RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:   ARMY 
SEPARATION DATE:  20030526 

 
NAME:  XXXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200230 
BOARD DATE:  20121128 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SGT/E-5  (54B/Chemical  Specialist),  medically 
separated for chronic back pain.  The CI developed chronic low back pain (LBP) after a motor 
vehicle accident in 1999.  Despite comprehensive conservative therapy as well as more invasive 
trigger  point  and  caudal  blocking  injections,  the  chronic  back  pain  condition  could  not  be 
adequately rehabilitated and the CI remained unable to meet the physical requirements of her 
Military Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a 
permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded 
no other conditions for Physical Evaluation Board (PEB) adjudication.  The PEB adjudicated the 
chronic  back  pain  condition  as  unfitting,  rated 10%,  with  application  of  the  Veteran’s  Affairs 
Schedule for Rating Disabilities (VASRD) and Department of Defense Instruction (DoDI) 1332.39.  
The CI made no appeals, and was medically separated with a 10% disability rating.   
 
 
CI CONTENTION:  “The Army rated me 10% for my chronic lower back pain but did not include 
my other service-connected diagnoses.” 
 
 
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  chronic  LBP  condition  is  the  only 
condition identified  by the  PEB.   The  other  requested  conditions of  scar  residual  of  ganglion 
cyst, residuals of rape, and gynecological condition 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 20030204 

VA (2 Mos. Post-Separation) – All Effective Date 20030527 

Condition 
Chronic Back Pain 

Code 

5299-5295 

Rating 
10% 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

 
 

Condition 

Disc  Disease of the Lumbar 
Spine 
Scar Residual of Ganglion Cyst, 
Right Wrist 
Residuals of Rape 

Code 

5293-5292 

Rating 
10% 

7804 
9411 

10% 
50% 

0% X 1/ Not Service-Connected x 2 

Combined:  60% 

Exam 

20030714 

20030714 
20040213 
20040219 

ANALYSIS SUMMARY:  The Board acknowledges the CI’s contention that suggests ratings should 
have been conferred for other conditions documented at the time of separation.  The Board 
wishes to clarify that it is subject to the same laws for disability entitlements as those under 
which  the  Disability  Evaluation  System  (DES)  operates.    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.    However  the  Department  of  Veteran  Affairs  (DVA),  operating  under  a 
different set of laws (Title 38, United States Code), is empowered to compensate all service-
connected conditions and to periodically reevaluate said conditions for the purpose of adjusting 
the  Veteran’s  disability  rating  should  her  degree  of  impairment  vary  over  time.    The  Board 
utilizes  DVA  evidence  proximal  to  separation  in  arriving  at  its  recommendations;  and,  DoDI 
6040.44 defines a 12-month interval for special consideration to post-separation evidence.  The 
Board’s authority as defined in DoDI 6040.44, however, resides in evaluating the fairness of DES 
fitness determinations and rating decisions for disability at the time of separation and is limited 
to  conditions  adjudicated  by  the  PEB  as  either  unfitting  or  not  unfitting.    Post-separation 
evidence therefore is probative only to the extent that it reasonably reflects the disability and 
fitness implications at the time of separation. 
 
Chronic  Back  Pain  Condition.    There  were  three  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.  The record does not 
specify whether these measurements were made with a goniometer and this was not required 
by the 2002 VASRD. 

 

Neurosurgery ~ 5 Months 

Pre-Separation 

70° 
10° 
30° 
30° 

Not Measured 
Not Measured 
140° to 200° 

Thoracolumbar 

ROM 

Flexion (90⁰ Normal) 

Extension (0-30) 

R Lateral Flex (0-30) 
L Lateral Flex 0-30) 
R Rotation (0-30) 
L Rotation (0-30) 
Combined (240⁰) 

Comment 

MEB ~5 Months  
Pre-Separation 

70⁰ 

Not Measured 

30⁰ (40) 
30⁰ (40) 

Not Measured 
Not Measured 
130° to 220° 

VA C&P ~1.5 Months  

Post-Separation 

90⁰ 
25⁰ 

25-30⁰ 
25-30⁰ 

Not Measured 
Not Measured 
165° to 225° 

No spasm, list, or tenderness; 
normal pinprick and strength 
5/5 bilateral lower extremities; 
reflexes 1/4 symmetric.  MRI 
slight desiccation and bulging 
of L4-5 disc.  EMG left lower 
extremity normal. 

Gait undisturbed; tenderness to 
palpation in bilateral lumbar 
paraspinal regions; straight leg raises 
are negative; reflexes 1+ at bilateral 
knees and ankles; motor strength 5/5 
and intact pinprick sensation in 
bilateral lower extremities. 

Slightly tender at L5-S1 level; 
no spasm, no abnormal 
curvature, and no radicular 
pain; strength is symmetrical 
in the lower extremities and 
reflexes and sensation were 
normal. 

§4.71a Rating 

5292 
5293 
5295 

 

 

10% 

10% 

 

10% 
10% 
10% 

 

10% 
10% 
10% 

 
The MEB narrative summary (NARSUM) completed approximately 5 months prior to separation 
and  it  reports  persistent  lower  back  pain  after  a  motor  vehicle  accident  in  1999.    Despite 
extensive  conservative  treatment  with  medication,  physical  therapy,  and  profiles  as  well  as 
more  invasive  treatment  with  trigger  point  and  caudal  blocking  injections  she  continued  to 
have pain that prevented her from performing the duties required of her MOS.  Neurosurgery 
noted that surgery was not indicated.  A magnetic resonance imaging (MRI) performed in May 
2002 noted minimally bulging discs at L4-5 and L5-S1 with minimal disc desiccation at L3-4 and 
L4-5.  Although the NARSUM notes a history of intermittent right lower extremity paresthesia 

to the level of the knee and a normal right lower extremity electromyogram (EMG), an EMG of 
the  left  lower  extremity  was  performed  in  July  2002  and  was  normal.    No  EMG  of  the  right 
lower extremity was found in the record.  Physical exertion, lifting more than 30 pounds, and 
wearing  military  gear  would  cause  her  pain  to  increase  to  7  or  8/10  and  she  was  limited  to 
administrative duties in her company.  At the MEB exam, the CI reported numbness and tingling 
shooting down both legs whenever her back “starts spasming.”  The MEB physical exam was 
done by the same examiner that prepared the NARSUM and the physical examination findings 
are  recorded  in  the  ROM  chart  above.    A  VA  Compensation  and  Pension  (C&P)  exam  was 
completed almost 2 months after separation and it documented a similar clinical history.  At the 
time of this examination, the CI reported pain of 6/10.  She complained of stiffness and the use 
of Oxycodone for pain. An X-ray noted questionable narrowing at the level of the L5-S1 disc 
that could have represented either a normal exam or mild disc disease.   
 
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  modified  on 
23 September  2002  to  add  incapacitating  episodes  (5293  Intervertebral  disc  syndrome),  and 
then  changed  to  the  current  §4.71a  rating  standards  on  26  September  2003.    The  2002 
standards for rating based on ROM impairment were subject to the rater’s opinion regarding 
degree of severity, whereas the current standards specify rating thresholds in degrees of ROM 
impairment.    When  older  cases  have  goniometric  measurements  in  evidence,  the  Board 
reconciles (to the extent possible) its opinion regarding degree of severity for the older spine 
codes and ratings with the objective thresholds specified in the current VASRD §4.71a general 
rating formula for the spine.  This promotes uniformity of its recommendations for different 
cases from the same period and more conformity across dates of separation, without sacrificing 
compliance with the DoDI 6040.44 requirement for rating IAW the VASRD in effect at the time 
of separation.  For the reader’s convenience, the 2002 rating codes under discussion in this case 
are excerpted below. 
 
5292  Spine, limitation of motion of, lumbar: 
  Severe............................................................................................     40 
  Moderate......................................................................................      20 
  Slight.............................................................................................      10 
 
5293  Intervertebral disc syndrome: 
  Pronounced; with persistent symptoms compatible with sciatic      
   neuropathy with characteristic pain and demonstrable muscle 
   spasm, absent ankle jerk, or other neurological findings 
   appropriate to site of diseased disc, little intermittent 
   relief..............................................................................................      60 
  Severe; recurring attacks, with intermittent relief.......................       40 
  Moderate; recurring attacks..........................................................      20 
  Mild.................................................................................................     10 
  Postoperative, cured.......................................................................       0 
 
5295  Lumbosacral strain: 
  Severe; with listing of whole spine to opposite side, positive      
   Goldthwaite's sign, marked limitation of forward bending in 
   standing position, loss of lateral motion with osteo- 
   arthritic changes, or narrowing or irregularity of joint 
   space, or some of the above with abnormal mobility on forced 
   motion..............................................................................................    40 

  With muscle spasm on extreme forward bending, loss of lateral  
   spine motion, unilateral, in standing position..................................   20 
  With characteristic pain on motion..................................................    10 
  With slight subjective symptoms only...............................................     0 
 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB rated the chronic back pain at 10% for characteristic pain on motion using the 5299-5295 
code.  The VA also rated the condition at 10% although they used a different code, 5293-5292, 
to incorporate the CI’s radicular symptoms.  They did not assign a separate rating for peripheral 
neuropathy.  While any of the three VASRD codes listed in the chart above could be used, all 
result in a 10% rating and none offers any advantage to the CI.  Additionally, if today’s VASRD 
was used to rate this condition, a 10% rating would result based on painful motion.   
 
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 and no motor impairment was 
documented.  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 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.    In  the  matter  of  the 
chronic back pain condition 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:   
 

VASRD CODE  RATING 
5299-5295 
COMBINED 

10% 
10% 

Chronic Back Pain 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120301, 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 
XXXXXXXXXXXXXXXXXXXXXXXXX, AR20120022041 (PD201200230) 
 
 
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 
 
 

     XXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)