RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

 

           SEPARATION DATE:  20030901 

                             BRANCH OF SERVICE:  ARMY  

 
NAME:  XXXXXXXXXXXXXXXX               
CASE NUMBER:  PD1200630                            
BOARD DATE:  20121108          
 
 
SUMMARY  OF  CASE:  Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  MAJ/O-4  (66H/Medical-Surgical  Nurse)  medically 
separated for lumbar and cervical spine conditions.  Prior to service was a history of lumbar disc 
disease  with  prior  surgery,  which  worsened  after  entry  and  was  more  severe  the  last  year 
preceding  separation.    She  additionally  developed  cervical  radicular  symptoms  that  were 
increasingly  symptomatic  after  2002.    She  was  diagnosed  with  multi-level  degenerative  disc 
disease  (DDD)  at  the  cervical  and  lumbar  levels;  and,  surgical  options  were  not  pursued.  
Neither condition could be adequately rehabilitated to meet the physical requirements of her 
Military  Occupational  Specialty  (MOS)  or  satisfy  physical  fitness  standards. 
  She  was 
consequently  issued  a  permanent  U3/L3  profile and  referred  for  a  Medical  Evaluation  Board 
(MEB).    The  cervical  and  lumbar  spine  conditions  were  forwarded  to  the  Physical  Evaluation 
Board (PEB) as medically unacceptable IAW AR 40-501.  No other conditions were submitted by 
the MEB.  The PEB (administratively corrected) adjudicated each spine condition as unfitting; 
rating  the  lumbar  spine  10%,  referencing  Department  of  Defense  Instruction  (DoDI)  1332.39 
and Army Regulation (AR) 635-40; and, rating the cervical spine 0%, referencing the US Army 
Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals, and was medically 
separated with a 10% combined disability rating. 
 
 
CI CONTENTION:  The application does not elaborate any specific comments or requests.  
 
 
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 
the  unfitting  lumbar  and  cervical  spine  conditions  are  addressed  below.    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 the Correction of Military 
Records. 
 
 
RATING COMPARISON:  
 

Service PEB – Dated 20030709 

Condition 

Chronic Low Back Pain, s/p 
Laminectomy 
Cervical DDD 

Code 

5293-5299 
5295 
5099-5003 

Rating 
10% 

0% 

No Additional MEB/PEB Entries 

VA (1 Mo. Post-Separation) – Effective 20030902 
Condition 
DDD, Lumbar Spine 
DDD, Cervical Spine 
Cervical Radiculopathy, LUE 
Dermatitis... 

Rating 
10% 
10% 
20% 
10% 

5299-5242 
5299-5237 

8510 
7806 

Code 

0% X 6 / Not Service Connected x 1 

Exam 

20031006 
20031006 
20040401 
20031006 
20031006 

 

Combined:  10% 

Combined:  40% 

 

ANALYSIS  SUMMARY:    The  Board  notes  that  the  CI  was  separated  just  prior  to  a  significant 
change in Veterans Administration Schedule for Rating Disabilities (VASRD) codes and criteria 
for  the  spine.    The  older  codes  were  applied  for  rating  by  the  PEB,  and  the  new  codes  and 
criteria were in effect at the time of VA rating (still quite proximate to separation).  IAW DoDI 
6040.44,  the  Board’s  recommendation  must  be  premised  on  the  VASRD  in  effect  (criteria 
elaborated below); although, the VA exam evidence remains probative.  
 
Lumbar Spine Condition.  The CI had undergone a lumbar laminectomy in 1984 and was waived 
for enlistment.  She further underwent a MEB for the condition in 1996 and was cleared for 
duty under a permanent P3 profile.  According to the narrative summary (NARSUM), “She did 
well  until  approximately  one  year  ago  when  she  developed  [cervical  symptoms].”    Magnetic 
resonance imaging (MRI) from 2002 showed post-surgical changes and multilevel (L2-S1) disc 
disease  with  degenerative  changes,  spinal  stenosis,  and  facet  hypertrophy.    The  follow-up 
orthopedic  consultant  (February  2002)  documented  the  absence  of  significant  radicular 
symptoms,  minimal  pain,  normal  gait,  near  normal  range-of-motion  (ROM),  and  normal 
neurological  testing;  and,  recommended  continued  conservative  management.    Subsequent 
service treatment record (STR) entries document no change from this picture up to the time of 
separation.  The NARSUM noted continued low back pain “exacerbated over the past year due 
to the increasing pain in the neck.”  Documented functional restrictions (encompassing cervical 
and lumbar impairment) were inability to lift > 15 pounds, need for “frequent breaks at work,” 
inability  to  stand  for  long  periods  of  time,  and  inability  to  march  or  participate  in  physical 
training.    The  physical  exam  noted  normal  gait,  spinal  tenderness,  and  normal  neurological 
findings.  The NARSUM referenced ROMs from physical therapy (PT) with flexion to 3 inches 
from floor height (normal) and minimal limitations in the other planes of motion.  At the VA 
Compensation  and  Pension  (C&P)  exam,  the  back  pain  was  rated  4/10;  exacerbated  by 
“standing or walking for more than 15 minutes.”  The VA physical exam recorded normal gait 
and normal neurological testing (no comment on specific physical findings for the spine).  The 
VA  ROM  measurements  were  flexion  90  degrees  (normal)  “with  pain”, extension  15  degrees 
(normal 30 degrees), and bilateral excursions of 30 degrees (normal). 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
applicable codes for rating consideration IAW the 2003 VASRD in effect are excerpted below. 

 

 

5292 Spine, limitation of motion of, lumbar: 

Severe ………………………………………………………..……….………….... 40 
Moderate …………………………………….……………….…….…………...…. 20 
Slight ………………………………………………………..……………….…..….10 

5293 Intervertebral disc syndrome: 
... 

Severe; recurring attacks, with intermittent relief ……………..…….………..….…40 
Moderate; recurring attacks ……………………………………………............…...20 
Mild ……………………………………………………………..…………….….…10 
Postoperative, cured ……………………………………………..……………....…..0 

5295 Lumbosacral strain: 
... 

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 PEB’s rating defaulted to 5295 criteria; and, although DoDI 1332.39 and AR 635-40 were 
referenced  on  the DA  Form  199,  the  10%  assignment  was  consistent with  painful  motion  as 
documented by the VA examiner.  The next higher 20% criteria under 5295 were clearly not 
supported.  The Board considered rating under 5293; but, there was not a clinically active acute 
disc  syndrome  in  evidence  at  separation;  and,  certainly,  there  were  no ‘recurring  attacks’  to 
support a rating higher than 10% under 5293.  Likewise, the modest ROM limitation evidenced 
by  all  examiners  would  not  support  a  rating  higher  than  10%  under  5292.    There  was  no 
evidence  of  ratable  peripheral  nerve  impairment  to  support  additional  rating  on  that  basis.  
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 rating of the lumbar spine condition.  Members agreed that the three-tiered code applied 
by  the  PEB  was  not  compliant  with  VASRD  §4.27  (use  of  diagnostic  code  numbers),  and  the 
Board recommends a rating solely under 5295. 
 
Cervical  Spine  Condition.    The  CI  experienced  an  onset  of  radiating  neck  pain  in  1996  while 
doing push-ups.  She experienced intermittent pain after that with bilateral arm radiation, but 
in 2002 the pain worsened with predominantly left radicular radiation.  An MRI performed in 
October  2002  was  interpreted  as  “multilevel  cervical  spondylosis,  with  associated  neural 
foraminal narrowing at multiple levels.”  A neurological exam of October 2002 demonstrated 
some  diminished  left  upper  extremity  (LUE)  strength  that  was  attributed  to  neck  pain,  and 
slightly diminished LUE tendon reflexes.  An orthopedic consultant in May 2003 recorded 4+/5 
forearm flexors and extensors on the left compared to 5/5 on the right.  All other neurological 
examinations evidenced in the STR were normal.  No contemporary electrodiagnostic studies 
are in evidence.  Outpatient cervical ROM evidence was variable, but ranged from normal (with 
painful  motion)  to  occasional  moderate  limitations  of  extension  and  right  lateral  flexion 
(consistent with flares of LUE radiculopathy).  Surgical options were entertained, but the final 
neurosurgical  opinion  was  that  surgery  was  of  dubious  benefit  since  an  exact  level  for 
intervention could not be identified.  The NARSUM noted that an epidural steroid injection in 
May 2003 (4 months pre-separation) had rendered the CI free of current cervical radicular pain.  
Persistent neck pain (unquantified) was noted, and limitations were co-mingled with those for 
the lumbar spine as documented above.  The physical exam did not comment on cervical spasm 
or  tenderness,  but  noted  normal  neurological  findings.    The  contemporary  (3  months  pre-
separation) PT ROM measurements for the cervical spine were flexion ≥45 degree (normal 45 
degrees), but a combined ROM of 184 degrees (normal 340 degrees).  The post-separation (1 
month)  VA  C&P  examination  noted  “occasional  cervical  pain  [rated  2-3/10],  which  has  been 
partially relieved by the use of injection.”  The VA ROM measurements were flexion 30 degrees 
and combined 300 degrees.  The VA rating decision also referenced another ROM evaluation 
(August  15,  2003)  citing  cervical  extension  of  20  degrees  (normal  45  degrees),  but  added 
“Forward  flexion,  lateral  bending  and  rotation  were  within  normal  limits.”  The  source 
examination was not in evidence, but the VARD entry was considered probative.  The deferred 
VA evaluation for the LUE radiculopathy (6 months post-separation) noted a sensory deficit in 
the C6 dermatome, but normal strength and reflexes.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB’s 0% rating analogously to 5003 (degenerative arthritis) was supported by the USAPDA pain 
policy;  but,  did  not  account  for  VASRD  §4.59  (painful  motion)  which  was  supported  by  the 
evidence; and, which would yield the minimal compensable rating of 10%.  The VA’s 10% rating 
was  compliant  with  the  contemporary  VASRD  general  rating  formula  for  the  spine,  and 
consistent  with  the  evidence.    Under  the  VASRD  in  effect,  coding  and  rating  options  for  the 
cervical  spine  were  5290  (spine, 
limitation  of  motion,  cervical)  and  the  same  5293 

intervertebral  disc  code  excerpted  in  the  lumbar  spine  discussion.    Even  considering  that 
abatement  of  the  cervical  radicular  pain  may  have  been  a  temporary  effect  of  the  epidural 
injection, there were no ‘recurring attacks’ in evidence that would achieve a rating higher than 
10% under 5293.  The 5290 ROM code offered a 10% rating for ‘slight’, 20% for ‘moderate’, and 
30%  for  ‘severe’  limitation.    Given the  ROM limitation  in  evidence,  potentially higher  ratings 
could be entertained under 5290; and, IAW VASRD §4.7 (higher of two evaluations), members 
agreed that it was the preferential code for the Board’s rating recommendation.  All members 
agreed that the ‘severe’ rating was not supported by the evidence; but, deliberated between 
the ‘slight’ and ‘moderate’ rating levels.  Although the combined ROM recorded in the MEB PT 
measurements could be fairly characterized as ‘moderate’ limitation overall, flexion was normal 
and the prevailing  ROM  evidence from the  STR  would  not  corroborate  that  conclusion.    The 
post-separation VA ROM’s could not be reasonably characterized as ‘moderate’ limitation; and, 
were  more  proximate  to  separation  and  performed  by  a  physician  examiner.    Weighing 
probative value and considering the preponderance of the evidence, members agreed that the 
ROM limitation was more reasonably characterized as ‘slight’ than as ‘moderate’.  Considering 
the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed 
that  a  disability  rating  of  10%  for  the  cervical  spine  condition  under  code  5290  was 
appropriately recommended in this case.  
 
The Board additionally considered whether additional ratings could be recommended under a 
peripheral nerve code, as later conferred by the VA, for the cervical radiculopathy in this case.  
In  this  regard,  it  was  also  considered  that  the  acuity  was  perhaps  temporarily  abated  at 
separation.  Firm Board precedence requires a functional impairment tied to fitness to support 
a  recommendation  for addition  of  a peripheral  nerve  rating to disability  in  spine  cases.    The 
pain  component  of  a  radiculopathy  is  subsumed  under  the  spine  rating.    The  sensory 
component in this case (documented only on the 6 month VA examination) has no functional 
implications; and, the motor impairment (non-dominant extremity) was either intermittent or 
relatively minor and cannot be linked to significant functional consequence.  There is thus no 
evidence  of  separately  ratable  functional  impairment  (relevant  to  fitness)  from  the  residual 
radiculopathy;  and,  the  Board  cannot  support  a  recommendation  for  an  additional  disability 
rating on this basis.   
 
 
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  DoDI  1332.39  and  AR  635-40  for  rating  the  lumbar  spine  condition,  and  on  the 
USAPDA pain policy for rating the cervical spine condition was operant in this case; and, those 
conditions were adjudicated independently of those directives by the Board.  In the matter of 
the  lumbar  spine  condition  and  IAW  VASRD  §4.71a  in  effect  at  separation;  the  Board 
unanimously recommends no change in the PEB rating of 10%, but a change in code to 5295.  In 
the  matter  of  the  cervical  spine  condition,  the  Board  unanimously  recommends  a  disability 
rating  of  10%,  coded  5290,  IAW  VASRD  §4.71a  in  effect.    The  Board  members  unanimously 
agreed  that  no  additional  disability  rating  for  the  cervical  radiculopathy  could  be 
recommended.    There  were  no  other  conditions  within  the  Board’s  scope  of  review  for 
consideration.  
 
 
RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation: 

 

UNFITTING CONDITION 

Degenerative Disc Disease, Lumbar Spine 
Degenerative Disc Disease, Cervical Spine 

 

 
 
 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120607, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans Affairs Treatment Record. 
 
 
 
 
 
 
 
 

 

VASRD CODE  RATING 

10% 
10% 
20% 

5295 
5290 

COMBINED 

           XXXXXXXXXXXXXXXX 
           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 XXXXXXXXXXXXXXXXX, AR20120021436 (PD201200630) 
 
 
1.  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 to modify the individual’s disability rating to 20% without recharacterization 
of the individual’s separation.  This decision is final.   
 
2.  I direct that all the Department of the Army records of the individual concerned be corrected 
accordingly no later than 120 days from the date of this memorandum.    
 
3.  I request that a copy of the corrections and any related correspondence be provided to the 
individual concerned, counsel (if any), any Members of Congress who have shown interest, and 
to the Army Review Boards Agency with a copy of this memorandum without enclosures. 
 
BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)