RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20080818 

 
NAME:  XXXXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1201312 
BOARD DATE:  20130214 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SPC/E-4  (42A10/Human  Resources  Specialist), 
medically  separated  for  degenerative  disc  disease  (DDD)  of  the  lumbar  spine  with  back  pain 
status post (s/p) L5-S1 decompression L2-L5, laminectomy and L3, L4, and L5 microdiscectomy.  
He had insidious onset of increasing lower back pain (LBP) since 2005, with an evaluation in 
2006  diagnosing  him  with  multilevel  discogenic  disease  confirmed  by  magnetic  resonance 
imaging (MRI) showing moderate to severe degenerative disc changes throughout the lumbar 
spine.  On 12 September 2006, he had an L5-S1 decompression, L2-L5 laminectomy and L3, L4, 
L5  microdiscectomy  which  did  nothing  to  relieve  his  left  lower  extremity  pain  or  reduce  his 
overall pain below a 6/10.  The CI met his first Medical Retention Board (MRB) in February 2005 
based on the limitations imposed by his permanent physical profile and was reclassified from a 
13B10 Cannon Crewmember into his current Human Resources Specialist Military Occupational 
Specialty  (MOS).    Despite  this  reclassification  and  the  subsequent  surgery,  the  CI  did  not 
improve adequately with treatment to meet the physical requirements of his MOS or satisfy 
physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical 
Evaluation  Board  (MEB).    Chronic  right  foot  pain  s/p  bunionectomy,  chronic  right  knee  pain, 
chronic  right  shoulder  pain,  chronic  polycystic  kidney  disease  and  hemorrhoid  conditions, 
identified  in  the  rating  chart  below,  were  also  identified  and  forwarded  by  the  MEB.    The 
Physical Evaluation Board (PEB) adjudicated the low back condition as unfitting, rated 10% with 
application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The chronic right 
foot pain condition was determined to be not separately unfitting and the remaining conditions 
were determined to be not unfitting and therefore not rated.  The CI made no appeals, and was 
medically separated with a 10% disability rating.   
 
 
CI CONTENTION:  “There are many reason [sic] why I feel my rating was unfit for my disability. I 
was not able to Re class for any other job in the Army. I was unusable for the military. That also 
means I am unfit for civilian employment also. I came out broken hearted, wanting to retire in 
25yr but couldn't due to my back/mental problems. I feel I was unjustly discharge [sic] from the 
Army to be thrown out into the civlilan [sic] world, which I am not able to work in also.  I tried 
to provied [sic] for my family and give them a future but I can't I tried to go to school, use my GI 
bill but couldn't because my Lumbar and legs keep giving out under me. My PTSD is so bad I 
can't handle being in public. My atrophy in my left leg is worse. I have no action reflex in my left 
leg and I must use a cane to walk at all times. My lumbar stenosis is back AGAIN in my lower 
part of the sacrum bone which is causing me to have atrophy AGAIN in my left leg just like as 
before the laminectomy surgery. I now have more herniation to my discs, which I was told I will 
again need back surgery. I will HAVE to have spinal fusion. I was suppose to get fusion from my 
the first time I had my back surgery but Dr. XXXXXXXX asked me to wait due to my young age so 
we can prolong problems from the fusion to later. I was told by the military Dr my back is worse 
than an 80yr old man. I have lots of back pain which is not letting me work and on 15 meds to 
help me with pain, mental status, and to help me function in my everyday life. I tried to work 
for the TN Dept. of Corrections and that was the only job I was able to try to work and didnt 

even last a whole yr.  I was hired Nov 18, 2010 and was terminated in Nov 2011. I was/ am 
having very bad back/PTSD issues and TN Dept. of Corr. didnt want to honor my VA letter from 
my doctor to work with me. I was admitted in the VA hospital for being suicidal, I am currently 
not working/not ABLE to work.  I am also waiting for SS to approve me for benefits. I am not 
able to take care of myself properly/safely due to my back and PTSD. My wife is not able to 
work due to VA putting my wife through caregiver program to care for me. I should have been 
given full 100% medical retirement.”  The CI also provided two additional information packages 
in November and December 2012 with newer VA ratings (100%) and SSA disability information.   
 
 
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 (DDD L-spine) and general leg 
conditions  (Right  foot  pain  s/p  bunionectomy  and  right  knee  pain)  as  requested  for 
consideration  meet  the  criteria  prescribed  in  DoDI  6040.44  for  Board  purview;  and,  are 
addressed below, in addition to a review of the ratings for the unfitting condition.  The other 
requested posttraumatic stress disorder (PTSD) and left leg atrophy conditions are not within 
the  Board’s  purview.    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  IPEB – Dated 20080516 
Condition 

Code 

Rating 

VA (10 Mos. Pre-Separation) – All Effective Date 20080819 

Condition 

Code 

Rating 

Exam 

DDD L-Spine S/P L5-S1 
Decompression, L2-L5 
Laminectomy & L3,L4,L5 
Microdiscectomy 
Chronic Rt Foot Pain S/P 
Bunionectomy 
Chronic Rt Knee Pain 
Chronic Rt Shoulder Pain 
Chronic Polycystic Kidney 
Disease 
Hemorrhoids 

5299-5242 

10% 

L-Spine DDD S/P Laminectomy 
w/Radiculopathy and Back Scar 

5242 

40% 

20071016 

Not Separately 

Unfitting 

Rt Foot Hallux Valgus w/ Calcaneal 
Spurs, S/P Bunionectomy w/ Scar 
S/P Rt Knee Arthroscopy w/ 
Excision of Hypertrophic Plica 

Medically Acceptable 
Medically Acceptable  Rt Shoulder Condition 
Medically Acceptable  Bilateral Kidney Cysts 
Medically Acceptable  Hemorrhoids 

5260 
5201 
7533 
7336 
9411 
0% X 5 / Not Service-Connected x 2 

PTSD 

5280 

0% 

0% 
NSC 
0% 
0%* 
30% 

20071016 

20071016 
20071016 
20071016 
20071016 
20080624 
20071016 

No Additional MEB/PEB Entries 

Combined:  10% 

Combined:  60%* 

*VA increased 7336 to 20% effective 20090813 (combined 70%)  Subsequent VA changes (to 100%) effective January 2012 are 
not charted, but were noted by the Board. 
 
 
ANALYSIS SUMMARY: 
 
Low Back Condition.  The narrative summary (NARSUM) noted that “the service member had 
the  insidious  onset  of  increasing  back  pain  for  at  least  three  years.”    Magnetic  resonance 
imaging (MRI) showed moderate to severe DDD throughout the lumbar spine.  At L5-S1 there 
was a large left paracentral disk protrusion.  Surgery on 12 September 2006 consisted of an L5-
S1 decompression, L2-L5 laminectomy and L3-5 microdiscectomy.  Surgery did not relieve his 

left  lower  extremity  pain.    He  noted  rare  shooting  pain  in  the  upper  posterior  left  leg  and 
consistent numbness and tingling in the left lower extremity prior to surgery, but after surgery 
only slight numbness in one toe.  He reported constant chronic LBP which he rated at 4/9/10.  It 
changed with humidity, rainy weather, cold weather, and with any type of strenuous exercise.  
He used Lidoderm patches 2-4 times per week for pain, but no other medications.  There were 
no bowel or bladder dysfunctions.  Because of his consistent LBP he was unable to perform his 
MOS duties and was referred for an MEB. 
 
The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in 
arriving  at  its  rating  recommendation,  with  documentation  of  additional  ratable  criteria,  are 
summarized in the chart below. 
 

VA C&P ~10 Mo. Pre-Sep 

MEB ~5 Mo. Pre-Sep 

PT for MEB ~3 Mo. Pre-Sep 

Thoracolumbar ROM 
Flexion (90⁰ Normal) 

Ext (0-30) 

R Lat Flex (0-30) 
L Lat Flex 0-30) 
R Rotation (0-30) 
L Rotation (0-30) 
Combined (240⁰) 

20⁰ 
30⁰ 
30⁰ 
30⁰ 
30⁰ 
30⁰ 
170⁰ 

(35) 37⁰ 

15⁰  

(20) 22⁰ 

15⁰ 

(35) 34⁰ 
(30) 31⁰ 

150⁰ 

65⁰ 
15⁰ 
20⁰ 
20⁰ 

(30) 45⁰ 
(30) 45⁰ 

180⁰ 

Comment:  Surgery 23 
Mo. Pre-Sep; VASRD 
General Rating…Spine 
Note (2) applied  

§4.71a Rating 

+ Complained of pain, but 
no change in motion due to 
pain; No spasm; Gait 
normal 

40% (VA 40%) 

All ROM limited by pain, 
no further Deluca criteria 
other than pain 
20% 

Pain on forward flexion and 
Lat Flex; Gait & contour 
normal; No spasm; No 
scarring  

10% 

 
The MEB physical exam noted no acute or chronic distress, normal gait, ability to heel-walk, but 
did not test toe-walk due to the CI’s recent bunionectomy surgery.  Low back exam showed a 
well healed scar and tenderness to palpation from L3-S1.  S1 joints and sciatic notch were not 
tender.  Straight leg raise (SLR) testing was negative bilaterally.  Reflexes were 1+ and equal in 
the  lower  extremities.    There  were  no  neurological  deficits  noted  and  muscle  strength  was 
normal in the lower extremities.  There were no muscle spasms or guarding at the lower back.  
ROM of the spine is noted above.  It was noted that the “radicular pain he had prior to surgery 
has been cured with this surgery.”  It was not felt that he would ever be able to resume the 
rigorous activities required of soldiering.  A physical therapy note dated 2 May 2008, 3 months 
prior to separation, noted chief complaint of 1/10 pain at knee, LBP today, feels stiff.  Knee has 
been  doing  well,  no  problems  with  any  functional  activity.    No  problems  with  up  and  down 
stairs.  He was cleared to return to walking and light jogging, “no reason for pt to be running at 
all  due  to  increased  stress  at  knee  and  back  with  impact.”    There  was  a  formal  ROM 
measurement  of the  thoracolumbar  spine  with  a  reason for  request  as  “MEB-sm  needs new 
ROM  of  lumbar  spine  with  de  Luca  criteria.”    This  exam  is  summarized  above  and  was 
referenced by the PEB.  
 
At  the  VA  Compensation  and  Pension  (C&P)  exam  10  months  prior  to  separation,  the  CI 
reported lumbar pain; tingling and numbness aggravated by prolonged standing, bending; and 
changes in weather.  Symptoms were relieved by stretching and medications.  Flare ups were 
daily and rated at 8/10.  Physical examination noted no lumbar pain to palpation, no muscle 
spasms, 5/5 muscle strength, negative SLR and ROM as noted above.  The CI complained of pain 
with ROM testing, but there was no change in motion with repetition.  No other DeLuca criteria 
were noted. 
 

The Board directs attention to its rating recommendation based on the above evidence.  Both 
the PEB and VA rated the CI using the criteria of 5242 (Degenerative arthritis of the spine) using 
the  MEB/PT  or  VA  exams  summarized  above.    It  is  obvious  that  there  is  a  clear  disparity 
between  these  examinations,  with  very  significant  implications  regarding  the  Board's  rating 
recommendation.    The  Board  thus  carefully  deliberated  the  probative  value  assignment  to 
these conflicting evaluations, and carefully reviewed the file for corroborating evidence from 
the  period  preceding  separation.    Of  significant  import,  however,  is  the  close  temporal 
alignment  of  the  evidence  with  the  date  of  separation,  which  must  remain  as  the  Board’s 
definitive benchmark in its recommendations.  Both the MEB and PT exams are similar for all 
ROMs except for forward flexion, where the NARSUM referenced ROM was more limited.  The 
PT  ROM  was  less  comprehensive  than  the  NARSUM  exam  and  also  indicated  “no  scarring,” 
despite  the  CI’s  prior  surgery  and  VA  noted  18x3  cm  mid  lumbar  surgical  scar.    The  Board 
therefore placed its highest probative value on the NARSUM exam results as being consistent 
with the remainder of the record and IAW VASRD §4.7 (Higher of two evaluations).  This exam 
met the 20% rating criteria of “forward flexion of the thoracolumbar spine greater than 30⁰, but 
not greater than 60⁰.”  The General Rating Formula for Diseases and Injuries of the Spine coding 
is with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the 
area of the spine affected by residuals of injury or disease.  After due deliberation, considering 
all  of  the  evidence  and  mindful  of  VASRD  §4.3  (Reasonable  doubt)  and  §4.7  (Higher  of  two 
evaluations), the Board recommends a disability rating of 20% for the lumbar spine condition. 
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were chronic right foot pain s/p bunionectomy and chronic right knee pain.  The Board’s first 
charge with respect to these conditions is an assessment of the appropriateness of the PEB’s 
fitness  adjudications.    The  Board’s  threshold  for  countering  fitness  determinations  is  higher 
than  the  VASRD  §4.3  (Reasonable  doubt)  standard  used  for  its  rating  recommendations,  but 
remains adherent to the DoDI 6040.44 “fair and equitable” standard. 
 
The NARSUM documented the CI’s bunionectomy surgery in December 2007 reduced his pain 
from 8/10/10 to 4/10, but that the CI was unable to make attempts at running.  He also noted 
right knee pain for 3-4 years which he rated as 2/5-10, but it was not constant.  It was made 
worse by certain types of exercise and prevented him from running.  MRI was performed on 
28 December  2007  and  was  normal.    Orthopedic  evaluation  recommended  physical  therapy 
only with no anticipation of surgery.  The NARSUM documented examination of the right knee 
as  normal  with  no  ligamentous  or  meniscal  signs,  no  tenderness  and  normal  ROM.    The  CI 
underwent right foot bunionectomy in December 2007 and the NARSUM indicated the CI could 
not  toe  walk  due  to  recent  surgery  and  that  the  CI  was  “unable  to  do  the  bike  because  it 
significantly increases the pain in his knee, back and right foot.”  None of these conditions were 
previously unfitting for duty and all conditions were documented as improved by the time of 
the  CI’s  MEB  evaluation.    None  were  profiled,  none  were  mentioned  in  the  commander’s 
statement and none were judged to fail retention standards.  The PEB specifically addressed the 
right foot condition and stated: 
 

“MEB Diag 2 (chronic right foot pain s/p bunionectomy) is not separately unfitting.  There are 
minimal health record entries regarding this condition prior to surgery in December 07, which 
indicates it was not affecting his duty performance.  NARSUM reflects pain at 8-10/10 prior to 
surgery  and  4/10  after  surgery.    If  it  was  not  an  unfitting  condition  prior  to  surgery  and  was 
improved after surgery, there is no basis for finding this condition unfitting.” 

 
Both conditions were reviewed by the action officer and considered by the Board.  There was 
no  indication  from  the  record  that  any  of  these  conditions  significantly  interfered  with 

satisfactory duty performance.  After due deliberation in consideration of the preponderance of 
the evidence, the Board concluded that there was insufficient cause to recommend a change in 
the PEB fitness determination for the contended chronic right foot pain s/p bunionectomy or 
chronic  right  knee  pain  conditions;  and,  therefore,  no  additional  disability  ratings  can  be 
recommended. 
 
 
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  lumbar  spine  pain  condition,  the  Board  unanimously 
recommends a disability rating of 20%, coded 5299-5242 IAW VASRD §4.71a.  In the matter of 
the chronic right foot pain s/p bunionectomy and the chronic right knee pain conditions and 
IAW  VASRD  §4.71a,  the  Board  unanimously  recommends  no  change  from  the  PEB 
determinations as not unfitting.  There were no other conditions within the Board’s scope of 
review for consideration. 
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation: 
 

UNFITTING CONDITION 

DDD L-Spine S/P L5-S1 Decompression, L2-L5 Laminectomy & L3, 
L4, L5 Microdiscectomy 

VASRD CODE  RATING 
5299-5242 
COMBINED 

20% 
20% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120628, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXX, DAF 
           Acting Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / xxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for xxxxxxxxxxxxxxxxxxxxx, AR20130003076 (PD201201312) 
 
 
1.  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 to modify the individual’s disability rating to 20%  
without recharacterization of the individual’s separation.  This decision is final.   
 
2.  I direct that all the Department of the Army records of the individual concerned be 
corrected accordingly no later than 120 days from the date of this memorandum.    
 
3.  I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 
shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 
 
 BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 

     xxxxxxxxxxxxxxxxxxxxxxx 
     Deputy Assistant Secretary 
         (Army Review Boards)