RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY
CASE NUMBER: PD1200194 SEPARATION DATE: 20051216
BOARD DATE: 20121121
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty Soldier, SGT/E-5(25Q/Multichannel Transmission
Systems Operator), medically separated for chronic low back pain (LBP). In July 2000, while in
the field, the CI fell, the next day after a road march, he developed back pain and went to the
CTMC. Despite non steroidal anti inflammatory drugs (NSAIDS), narcotics, orthopedic, pain
management, neurology, and chiropractor consults, two epidural steroid injections, three facet
injections, spinal stabilization class, physical therapy, nerve conduction study (NCS) and a TENS
unit, the CI failed to meet the physical requirements of his Military Occupational Specialty
(MOS) or satisfy physical fitness standards. The CI was issued a permanent L3 profile and
referred for a Medical Evaluation Board (MEB). The MEB forwarded LBP as medically
unacceptable IAW AR 40-501 on DA Form 3947 to the Physical evaluation Board (PEB). The
MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB
adjudicated the chronic LBP with degenerative joint disease (DJD) L5/S1 as well L4/L5 as
unfitting, rated 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities
(VASRD) and with likely application of the US Army Physical Disability Agency (USAPDA) pain
policy. The CI made no appeals, and was medically separated with a 10% disability rating.
CI CONTENTION: The CI states: “I believe my rating did not truly reflect my disability level at
that time. Shortly after my separation I was found to be 50% disabled. I filed a letter of
disagreement and was found to be 70% disabled. Also, within a year of separation I was
diagnosed with PTSD that was found to be service connected. While I was in the service I
refused to get help for the PTSD due to the negative stigma I was given due to my back
disability alone. I would like the board to reevaluate my disability rating with all of the evidence
at hand. Less than a year after my separation, VA found more problems with not just my lower
back but my upper back, knees, legs, and arms as well. I believe that my PTSD should be
considered in this case. I was told my my [sic] Med-Hold company that I shouldn't add anything
to my case because it could slow down the process. I was also told to accept any rating the PEB
gives me. If I didn't it could result in a lower rating or a longer time to out-process. My chain of
command said the PEB rating didn't matter because the VA would take care of us after we got
out. I hope that the PDBR can right this wrong.”
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 left and right leg conditions
(peripheral neuropathy) as requested for consideration meet the criteria prescribed in DoDI
6040.44 for Board purview (as part of the unfitting condition); and, are addressed below, in
addition to a review of the ratings for the unfitting LBP condition. The remaining conditions
rated by the VA at separation and listed on the DD Form 294 application are 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
Army Board for Correction of Military Records.
RATING COMPARISON:
Service PEB – Dated 20050928
VA (6 Mos. Post-Separation) – All Effective Date 20051217*
Condition
Code
Rating
Condition
Chronic LBP… (DJD, BLE
denervation; see text)
5242
10%
↓No Additional MEB/PEB Entries↓
Degenerative Disc Disease
(DDD), Lumbar Spine
Peripheral Neuropathy, Left (L)
Leg
Peripheral Neuropathy, Right
(R)Leg
Patellofemoral Pain Syndrome,
R Knee
Patellofemoral Pain Syndrome, L
Knee
DDD, Cervical Spine
Peripheral Neuropathy, L Arm
Peripheral Neuropathy, R Arm
Code
5243
Rating
10%
8521
8521
5299-5014
5299-5014
5243
8515
8515
10%
10%
10%
10%
10%
10%
0%
Exam
20060614
20060614
20060614
20060614
20060614
20060614
20060614
20060614
20060614
Combined: 10%
0% X 1 / Not Service-Connected x 0
Combined: 50%
ANALYSIS SUMMARY: The Board notes the current VA 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 VA ratings which it considers in that regard are those
rendered most proximate to separation. The Disability Evaluation System (DES) has neither the
role nor the authority to compensate members for anticipated future severity or potential
complications of conditions resulting in medical separation. That role and authority is granted
by Congress to the Department of Veterans’ Affairs.
Chronic LBP and Lower Extremity Neuropathy Condition. The PEB disability description was:
“Chronic low back pain with Degenerative Joint Disease L5/S1 as well L4/L5 and foraminal narrowing L4/L5
right greater than left side Epidural steroids did not give Soldier relief and he was referred to neurosurgery
The neurosurgical recommendation was for discography The Soldier declined Nerve conduction testing
showed muscle transmissions to be normal save denervation in both legs of the L5/S1 nerve roots The
declination for surgical intervention was considered to be reasonable and acceptable. Soldier can forward
flex to 70 degrees with pain. The neurological examination was non-focal.”
The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in
arriving at its rating recommendation, with documentation of additional ratable criteria, are
summarized in the chart below.
PT ~7 Mo. Pre-Sep
MEB ~4 Mo. Pre-Sep
VA C&P ~6 Mo. Post-Sep
Thoracolumbar ROM
Flexion (90⁰ Normal)
Ext (0-30)
R Lat Flex (0-30)
L Lat Flex 0-30)
R Rotation (0-30)
L Rotation (0-30)
Combined (240⁰)
70⁰
10⁰
30⁰
30⁰
30⁰ (60/65/70⁰)
30⁰ (70/70/75⁰)
200⁰
Comment: Used Notes
2 and 4 from VASRD
§4.71a. Spine Formula
“Active ROM WNL, …was
pain with forward flexion
at 70⁰ and … extension at
18⁰”
Painful motion; +straight
leg raise (SLR) pain
bilaterally at 35⁰; “BSG
was noted to have been
90⁰ 40⁰*
30⁰ 10⁰*
30⁰ 5⁰*
30⁰ 5⁰*
30⁰
30⁰
240⁰
* “… with X⁰ of pain at the end”; gait
normal; Pain with movement;
tenderness; mildly + SLR with pain at
L4S1; R knee reflex 1+/2+;” no
decreased by 50%”
appreciable motor deficit”;
decreased sensation L front leg, R/L
medial leg distally
10% (see text)
§4.71a Rating
10%
10%
The magnetic resonance imaging (MRI) performed in August 2000 demonstrated slight facet
asymmetry at L5-S1. The CI went through extensive PT treatments, however because of his lack
of progress, he was referred for a spinal stabilization class, and then he underwent extensive
chiropractor therapy. A lumbar spine X-ray showed DJD L5-S1 and an MRI confirmed this
finding along with foraminal narrowing at L4-L5 with the right being greater than the left. The
CI underwent two epidural steroid injections without relief and his treatment was changed to
three facet injections, which failed to provide relief. The CI was then referred for a discography
which he (reasonably) declined. A nerve conduction study performed indicated a denervation
of the tested muscles of both legs supplied by the L5-S1 nerve roots. A medical clinic note
documented no radiculopathy. The MEB examination, 4 months prior to separation noted that
daily pain was aggravated by prolonged sitting, standing or other movements. The MEB
physical exam findings are summarized in the chart above. The VA Compensation & Pension
(C&P) examination 6 months after separation indicated stiffness, weakness, sharp, aching,
sticking, cramping sharp daily pain made worse by physical activity or stress and relieved by
narcotics, NSAIDS and muscle relaxants. The CI indicated that there was incapacitation one
time a year for two days along with functional impairment. The C&P physical exam findings,
including the lower extremity sensory abnormalities, are summarized in the chart above.
Thoracic and lumbar radiographs were normal.
The Board directs attention to its rating recommendation based on the above evidence. The
PEB rated the chronic LBP as 5242 (Degenerative Arthritis of the Spine) at 10% with an implied
not unfitting determination for the radiculopathies. The VA coded the condition as 5243
(Intervertebral Disc Syndrome) at 10%. The VA rated each lower extremity at 10% coded 8521
for peripheral neuropathy. 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.”
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 - decreased sensation left front leg, right and left medial leg
distally- has no functional implications. There was no motor 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.
All exams proximate to separation met the 10% rating criteria for “Forward flexion of the
thoracolumbar spine greater than 60 degrees but not greater than 85 degrees” or for painful
motion IAW VASRD §4.59. As noted above, the Board adjudged that the peripheral neuropathy
was not separately unfitting or ratable. 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 with not
unfitting left and right lower extremity peripheral nerve conditions.
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 the USAPDA pain policy for rating the chronic LBP condition was likely operant in
this case and the condition was adjudicated independently of that policy by the Board. 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 lower legs (left
and right lower extremity neuropathy) conditions, the Board unanimously recommends no
change from the PEB (implied) 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
5242
COMBINED
10%
10%
Chronic LBP
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20120225, w/atchs
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
XXXXXXXXXXXXXXXXXXXXXXX, AR20120021972 (PD201200194)
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)
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