RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20021129 

 
NAME:  XXXXXXXXXXXX 
CASE NUMBER:  PD1201063 
BOARD DATE:  20130201 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SPC/E-4 (71L/Admin Specialist), medically separated 
for  back  pain  and  left  wrist  pain.    These  conditions  could  not  be  rehabilitated  for  the  CI  to 
improve adequately to meet the physical requirements of her Military Occupational Specialty or 
satisfy physical fitness standards.  She was issued a permanent U3L4 profile and referred for a 
Medical Evaluation Board (MEB).  The MEB forwarded no other conditions for Informal Physical 
Evaluation Board (IPEB) adjudication.  The IPEB adjudicated the back pain and left wrist pain 
conditions as unfitting, rated 10% and 0%, with application of the Veteran’s Affairs Schedule for 
Rating  Disabilities  (VASRD)  and  likely  application  of  the  US  Army  Physical  Disability  Agency 
(USAPDA) pain policy.  The CI did not agree with the IPEB’s findings and appealed to the Formal 
PEB (FPEB).  The FPEB affirmed the IPEB’s findings; and was then medically separated with a 
10% disability rating. 
 
 
CI CONTENTION:  “All injuries were not properly evaluated.” 
 
 
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  back  pain  and  left  wrist  pain 
conditions  as  requested  for  consideration  meet  the  criteria  prescribed  in  DoDI  6040.44  for 
Board purview; and, 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 service Board for Correction of Military Records.   
 
 
RATING COMPARISON:   
 

Service FPEB (Review) – Dated 20020821 

VA (~8 Mos. Post-Separation) – All Effective Date 20021130 

*Increased to 20% effective 20081128 (see 20100225 VARD).   
**Additional non-PEB conditions added to increase overall rating to 60% effective 20081128 (see 20100225 VARD). 
 
 
ANALYSIS SUMMARY:  The Board wishes to clarify that it is subject to the same laws for service 
disability entitlements as those under which the Disability Evaluation System (DES) operates.  

Condition 

Back Pain 
Left Wrist Pain 

Code 

5299-5295 

5003 

Rating 
10% 
0% 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

Condition 

Lumbar Strain 
Residuals, Fracture, Left Distal 
Radius 
Residuals, Right Hip Fracture 

Code 
5295 
5215 

Rating 
10%* 
0% 
10% 

Exam 

20030717 
20030717 
20030717 
20030717 

5299-5255 

0% X 3 
Combined:  20%** 

While  the  DES  considers  all  of  the  member's  medical  conditions,  compensation  can  only  be 
offered for those medical conditions that cut short a member’s career, and then only to the 
degree  of  severity  present  at  the  time  of  final  disposition.    However  the  Department  of 
Veterans  Affairs  operating  under  a  different  set  of  laws  (Title  38,  United  States  Code),  is 
empowered to compensate all service-connected conditions and to periodically reevaluate said 
conditions  for  the  purpose  of  adjusting  the  Veteran’s  disability  rating  should  the  degree  of 
impairment vary over time. 
 
Back Pain Condition.  The 2002 Veteran Administration Schedule for Rating Disabilities (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 in 2004.  The pre-2004 ratings were based on a 
judgment  as  to  whether  the  disability  was  mild,  moderate  or  severe.    The  2004-to-current 
standards  are  grounded  in  range-of-motion  (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 medical 
record  indicates  a  history  of  episodic  low  back  pain  (LBP)  beginning  in  approximately  1998.  
Progressive worsening of pain in the buttocks with radiation to the right leg led to an inability to 
run or wear professional gear.  X-rays and bone scans showed evidence of inflammation of the 
sacroiliac joints.  Multiple anti-inflammatory medications and physical therapy were not helpful 
for her pain.  At the MEB exam on 15 April 2002 (7 months prior to separation), the CI reported 
numbness  and  tingling  in  both  lower  extremities  with  standing  or  running.    The  narrative 
summary  (NARSUM)  examination  on  18  April  2002  (7  months  prior  to  separation)  reported 
“full” ROM of the spine.  Forward flexion was noted to be “10 inches from the floor.”  Straight 
leg raise testing (SLR) was negative and muscle strength of the lower extremities was normal.  
Tenderness of the sacroiliac regions was present.  At the VA Compensation and Pension (C&P) 
exam on 17 July 2003 (8 months after separation), the CI reported a 4 year history of back pain 
with  radiation  to  the  right  leg.    Severity  was  reported  to  be  a  6  on  a  0-10  scale,  and  the  CI 
claimed  to  have  been  bedridden  and  incapacitated  100  times  for  a  period  of  one  to  2  days 
during the preceding year due to back or hip pain.  Physical exam reported limping on the right 
leg.  Lumbar flexion was 90 degrees (90 degrees is normal by current standards), extension 25 
degrees (30 degrees normal by current standards), and lateral flexion to 25 degrees bilaterally 
(30 degrees normal).  SLR was “positive at 70 degrees on the right” although location of pain 
was not specified.  Deep tendon reflexes (DTR) were equal except for a slightly diminished left 
Achilles  reflex.    A  magnetic  resonance  imaging  (MRI)  study  of  the  lumbar  spine  showed  no 
abnormalities.  The Board must correlate the above clinical data with the 2001 rating schedule 
which, for convenience, is excerpted below: 
 

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 

 
5294 Sacro-iliac injury and weakness: 
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 

 
Although not  specifically  noted  in  the  NARSUM  physical  examination,  “characteristic  pain  on 
motion” supporting the PEB’s 10% rating under the 5295 code is reasonably conceded given the 
CI’s history and symptoms of lifestyle limiting pain at the time of separation.  The VA’s initial 
rating used the same code, which was subsequently changed to reflect newer coding options; 
but, this did not result in a change in the VA’s 10% rating.  Board members agreed that the 
evidence  did  not  support  a  higher  rating  under  the  5295  code,  but  debated  if  any  of  the 
documented  examinations  met  the  requirements  for  the  20%  level  under  the  5292  code.  
However,  it  was  decided  that  ROM  in  evidence  did  not  reflect  the  “moderate”  descriptor.  
Finally, the Board debated a rating under the 5293 code but concluded this was a poor fit for 
the pathology in this case.  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 back pain condition. 
 
Left Wrist Pain Condition.  A left distal radius fracture in May 2000 required closed reduction 
and  percutaneous  pinning  for  stabilization.    Despite  uneventful  healing  and  occupational 
therapy, ongoing pain caused activity limitation.  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. 
 

Left Wrist ROM 

NARSUM ~7 Mos. Pre-Sep 

VA C&P ~8 Mos. Post-Sep 

Dorsiflexion (0-70⁰) 
Palmar Flexion (0-80⁰) 
Ulnar Deviation (0-45⁰) 
Radial Deviation (0-20⁰) 
Forearm Pronation (0-80⁰) 
Forearm Supination (0-85⁰) 

90⁰ 
80⁰ 

“Full” 

80⁰ 
80⁰ 
30⁰ 
30⁰ 
-- 
-- 

Comment 

+minimal tenderness 

“No symptoms” 

§4.71a Rating 

10% 

0% 

 
At the MEB exam, the CI indicated that the left wrist was painful in cold weather and that she 
was unable to lift weight with her left arm.  Use of a wrist brace was also annotated, although it 
was not specified if this was a current or past requirement.  Examination made no mention of a 
wrist brace.  At the NARSUM exam, the right hand dominant CI reported the presence of daily 
pain.  She could not perform repetitive tasks and pushups.  Pain was reported to occur with 
pronation and supination.  The physical examination noted the ROM in the above table, but 
stated that the 80 degrees of palmar flexion represented a loss of 10 degrees compared to her 

right  wrist.    X-rays  of  the  left  wrist  showed  minimal  degenerative  changes.    At  the  VA 
Compensation  and  Pension  (C&P)  exam,  the  CI  reported  that  since  treatment  for  the  wrist 
injury,  “she  has  had  no  symptoms.”    Physical  examination  revealed  punctuate  scars  on  the 
medial and lateral aspect of the left wrist at the site of previous pin placements.  Tenderness 
was  absent  and  grip  strength  was  good.    An  X-ray  was  normal.    The  assessment  was  “no 
residual disability.” 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB assigned a 0% rating under a 5003 code (degenerative arthritis).  Board members agreed 
that the ROM data and other clinical findings at the VA exam were consistent with the service 
exams and did not support a compensable disability rating.  While a 10% rating under §4.40 is 
suggested by the history reported to the examiners and by the permanent profile restrictions, 
the statement to the VA examiner by the CI that she had been asymptomatic since treatment 
for  her  injury  carried  significant  weight  in  the  Board’s  deliberation.    Therefore,  the  Board 
concluded that the clinical picture was most accurately described by the 0% 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 left wrist 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.  As discussed above, PEB 
reliance on the USAPDA pain policy for rating back pain and wrist pain was operant in this case 
and the condition was adjudicated independently of that policy by the Board.  In the matter of 
the  back  pain  condition  and  IAW  VASRD  §4.71a,  the  Board  unanimously  recommends  no 
change in the PEB adjudication.  In the matter of the left wrist pain 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:   
 

UNFITTING CONDITION 

VASRD CODE  RATING 
5299-5295 

10% 
0% 
10% 

5003 

COMBINED 

Back Pain 
Left Wrist Pain 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120614, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 

 
 
 
 

           XXXXXXXXXXXXXXXXXX, 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 XXXXXXXXXXXXXXXXXXXXXX, AR20130003779 (PD201201063) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)