RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXXX                                                                  BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200837                                                           SEPARATION DATE:  20030302 
BOARD DATE:  20130122 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SGT/E-5  (11B/Infantry)  medically  separated  for  a 
lumbosacral spine condition.   He had a long standing history of chronic low back pain  (LBP), 
with  an  initial  diagnosis  of  sacroiliac  (SI)  degenerative  arthritis  and  a  subsequent  additional 
diagnosis  of  lumbar  spine  degenerative  disc  disease  (DDD).    No  surgical  interventions  were 
indicated and the condition did not improve adequately with conservative measures to meet 
the  physical  requirements  of  his  Military  Occupational  Specialty  or  satisfy  physical  fitness 
standards.    He  was  consequently  issued  a  permanent  L3  profile  and  referred  for  a  Medical 
Evaluation Board (MEB).  The condition was forwarded to the Physical Evaluation Board (PEB) 
under separate diagnoses of SI joint osteoarthritis and lumbar spine DDD, each judged to be 
medically unacceptable IAW AR 40-501.  No other conditions were submitted by the MEB.  The 
PEB combined the separate lumbar spine and sacroiliac diagnoses as a single unfitting condition 
“(chronic pain, due to bilateral sacroiliac joint osteoarthritis and lumbar spine degenerative disc 
disease)” rated 20%, referencing Army Regulation (AR) 635-40 (paragraph B, 24f).  The CI made 
no appeals, and was medically separated with a 20% disability rating. 
 
 
CI  CONTENTION:    The  application  states  simply,  “Because  my  condition  is  not  getting  any 
better.” 
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of Defense Instruction (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 rating for the unfitting lumbar/sacroiliac condition 
is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview 
of  the  Board.    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. 
 
The Board acknowledges the CI’s statement regarding the significant impairment with which his 
service-connected condition continues to burden him; but, must emphasize that 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 (DVA), operating under a different set of laws. 
 
 

 

RATING COMPARISON:  
 

Service PEB – Dated 20021223 
Condition 
Chronic Pain, SI Joint Arthritis 
and Lumbar Spine DDD 

Code 
5003 

Rating 
20% 

No Additional MEB/PEB Entries 

VA (1 Mo. Post-Separation) – Effective 20030303 
Condition 
Bilateral  SI  Joint  Osteoarthritis 
and Lumbar Spine DDD 
PFS, Right Knee  
PFS, Left Knee 
Right Wrist Strain 
Gastroesophageal Reflux Disease 
Urticaria 
0% X 3 
Combined:  40% 

Code 
5010-5295 
5099-5024 
5099-5024 
5215 
7399-7346 
7825 

Rating 
10%* 
10% 
10% 
10% 
10% 
10% 

Exam 
20030414 
20030414 
20030414 
20030414 
20030414 
20041023 
20030414 

Combined:  20% 
*Increased to 20% by Review Decision dated 20041220, citing exam of 20040821 (17 mo. post-separation). 
 
 
ANALYSIS SUMMARY: 
 
Lumbar Spine/Sacroiliac Condition(s).  The CI began experiencing LBP approximately 12 years 
prior to separation, and symptoms worsened in 1995.  There was no history of discrete trauma 
or other precipitant; X-ray findings demonstrated mild degenerative changes bilaterally of the 
SI joints; and, the pain was managed conservatively with temporary profiles.  In 2002 the CI 
began experiencing radiation of the pain (buttocks, posterior legs, left > right), and magnetic 
resonance imaging diagnosed mild DDD at L3/4 and L5/S1 without disc herniation, stenosis, or 
neuroforaminal  involvement).    The  radicular  pain  was  not  associated  with  motor  symptoms, 
and  electrodiagnostic  testing  in  August  2002  was  normal.    The  Physical  Medicine  (PM) 
consultant at that time noted the radicular pain (as above) with occasional paresthesias on the 
left,  but  no  weakness  or  bowel/bladder  symptoms.    Pain  was  constant  and  aggravated  by 
prolonged standing and sitting.  The physical examination made no comment on gait, curvature, 
spinal tenderness, or spasm; other MEB clinical entries document normal gait and curvature, 
and occasionally paraspinal tenderness.  Motor strength and reflexes were normal, with mild 
sensory decrease to fine touch on the left.  Formal range-of-motion (ROM) measurements of 
the  thoracolumbar  spine  were  flexion  of  90  degrees  (normal)  and  a  combined  ROM  of  240 
degrees  (normal).    The  PM  consultant  recommended  continuance  of  the  MEB;  and,  the 
narrative summary composed 3 months later essentially duplicated the PM history and findings.  
The VA Compensation and Pension exam (a month post-separation) reported “10/10 sharp pain 
two  times  per  month  with  bending  and  lifting.”    The  VA  physical  exam  noted  a  “slight  limp 
favoring  the  left  leg”,  with  no  comment  on  direct  spinal  findings.    Neurologic  findings  were 
normal.  Complete thoracolumbar ROM measurements by the VA were normal in all planes. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board first considered if separate ratings could be recommended for the separate lumbar spine 
and SI joint diagnoses evidenced in the case.  It is noted, however, that VASRD §4.71a separate 
coding  options  for  SI  disease  default  to 
lumbar  spine  ratings  (as  below);  and,  this 
notwithstanding, the pathology and disability are linked as such that any attempt at separate 
ratings  would  not  comply  with  VASRD  §4.14  (Avoidance  of  pyramiding).    The  2003  VASRD 
coding  and  rating  standards  for  the  spine,  which  must  be  applied  to  the  Board’s 
recommendation IAW DoDI 6040.44, differ significantly from the current §4.71a general rating 
formula for the spine.  The applicable coding options for this case are excerpted below.  
 

 

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5292 Spine, limitation of motion of, lumbar 

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

 5294 Sacro-iliac injury and weakness: [Defaults to 5295 criteria below.] 
 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 

The  PEB’s  rating  under  5003  (degenerative  arthritis)  cited  the  AR  635-40  provision  for  a 
maximum 20% rating for pain.  The criterion of pain on motion was met for a 10% rating under 
5295, as initially conferred by the VA; but, the criteria for a higher rating under that code were 
not  met.    The  normal  ROMs  in  evidence  would  clearly  not  support  an  advantageous  rating 
under  5292.    The  only  remaining  code  available  in  the  2003  VASRD  schedule  was  5293 
(intervertebral  disc  syndrome),  which  is  clearly  not  applicable  to  this  case.    The  VA’s  later 
increase  in  rating  as  footnoted  above  in  the  rating  comparison  chart  was  premised  on 
incapacitating  episodes  that  developed  after  separation.    It  is  thus  apparent,  based  on  the 
evidence at the time of separation, that a maximum rating of 10% is achievable IAW the VASRD 
in  effect  at  separation.    IAW  DoDI  6040.44,  however,  the  Board  may  not  lower  the  rating 
conferred  by  the  service  PEB;  which  takes  precedence  if  service  or  DoD  guidance  is  more 
favorable  to  rating  than  the  VASRD.    There  was  no  evidence  of  ratable  peripheral  nerve 
impairment  in  this  case  which  would  provide  for  additional  rating.    After  due  deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the 
Board  concluded  that  there  was  insufficient  cause  to  recommend  a  change  in  the  PEB 
adjudication of the lumbar spine 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.  As discussed above, PEB 
reliance on AR 635-40 for rating the lumbar spine/sacroiliac condition was operant in this case; 
but DoDI 6040.44 caveats the above mandate with the stipulation that the service combined 
rating may not be lowered; and the Board’s recommendation for this condition is thus derived 
from AR 635-40.  In the matter of the lumbar spine/sacroiliac condition, 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: 
 

UNFITTING CONDITION 
Sacroiliac  Joint  Osteoarthritis  and  Degenerative  Disc  Disease, 
Lumbosacral Spine 

 

VASRD CODE  RATING 
5003 
COMBINED 

20% 
20% 

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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. 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

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SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXX, AR20130002541 (PD201200837) 
 
 
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 
 
 
 
 

      XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 

 

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