RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY  
SEPARATION DATE:  20020119 

 
NAME:  XXXXXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200708 
BOARD DATE:  20130116   
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SPC/E-4 (92G10/Food Service Specialist), medically 
separated for chronic low back pain (LBP) with imaging findings of mild facet changes L4/L5.  
The CI had a one year history of gradually worsening LBP follow a fall.  The CI did not improve 
adequately  with  treatment  to  meet  the  physical  requirements  of  his  Military  Occupational 
Specialty  or  satisfy  physical  fitness  standards.    He  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  LBP  with 
imaging findings of mild facet changes L4/L5 condition as unfitting, rated 10%.  The CI made no 
appeals, and was medically separated with a 10% disability rating.   
 
 
CI CONTENTION:  “Had major back and spine surgery in 2009.  L4-L5, L5-S1 completely taken 
out and replaced with medal Rods, screws, pins and cased.”   
 
 
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 with imaging findings of 
mild facet changes L4/L5 condition as requested for consideration meet the criteria prescribed 
in DoDI 6040.44 for Board purview; and, is 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 Correction of Military Records.   
 
 
RATING COMPARISON:   
 

5299-5295 

VA (~1 Mo. Post-Separation) – All Effective Date 20020120 
Condition 
Degenerative  Disc  Disease  Due 
To Trauma, Lumbar Spine  
0% X 1 / Not Service-Connected x 1 
Combined:  20%* 

Service IPEB – Dated 20011022 
Condition 
 Chronic  Low  Back  Pain 
with  Imaging  Findings  of 
Mild Facet Changes L4/L5 
↓No Additional MEB/PEB Entries↓ 
Combined:  10% 
* Temporary 100% (convalescent) rating from 20090519-20091201 
 
 
ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant 
impairment  with  which  his  service-connected  condition  continues  to  burden  him,  and  his 
additional back surgery; but, must emphasize that the Disability Evaluation System has neither 
the role nor the authority to compensate members for anticipated future severity or potential 

Rating 

Exam 

Rating 

5010-5292 

20%* 

20021108 

Code 

Code 

10% 

 

  Post-separation  evidence 

complications of conditions resulting in medical separation.  That role and authority is granted 
by  Congress  to  the  Department  of  Veteran  Affairs  (DVA),  operating  under  a  different  set  of 
laws.    The  Board  considers  DVA  evidence  proximate  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 
recommendations  only  to  the  extent  that  it  reasonably  reflects  the  disability  at  the  time  of 
separation.  The Board notes that the Veterans Affairs Schedule for Rating Disabilities (VASRD) 
standards  for  the  spine  which  were  in  effect  at  the  time  of  separation,  were  changed  in 
September  2002  (for  code  5293  only),  and  then  to  the  current  §4.71a  rating  standards  in 
September  2003.    The  Board  must  correlate  the  above  clinical  data  with  the  2002  rating 
schedule (applicable diagnostic codes include:  5292 (limitation of lumbar spine motion); 5293 
(Intervertebral disc syndrome); and 5295 (Lumbosacral strain).  For the reader’s convenience, 
the 2001 rating codes under discussion in this case are excerpted below.   
 

is  probative 

to 

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 osteoarthritic changes, or narrowing or 
irregularity  of 
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  above  with  abnormal  mobility  on 

space,  or 

some  of 

joint 

 
Chronic Low Back Pain:  Service treatment records indicate a history of intermittent LBP since 
approximately 1997.  An April 2001 physical therapy examination noted palpable muscle spasm; 
however, subsequent examinations did not note the presence of muscle spasm.  An 11 June 
2001  clinic  encounter  recorded  complaint  of  radiating  pain.    On  examination  there  was 
tenderness.    Straight  leg  raising  (SLR)  was  negative  for  nerve  root  irritation;  and  strength, 
reflexes and sensation were normal.  X-rays were reported to show degenerative disc disease 
(DDD) at L4-5 and L5-S1.  The MEB narrative summary (NARSUM), 11 July 2001, reported a one 
year  history  of  increasing  chronic  LBP  leading  to  referral  for  MEB.    The  CI  complained  of 
increased  pain  with  prolonged  sitting/standing,  bending  and  activity.    On  examination,  there 
was tenderness to palpation, and paraspinous musculature was “symmetric”.  Range-of-motion 
(ROM) was reported for the lumbar spine using a bubble inclinometer.  Lumbar flexion was 50 
degrees  with  extension  of  15  degrees  and  lateral  flexion  of  20  degrees  bilaterally  (with  no 
normal values stated).  SLR was negative and there was no weakness or loss of sensation noted 
on  exam.    A  magnetic  resonance  imaging  (MRI)  scan  on  2  October  2001,  3  months  prior  to 
separation, demonstrated DDD at L4-5 and L5-S1 with disc protrusions at both levels and mild 
neural foraminal stenosis and mild canal stenosis.   
 

At the VA Compensation and Pension (C&P) exam, 9 months after separation, the CI reported 
back  pain  that  worsened  with  bending  with  origin  in  the  neck  radiating  down  to  his  lumbar 
spine.  He reported occasional numbness in his arms and on the plantar surfaces of his feet.  He 
denied weakness in his extremities and changes in bladder or bowel function.  On examination, 
there  was  mild  palpable  tenderness  noted  in  the  lumbar  region  without  mention  of  muscle 
spasm.    Gait  and  posture  were  normal.    Back  ROM  was  flexion  90  degrees,  extension  20 
degrees,  lateral  bending  30  degrees  both  sides  and  rotation  30  degrees  both  sides  (with  no 
normal values stated).  There was report of pain on flexion and extension of the spine.  Strength 
and sensation were normal.  Subsequent VA records indicate lumbar inter-body fusion surgery 
in May 2009 (over six years post-separation), with no post-surgical VA exams, but a return to a 
20% VA rating effective December 1, 2009.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  rated  the  condition  10%  based  on  pain  on  forward  motion  under  the  5295  code  for 
lumbosacral strain.  The VA granted 20% for moderate limitation of motion (5292, limitation of 
motion) based on the C&P examination.  Of particular note in this case was that the older VA 
criteria  for  the  spine  separated  lumbar  and  thoracic  (dorsal)  spine  segments  for  rating,  and 
there  were  no  VA-specified  normal  ROMs  (guidance  suggested  the  American  Medical 
Association  (AMA)  guidelines,  but  any  provider-specified  normal  ROM  was  applied).    The 
current VA normal spine ROMs were added in September 2003 with Plate V and the General 
Rating Formula for Diseases and Injuries of the Spine which was not in effect at the time of the 
CI’s  separation.    The  VA  reported  90  degrees  of  lumbar  forward  flexion  and  ROMs  were 
consistent  with  near-normal  ROMs  from  the  AMA  guidelines  in  effect  at  the  time,  and  the 
Board adjudged these as slight limitation (IAW 5292, Spine, limitation of lumbar motion).  The 
NARSUM  reported  the  50  degrees  lumbar  forward  flexion  was  accomplished  using  a  bubble 
inclinometer (not a goniometer), indicating measurement of isolated lumbar spine motion.  No 
normal values were reported, however, normal ROMs in use at the time were from 60 to 80 
degrees depending  on the  source  and  method of  inclinometer use,  which  was  not  specified.  
The Board majority considered this slight limitation of motion.  A rating under code 5293 for 
intervertebral disc syndrome to address MRI findings and radicular symptoms; however, there 
was a lack of evidence to support recurring attacks at the moderate level (20%).  The Board 
considered the rating under 5295, lumbosacral strain, and agreed there was characteristic pain 
on motion supporting the 10% rating.  After due deliberation, considering all of the evidence 
and mindful of VASRD §4.3 (Resolution of reasonable doubt) and §4.59 (Painful motion), the 
Board majority concluded that there was insufficient cause to recommend a change in the PEB 
adjudication for the chronic low 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.    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 chronic LBP condition and IAW VASRD §4.71a, the Board, 
by a vote of 2:1, recommends no change in the PEB adjudication.  The single voter for dissent 
(who recommended 20%, coded 5010-5292) did not elect to submit a minority opinion.  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 
Chronic Low Back Pain 

VASRD CODE  RATING 
5299-5295 
COMBINED 

10% 
10% 

 
 
 
 
 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120611, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXX, AR20130002783 (PD201200708) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)