knee 

140 

5 degree flexion contracture 

Inc Pain with Repetition 

10% 

10% 

 
The CI first was seen for bilateral knee pain in August 1995 when he presented with progressive 
pain for 3 months without antecedent trauma.  His pain persisted and he had his first surgical 

procedure on 20 February 2001 when he had “picking” of the femoral condylar surface of the 
left knee.  Over the next few years, he also had a Carticel implantation (an injection of cartilage 
cells from the individual), chrondroplasty, debridement and Synvisc injection of the left knee.  
An  MRI  performed  on  29  May  2008  showed  intact  menisci,  anterior  and  posterior  cruciate 
ligaments as well as medial and lateral collateral ligaments.  Non-specific edema of the medial 
femoral  condyle  was  noted  as  well  as  medial  chondromalacia  patella.    Despite  the  surgical 
intervention  and  PT,  his  left  knee  pain  persisted  and  he  was  unable  to  meet  his  MOS 
requirements.  At the MEB exam performed on 11 September 2008, the CI reported persistent 
bilateral knee pain and the use of braces.  The MEB physical exam noted bilateral knee pain 
with  squatting.   The  narrative  summary  (NARSUM)  was  dictated 15  October 2008,  5  months 
prior  to  separation.    The  examiner  noted  a  normal  gait  and  heel  to  toe  walking.    The  legs 
showed symmetric motor mass, strength and reflexes.  The ROM was reduced, but symmetric.  
There  was  no  edema.    At  the  C&P  performed  on  31  October  2009  exam,  7  months  after 
separation, the CI reported that he did not use any assistive devices but did have bilateral knee 
braces for strenuous activity.  His pain was primarily on the inside aspect of his left knee and 
the  CI  was  also  tender  at  this  location.    The  post-operative  scars  were  nontender  and  non-
adherent.    A  5  degree  flexion  contracture  was  present.    He  had  minimal  retropatellar 
tenderness  on the  left without  joint  line  tenderness.    Tests  for  instability  were  negative  and 
effusion  absent.    A  test  for  meniscal  injury  was  mildly  positive  on  the  left.    With  repetition, 
there was increased pain without further limitation in ROM.  The Board directs attention to its 
rating recommendation based on the above evidence.  The PEB and VA both rated the left knee 
condition  at  10%  and  coded  it  5003,  degenerative  arthritis,  although  the  PEB  did  so 
analogously.  The Board reviewed alternate coding options, but none provided an advantage to 
the CI or better described the underlying condition.  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  left  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.    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  low  back  pain  and  left  knee  pain  conditions  and  IAW 
VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120117, w/atchs 

Spinal Fusion L5-S1 in 2007 due to Chronic Back Pain from DDD 
Lt Knee Pain Evaluated as Degenerative Arthritis 

5241 

5099-5003 
COMBINED 

10% 
10% 
20% 

Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXXXXX AR20120022037 (PD201200078) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 
 

     XXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)