BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20040204 

 
NAME:  XXXXXXXXXXXXXXX 
CASE NUMBER:  PD1201330 
BOARD DATE:  20130124  
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  activated  National  Guard  CPL/E-4  (88M10/Truck  Driver), 
medically  separated  for  chronic  low  back  pain  (LBP).    The  CI  sustained  a  back  injury  while 
deployed  to  Iraq  in  February  2003.    The  chronic  LBP  condition  could  not  be  adequately 
rehabilitated and did not improve adequately after surgery to meet the physical requirements 
of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued 
a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded 
no other conditions for Physical Evaluation Board (PEB) adjudication.  The PEB adjudicated the 
chronic  back  pain  condition  as  unfitting,  rated 10%,  with  application  of  the  Veteran’s  Affairs 
Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated 
with a 10% disability rating.   
 
 
CI CONTENTION:  “VA rated my back at 40 percent, when I separated (sic) I was given 10%.  I 
have 10% for hearing loss.  I was also service connected for ED.  I was also told I have PTSD.”   
 
 
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 other requested conditions, hearing 
loss,  erectile  dysfunction  (ED)  and  posttraumatic  stress  disorder  (PTSD)  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 PEB – Dated 20031211 

VA (18 Mos. Post-Separation) – All Effective Date 20050207 

Condition 
Chronic Back Pain 

Code 
5243 

Rating 
10% 

Condition 

S/P L3 S1 Discectomy for 
Herniated Nucleus Pulposus  

Code 

5299-5243 

Rating 
40% 

Exam 

20050826 

RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

Combined:  10% 

Combined:  40% 

 
 
ANALYSIS SUMMARY:   
 
Chronic  Back  Pain,  Status  Post  L5-S1  Discectomy,  without  Neurologic  Abnormality.    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.   

Thoracolumbar ROM 

(degrees) 

Flexion (90 Normal) 

Ext (0-30) 

R Lat Flex (0-30) 
L Lat Flex (0-30) 
R Rotation (0-30) 
L Rotation (0-30) 
Combined (240) 

55 
15 

(30) 60 
(30) 60 
(30) 50 
(30) 50 

190 

30 
30 
30 
30 
30 
30 
180 

Normal gait (see text) 

40% 

 

MEB ~3.5 Mo. Pre-Sep* 

VA C&P ~18 Mo. Post-Sep* 

Comment:  Surgery ~7 

Mo. Pre-Sep 
§4.71a Rating 

Pain with flexion; 
radiation of pain 
20% (PEB 10%) 

* VASRD Spine note 2 applied.  VA exam extracted from detailed VARD.   

 
The CI underwent a discectomy in July 2003, approximately 7 months prior to separation.  The 
MEB physical exam in October 2003, 3 months prior to separation, described “pain with flexion 
at around 40-45 degrees,” and “pain with…bending and twisting….”  In the narrative summary 
(NARSUM)  in  October  2003,  the  CI  reported  moderate  pain  with  sitting,  bending  over,  and 
straightening his back.  He reported numbness and tingling down to his lower left leg.  He said 
that his symptoms were unchanged by his surgery and worse after physical therapy (PT).  He 
had no loss of bladder or bowel control.  The NARSUM physical exam noted tenderness over 
the spine at L4-5.  Lower extremity strength, reflexes, and light touch sensation were normal.  
He  had  a  positive  straight  leg  test.    He  was  able  to  walk  toe  to  heel.    There  was  no 
documentation of imaging or electrodiagnostic studies.  The ROM is summarized in the chart, 
above.  The PEB assigned a rating of 10% based on the “combined thoracolumbar rotation” (sic) 
of  290  degrees  and  localized  tenderness.    The  report  of  the  VA  Compensation  and  Pension 
(C&P) exam, in August 2005, 18 months after separation, was not available for review.  The VA 
Rating Decision in September 2005 cited the VA exam as (summarized) “normal posture and 
gait;  normal  curvature,  symmetry,  and  head  positioning;  no  muscle  spasms,  weakness,  or 
guarding; neurological examination revealed normal sensation and no motor deficits with no 
atrophy and normal muscle tone; reflexes were 2 plus and equal; Lasegue’s sign (straight leg 
raise)  was  positive  bilaterally;  lumbar  spine  forward  flexion  was  measured  as  being  30 
degrees….”    There  was  insufficient  evidence  of  any  additional  functional  loss  due  to  DeLuca 
criteria  to  warrant  consideration  of  a  higher  evaluation.    The  remainder  of  the  ROMs  are 
charted above.  Further remote C&P exams in evidence indicated improved forward flexion to 
65 degrees on multiple exams.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB rating of 5243 at 10% cited “combined thoracolumbar rotation 290 degrees.  With localized 
tenderness.”    The  VA  40%  rating  was  based  on  forward  flexion  to  30  degrees.    The  Board 
adjudged that the MEB evidence had the higher probative value in the Board’s deliberation due 
to its proximity to separation.  The remote VA exam was considered post-separation worsening.  
The CI’s limitation of forward flexion to 55 degrees, as documented in the NARSUM, supported 
a  rating  of  20%  for  rating  code  5243  for  forward  flexion  of the thoracolumbar  spine  greater 
than  30  degrees  but  not  greater  than  60  degrees.    There  was  insufficient  evidence  of  any 
additional  functional  loss  due  to  DeLuca  criteria  to  warrant  consideration  of  a  higher 
evaluation.  The General Rating Formula for Diseases and Injuries of the Spine ratings are 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.  There was no evidence of incapacitating 
episodes, or associated objective non-pain neurologic abnormalities which would warrant other 
rating  considerations.  After  due  deliberation, considering  all  of  the  evidence  and  mindful  of 

VASRD  §4.3  (reasonable  doubt),  the  Board  recommends  a  disability  rating  of  20%  for  the 
chronic back pain, status post L5-S1 discectomy, without neurologic abnormality 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.    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 chronic back pain, status post L5-S1 discectomy, without 
neurologic  abnormality  condition,  the  Board  unanimously  recommends  a  disability  rating  of 
20%, coded 5243 IAW VASRD §4.71a.  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 

Chronic  Back  Pain,  Status  Post  L5-S1  Discectomy,  without 
Neurologic Abnormality 

VASRD CODE  RATING 

5243 

COMBINED 

20% 
20% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120719, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXX, DAF 
           Acting Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-
3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXX, AR20130003091 (PD201201330) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)