RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20021017 

 
NAME:  XXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200984 
BOARD DATE:  20130212 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  Soldier,  SGT/E-5(77F/Petroleum  Supply  Specialist), 
medically separated for right ankle pain, low back pain (LBP), and superior labral tear of the left 
hip.  An ankle injury in 1994 resulted in a talar dome avulsion fracture.  The CI injured her back 
in  October  1998  when,  during  training,  she  fell  from  a  two-story  obstacle  that  was 
approximately  10  feet  high.    An  August  2000  magnetic  resonance  imaging  (MRI)  showed  a 
labral tear of her left hip.  These conditions could not be adequately rehabilitated, and the CI 
did not improve adequately with treatment 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 MOS Medical Retention Board (MMRB).  The MMRB denied her 
reclassification,  and  referred  her  to  a  Medical  Evaluation  Board  (MEB).    The  MEB  forwarded 
chronic LBP with facet joint arthritis, superior labral tear of the left hip, and right ankle pain 
secondary to  avulsion fracture of talus  as  medically  unacceptable  IAW  AR  40-501.    The  MEB 
forwarded  no  other  conditions  for  Physical  Evaluation  Board  (PEB)  adjudication.    The  PEB 
adjudicated the right ankle pain, LBP, and superior labral tear of the left hip as unfitting, rated 
10%,  0%,  and  0%  respectively,  with  application  of  the  Veterans  Affairs  Schedule  for  Rating 
Disabilities (VASRD) and likely application of the US Army Physical Disability Agency (USAPDA) 
pain policy.  The CI made no appeals, and was medically separated with a 10% disability rating.  
 
 
CI CONTENTION:  The CI states: “Should be changed to retirement due the VA rating of 2009 
granting 30% disability.”  [sic] 
 
 
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.  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 20020624 
Condition 
Right Ankle Pain 

Code 
5271 

Rating 
10% 

VA (2 & 4 Mos. Post-Separation) – All Effective Date 20021018 
Condition 
Right Ankle Talar Dome Fracture 
Residuals 
Degenerative Changes and Facet 
Joint Arthritis, Lumbar Spine 
Left Hip Superior Labral Tear 

Rating 
0% 

Code 
5271 

5010-5295 

5010-5252 

10%* 

20%* 

Exam 
20030206 

0% 

0% 

20011226 

20030206 

20030206 

5099-5003 

5299-5295 

Combined:  30% 

0% X 1 / Not Service-Connected x 7 

Low Back Pain 
Left  Hip  Superior  Labral 
Tear 
 
↓No Additional MEB/PEB Entries↓ 
 
Combined:  10% 
*Rating decision 20090825 increased lumbar spine to 20%, changed code to 5242; and decreased left hip to 10%; combined 
30% effective 20090814  
 
 
ANALYSIS  SUMMARY:    The  Board  notes  the  current  VA  ratings  listed  by  the  CI  for  all  of  her 
service-connected conditions, but must emphasize that its recommendations are premised on 
severity at the time of separation.  The VA ratings which it considers in that regard are those 
rendered most proximate to separation.  The Disability Evaluation System 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.  
 
Right Ankle Pain Condition.  The diagnosis of a grade 2-3 osteochondritis dissecans (OCD) lesion 
of  the  talar  dome  was  made  by  an  orthopedist  in  October  1994  after  the  CI  sustained  an 
inversion injury while running.  Conservative treatment with physical therapy (PT) and activity 
modification  resulted  in  improvement  in  pain.    The  last  clinical  entries  regarding  ankle  pain 
prior to the MEB process were in 1996, at which time she was seen for ankle  pain that was 
precipitated by running.  The final entry on 23 September 1996 indicated that ankle pain had 
resolved.  An orthopedic evaluation for unrelated problems on 22 February 2001 indicated that 
the CI experienced occasional right ankle swelling, but examination showed no swelling.  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.   
 

Right Ankle ROM 

VA C&P ~10 Mos. Pre-Sep 

PT ~4 Mos. Pre-Sep 

VA C&P ~4 Mos. Post-Sep 

Dorsiflexion (0-20⁰) 
Plantar Flexion (0-45⁰) 
Comment 
§4.71a Rating 

20⁰ 
40⁰ 
+Tenderness 
10% 

5⁰ 
60⁰ 
+Painful motion 
10% 

“Full” 

Intermittent pain 
0% or 10% (VA 0%) 

 
A  commander’s  evaluation  performed  10  months  prior  to  separation  (6  December  2001) 
addressed a back and hip condition, but did not mention ankle problems.  A VA Compensation 
and  Pension  (C&P)  exam  10  months  prior  to  separation  (20  December  2001)  noted  current 
wear of a right ankle bandage due to a recent sprain.  Examination revealed a right leg limp 
without use of support.  A second C&P exam 6 days later however reported that she used a 
cane for ambulation support for low back and left hip pain.  She reportedly used a brace on her 

right ankle during cold weather.  Examination revealed ability to perform toe raises.  Inversion 
and eversion of the ankle were completed without difficulty.  Mild swelling of the ankle was 
present.  X-rays of the ankle were normal.  The examiner’s assessment was that no evidence of 
talar dome fracture residuals existed.  A third C&P examiner on the same day indicated that 
weather changes caused mild swelling and discomfort, and that she wore an ankle sleeve.  The 
MEB narrative summary (NARSUM) report, dictated 8 months prior to separation (6 February 
2002) listed “Right ankle pain secondary to avulsion fracture of the talus” as a diagnosis, but 
provided no recent historical details about ankle symptoms or impairment.  A PT evaluation 4 
months prior to separation (5 June 2002) reported ankle pain.  During ROM testing, pain was 
reported in all directions tested.  At the C&P exam 4 months after separation, the CI reported 
that  right  ankle  pain  was  intermittent,  but  had  a  current  complaint  of  pain  anteriorly.  
Examination revealed use of a cane; she walked with a limp avoiding pressure on the left side.  
The ankle appeared normal.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB and the VA used the same 5271 code (ankle, limited motion of) but arrived at different 
ratings.    The  PEB’s  10%  rating  was  based  on  painful,  limited  dorsiflexion  while  the  VA’s  0% 
rating was based on normal, though unmeasured, ROM.  Board members agreed that a 10% 
rating was justified based on limitation of motion or with application of §4.59 (Painful motion), 
and that there was no pathway to a rating higher than 10% under other applicable codes.  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 for the right ankle condition. 
 
Low Back Pain Condition.  The 2002 VASRD coding and rating standards for the spine, which 
were in effect at the time of separation, were changed to the current §4.71a rating standards 
on 26 September 2003, and were identical to the interim VASRD standards used by the VA in its 
rating  decision.    The  ratings  prior  to  26  September  2003  were  based  on  a  judgment  as  to 
whether the disability was mild, moderate or severe.  The current standards are grounded in 
ROM measurements.  IAW DoDI 6040.44, this Board must consider the appropriate rating for 
the  CI’s  back  condition at  separation  based  on the  VASRD  standards  in  effect  at the time of 
separation (i.e. pre-2004 standards).  The CI injured her back during a fall from a height of 8-10 
feet in October 1998.  An MRI evaluation on 9 August 2001 revealed degenerative changes and 
facet joint arthritis, but no disc herniation.  Ongoing pain did not respond to PT and required 
narcotic medication for management.  The MEB physical exam a year prior to separation noted 
that although the CI could not bend into a crouching or squatting position due to back pain, she 
was observed to bend over to robe and disrobe.   As previously noted, the C&P examiner on 
20 December 2001 (10 months prior to separation) reported a limp due to a recent right ankle 
sprain  which  did  not  require  support.    ROM  measurements  showed  lumbar  flexion  of  80 
degrees (90 degrees normal by current standards), extension of 15 degrees (30 degrees normal) 
and lateral flexion of 15 degrees bilaterally (30 degrees normal).  Tenderness was present.  A 
second C&P examiner on 26 December 2001 reported use of a cane for low back and left hip 
pain.  Straight leg raise testing did not produce pain characteristic of radiculopathy.  “Exquisite 
tenderness” of the lumbar region was noted.  X-rays of the lumbar spine were normal, although 
minimal degenerative change of the right sacroiliac joint was present.  Another C&P examiner 
that day reported “full range of motion, flexion, and extension of her lumbar spine.”  Rotation 
and lateral flexion were also considered “full.”  Moderate to severe tenderness and mild muscle 
spasm  of  the  left  paraspinal  muscles  was  noted.    At  the  NARSUM  exam,  the  CI  reported  an 
inability to bend, crouch or squat due to back pain.  She was noted to ambulate with a cane, 
and was observed to assist herself by leaning on furniture.  Decreased ROM in all directions was 
reported,  but  measurements  were  not  specified.    The  examiner  referred  to  an  Occupational 

Therapy functional work capacity evaluation which noted an inability to tolerate standing for 
longer  than  15  minutes,  but  could  tolerate  over  one  hour  of  sitting  with  frequent  position 
changes.  It was recommended that she not engage in occupations requiring frequent bending 
or stooping, and limit lifting to 10 pounds infrequently.  The PT evaluation reported that pain 
was rated 10/10 by the CI, although a distinction between back, hip and ankle pain was not 
specified.    Flexion  was  120  degrees,  extension  40  degrees  and  lateral  flexion  30  degrees 
bilaterally.  During ROM testing, “pain at end range” was reported in all directions, although 
rotation was not tested.  A subjective LBP disability questionnaire scored the condition at 60% 
on a 0 to 100% scale (0% is completely normal).  At the C&P exam the CI reported left LBP that 
was constant, rated at a severity of 7-8 out of 10.  The purpose of a cane during ambulation was 
“because  the  leg  feels  weak.”    Examination  noted  the  impression  that  she  was  in  pain.  
Equilibrium and posture were good.  Normal lumbar lordosis was present.  She complained of 
severe  pain  with  touching  of  the  low  back.    Spasm  was  absent.    Flexion  was  15  degrees, 
extension  5  degrees,  lateral  flexion  10  degrees  bilaterally  and  rotation  0  degrees  bilaterally.  
The ROMs noted were stated in the following way:  “Range of motion resisted to 5 degrees of 
extension out of 30 degrees with complaint of severe pain.”  This descriptive language was used 
for all ROM values.  This examiner stated that ROM was inconsistent with any pathology.  X-rays 
of the lumbosacral spine were reportedly within normal limits.  A second C&P examiner on the 
same day stated that the CI had used a cane for the prior a year because of the back problem. 
 
The  Board  must  correlate  the  above  clinical  data  with  the  2002  rating  schedule  which,  for 
convenience, is excerpted below: 
 

5292 Spine, limitation of motion of, lumbar: 

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

 

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 PEB and VA assigned respective ratings under the 5295 code (lumbosacral strain).  The PEB 
cited pain occurring “beyond the ratable range” in their 0% adjudication, while the VA assigned 
a 10% rating, stating that the disability was evaluated based on clinical findings since objective 
ROM was “not available.”  Board members considered the MEB examiner’s observation (that 
the CI could bend over to dress and undress despite a reported inability to bend or crouch) and 
the  ROM  values  by  the  service  PT  that  was  normal  by  today’s  standards.    Board  members 
likewise agreed that the dramatically reduced ROM values reported by the C&P examiner were 
not  consistent  with  other  clinical  observations.    The  Board  debated  if  there  was  sufficient 
evidence of Functional loss (§4.40) or Pain motion (§4.59) to justify a minimum compensable 
rating,  but  the  Board  majority  concluded  that  such  evidence  was  not  present.    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 for the LBP condition.   
 
Left  Hip  Condition.    There  were  two  goniometric  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.   
 
 
 
 
 
 

VA C&P ~10 Mos. Pre-Sep 
90⁰ 

PT ~4 Mos. Pre-Sep 
90⁰ 
10⁰ 
40⁰ 
16⁰ 
6⁰ 
+Painful motion 
10% 

VA C&P ~4 Mos. Post-Sep 
30⁰ 
0⁰ 
30⁰ 
15⁰ 
0⁰ 
+Painful motion 
20% 

Left Hip (Thigh) ROM 
Flexion (0-125⁰) 
Extension (0-20⁰) 
External Rotation (0-45⁰) 
Abduction (0-45⁰) 
Adduction (0-45⁰) 
Comment 
§4.71a Rating 

“Full” 

+Painful motion 
10% 

 
An  orthopedic  note  on  21  July  2001  (15  months  prior  to  separation)  reported  that  the  hip 
condition was doing well.  “The hip really does not bother her much.”  A follow-up orthopedic 
note  2  weeks  later  stated:  “Hip  pain  is  pretty  much  resolved.”    A  final  orthopedic  note  on 
13 September 2001 stated she was having no groin pain.  The MEB examiner on 30 October 
2001 (6 weeks after the last orthopedic exam and a year prior to separation) and the NARSUM 
examiner (8 months prior to separation) both noted that the CI suffered from chronic left hip 
pain,  but  gave  no  descriptive  details  about  the  condition.    The  NARSUM  examiner  reported 
decreased ROM and pain with hip flexion, and decreased strength of hip flexors.  A C&P exam 
performed 10 months prior to separation (26 December 2001) reported the use of a cane at 
times  of  increased  left  hip  pain  severity.    Examination  revealed  full  flexion,  extension  and 
internal and external rotation of the left hip.  Strength was normal.  Tenderness of the lateral 
aspect  of  the  hip  was  present.    A  palpable  click  was  noted  during  abduction  and  external 
rotation, which reproduced her pain.  A second C&P exam performed that same day reported 
she  used  a  cane  for  both  back  and  hip  discomfort.    “Full  ROM  of  the  bilateral  hips”  was 
reported,  although  the  measured  flexion  noted  in  the  above  table  of  the  left  hip  was  90 
degrees.    X-rays  of  the  hip  were  normal.    The  PT  examiner  who  performed  the  ROM 
measurements noted pain during flexion, extension and abduction.  At the C&P exam 4 months 
after separation, the CI reported that she injured her hip during the same incident in 1998 that 
caused  her  back  issue.    All  ROMs  noted  in  the  table  above  were  resisted  by  the  CI  due  to 
reports  of  pain.    X-rays  of  the  hip  were  reported  to  be  normal.    As  previously  noted,  this 
examiner opined that subjective ROM was inconsistent with any orthopedic pathology.  A VA 
rating decision on 16 June 2004 reported that the CI underwent an arthroscopic partial labral 
resection and chondroplasty on 12 September 2003 (11 months after separation) as treatment 
for the labral tear. 
 
The Board directs attention to its rating recommendation based on the above evidence.  While 
the  ROM  at the  post-separation VA  exam  supported  the  VA’s  20%  rating  under  VASRD  code 
5252 (thigh, limitation of flexion of), the Board assigned lower probative value to this exam due 
to inconsistencies noted by that examiner.  The PEB assigned a 0% rating under an analogous 

5003  code  with  likely  application  of  the  USAPDA  pain  policy.    The  Board  acknowledged  that 
limitation of motion was non-compensable but considered if a 10% rating was justified under 
the 5003 code, or with application of §4.40 or §4.59.  The documentation of absence of hip pain 
for  several  months  prior  to  the  MEB  process  weighed  heavily  in  the  Board’s  deliberation.  
Ultimately,  the  Board  majority  agreed  that  the  evidence  of  record  did  not  support  a  rating 
higher than  that  allowed  under  §4.71a  for non-compensable  limitation of  hip  motion.    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 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 
inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB 
reliance on the USAPDA pain policy for rating the low back and left hip was operant in this case 
and the conditions were adjudicated independently of that policy by the Board.  In the matter 
of the right ankle pain condition, the Board unanimously recommends no change in the PEB 
adjudication.  In the matter of the LBP condition, the Board by a vote of 2:1 recommends no 
change in the PEB adjudication.  The single voter for dissent (who recommended a rating of 
10%) did not elect to submit a minority opinion.  In the matter of the left hip superior labral 
tear condition, the Board by a vote of 2:1 recommends no change in the PEB adjudication.  The 
single voter for dissent (who recommended a rating of 10%) 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 
Right Ankle Pain 
Low Back Pain 
Left Hip Superior Labral Tear 

VASRD CODE  RATING 
5271 
5299-5295 
5099-5003 
COMBINED 

10% 
0% 
0% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120627, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           xxxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 
           Acting 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 xxxxxxxxxxxxxxxxxxx, AR20130003756 (PD201200984) 
 
 
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 
 
 
 

     xxxxxxxxxxxxxxxxxxxxxxx 
     Deputy Assistant Secretary 
         (Army Review Boards)