RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
BRANCH OF SERVICE: ARMY
SEPARATION DATE: 20010924
NAME: XXXXXXXXXXXXXXX
CASE NUMBER: PD1200857
BOARD DATE: 20130109
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty SGT/E‐5 (71L/Administrative Specialist), medically
separated for chronic low back pain (LBP). The CI developed LBP that did not improve
adequately with treatment to meet the physical requirements of his Military Occupational
Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent P3 profile and
later was 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 as unfitting, rated 10%, with application of the Department of Defense Instruction (DoDI)
1332.39 and Army regulation. The CI made no appeals, and was medically separated with a
10% disability rating.
CI CONTENTION: “Degenerative Disc Disease”
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 condition, chronic LBP, will be reviewed by the Board. The other conditions rated
by the VA at separation (headaches, pes planus) are not within the Board’s purview. The CI's
remaining contended conditions of right knee, left knee, eczema and non‐cardiac chest pain are
also not within the 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.
RATING COMPARISON:
Service PEB – Dated 20010611
VA (25 Mos. Post‐Separation) – All Effective Date 20010925
ANALYSIS SUMMARY:
Chronic low back pain. The CI developed LBP about 7 years prior to MEB without specific injury.
Magnetic resonance
lumbar spine 27 January 2000 documents
degenerative changes of L5‐S1, without intervertebral disc protrusion or herniation. A
neurosurgical evaluation performed on 27 February 2001, 7 months before separation,
recorded “good ROM in flexion and extension,” and normal gait. The neurosurgeon noted the
MRI showed no disc herniation and recommended non‐surgical treatment. The CI declined
imaging (MRI) of the
Condition
Chronic low back pain
Code
5299‐5295
Rating
10%
↓No Addi(cid:415)onal MEB/PEB Entries↓
Combined: 10%
Condition
Disc disease low back
Headaches
Pes planus, bilateral
Code
5293‐5292
8100
5276
Rating
40%
30%
10%
Exam
20021025
20021025
20021025
0% X 4 / Not Service‐Connected x 1
Combined: 60%
injections offered by a pain specialist. At the MEB examination, 3 May 2001, the CI's back
range‐of‐motion (ROM) was limited by pain to 90 degrees of forward flexion, extension zero
degrees. The CI stated he was unable to extend the back beyond normal anatomic plane
stating that hyperextension increased his back pain. Lateral movements were 5 degrees
bilaterally. He also stated that rotation of the lumbar spine worsened his pain. There was pain
reported with a maneuver not expected to cause pain. Straight leg raising (SLR) was negative
for nerve root irritation (he had pain in lower back with no radiation). Strength and sensation
were normal. Both his heel and toe walking were normal without mention of antalgia. At the
VA Compensation and Pension (C&P) exam on 25 October 2002, the CI underwent a general
medical examination and a neurology assessment. At the general examination, the CI claimed
tenderness to any percussion of the back and declined to participate in the ROM examination
stating “something I can’t do.” The CI also declined to cooperate with the knee ROM
examination “Because it hurts if I do.” Gait was slow. During the separate neurology C&P
examination on 25 October 2002, gait was normal with good tandem gait. There was
percussion tenderness over the lumbar spine. ROM of the lumbar spine was 30 degrees of
flexion, 5 degrees of extension, and 15 degrees of right and left lateral flexion, all with pain.
Strength was normal (5/5) in all muscle groups bilaterally although there was some give‐way
weakness in the lower extremities secondary to back pain. Deep tendon reflexes and sensation
were intact. Lumbar spine X‐rays 25 October 2002 were normal including normal intervertebral
disc spaces.
The Board directs attention to its rating recommendation based on the above evidence. In
accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in
effect at the time of separation. The Board notes that the 2001 Veteran Administration
Schedule for Rating Disabilities (VASRD) standards for the spine, which were in effect at the
time of separation, were changed to the current §4.71a rating standards in 2004. The Board
must correlate the above clinical data with the 2001 rating schedule (applicable diagnostic
codes include: 5292 limitation of lumbar spine motion; 5293 intervertebral disc syndrome; and
5295 Lumbosacral strain). The PEB rated the condition 10% citing “characteristic pain on
motion, coded 5299‐5295 (lumbosacral strain). The VA rated 40% citing limitation of motion at
the time of the C&P examinations over a year after separation (coded 5293‐5292). The Board
considered the rating under the VASRD diagnostic code 5292 in effect at the time. The Board
agreed that with the ROM at the time of the neurology examination 7 months before
separation and the MEB examination 4 months before separation, supported the 10% rating
but not a higher rating under code 5292. The Board noted the VA examinations over a year
after separation showing moderate to severe limitation of motion without apparent cause for
the marked reduction since the MEB examination. The neurology examination demonstrated
an otherwise normal examination including gait. X‐rays of the lumbar spine obtained at the
time of the C&P examination were normal. The Board concluded the MEB examination which
was more proximate to the time of separation, was more reflective of the disability at the time
of separation. The Board then considered whether a higher rating was warranted under codes
5293 or 5295 of the VASRD in effect at date of separation. Magnetic resonance imaging (MRI)
prior to separation did not demonstrate evidence of intervertebral disc disease and there was
no evidence of sciatic neuropathy or radiculopathy to warrant consideration under the 5293
intervertebral disc syndrome code. All members agreed the MEB examination also supported a
10% rating under the 5295 code, lumbosacral stain, characteristic pain on motion but not a
higher rating. 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 LBP 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
2 PD12‐00857
inconsistent with the VASRD in effect at the time of the adjudication. In the matter of the
chronic LBP 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 low back pain
UNFITTING CONDITION
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20120606, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record
XXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
SFMR‐RB
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD‐ZB / XXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202‐3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for
XXXXXXXXXXXXX, AR20130001175 (PD201200857)
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:
3 PD12‐00857
Encl
XXXXXXXXXXXX
Deputy Assistant Secretary
(Army Review Boards)
CF:
( ) DoD PDBR
( ) DVA
4 PD12‐00857
AF | PDBR | CY2012 | PD 2012 00938
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The PEB rated the condition 10% based on pain on forward motion under the 5295 code for lumbosacral strain. 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). Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXX, DAF Director Physical Disability...
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RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201023 SEPARATION DATE: 20020814 BOARD DATE: 20130124 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (13B/Canon Crewmember), medically separated for chronic low back pain (LBP) secondary to spondylolysis at L-3 without neurologic abnormality. RECOMMENDATION: The Board, therefore,...