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)