RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

SEPARATION DATE:  20070501 

 
NAME:  XXXXXXXXXXXXXXXXX                                                               BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1100863 
BOARD DATE:  20121127 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SFC/E-7  (74D40/Chemical  Operations  Specialist), 
medically separated for mood disorder and chronic radiating low back pain.  The CI developed 
chronic back pain in 1998 and increasing depression in 2005.  These conditions could not be 
adequately  rehabilitated  with  treatment  to  meet  the  physical  requirements  of  her  Military 
Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent 
L3/S3  profile  and  referred  for  a  Medical  Evaluation  Board  (MEB).    Polysubstance  abuse, 
personality  disorder,  restless  leg  syndrome,  and  history  of  pulmonary  embolus/deep  vein 
thrombosis, identified in the rating chart below, were also conditions forwarded as medically 
acceptable by the MEB.  The Physical Evaluation Board (PEB) adjudicated the mood disorder 
and chronic radiating low back pain conditions as unfitting, rated 10% and 0%, with application 
of DoDI 1332.39 and the Veteran’s Affairs Schedule for Rating Disabilities (VASRD) respectively.  
The CI made no appeals, and was medically separated with a 10% disability rating.   
 
 
CI CONTENTION:  “Veteran continues to suffer from physical and mental conditions resulting in 
initial discharge.  Veteran received an award of 80% Disability from the Veterans Affairs for the 
same and additional conditions.” 
 
 
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 restless leg syndrome, and history of 
pulmonary embolus/deep vein thrombosis conditions, as requested for consideration, meet the 
criteria prescribed in DoDI 6040.44 for Board purview; and are addressed below.  Polysubstance 
abuse  and  personality  disorder  are  not  physical  disabilities  IAW  DoDI  1332.38  and  will  be 
discussed  no  further.    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. 
 
 
 
 
 
 
 
 
 
 
 

VA (1 Mo. Pre-Separation) – All Effective Date 20070502 

Condition 

Adjustment Disorder with Mixed 
Lumbar Strain w/ Degenerative 
Changes 
Pulmonary Embolus 
Restless Leg Syndrome 

Right Knee Strain 
Right Shoulder Strain 
Hiatal Hernia w/ Pyrosis 

Code 
9440 

Rating 
30%* 

Exam 

20070427 

5242 

10%** 

20070427 

No VA Entry 

6899-6817 
8199-8103 

5299-5024 
5299-5024 

7346 

30% 
10% 

10% 
10% 
10% 

20070427 
20070427 

20070427 
20070427 
20070427 
20070427 

0% X 7 / Not Service-Connected x 3 
Combined:  70%** 

 
 
 
RATING COMPARISON:   
 

Service IPEB – Dated 20070208 
Condition 

Mood Disorder 
Personality Disorder 
Chronic Radiating LBP 
History of Pulmonary 
Embolus/DVT 
Restless Leg Syndrome 
Polysubstance Abuse 

Code 
9435 
Not Unfitting 

Rating 
10% 

5299-5237 

0% 

Not Unfitting 
Not Unfitting 
Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

*increased to 70% effective 20101001; **increased to 20% effective 20081003; ***overall rating increased to 90% effective 
20101001.  All increases from 20110912 VARD. 
 
 
ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit 
and  vital  fighting  force.    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.  The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or  potential  complications  of  conditions  resulting  in  medical  separation  nor  for  conditions 
determined  to  be  service-connected  by  the  Department  of  Veterans  Affairs  (DVA)  but  not 
determined to be unfitting by the PEB.  However, the DVA, operating under a different set of 
laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  all  service-connected 
conditions  and  to  periodically  re-evaluate  said  conditions  for  the  purpose  of  adjusting  the 
Veteran’s disability rating should the degree of impairment vary over time.  The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating  determinations,  compared  to  VASRD  standards,  based  on  severity  at  the  time  of 
separation. 
 
Mood Disorder Condition.  The CI developed increasing depression in 2005 related to marital 
difficulties and her father’s suicide.  Treatment with three different medication regimens was 
unsuccessful  and  she  was  admitted  for  inpatient  psychiatry  treatment,  10-24  May  2006  for 
increasing depression  and  acute  suicidal  ideation  after  a marital  argument.    Two  subsequent 
psychiatric hospitalizations occurred 5-11 July 2006,  for recurrent suicidal ideation related to 
marital  separation  and  12-23  August  2006,  for  suicidal  and  homicidal  ideation  toward  her 
children,  despite  intensive  outpatient  treatment.    The  August  2006  admission  occurred  for 
increased suicidal ideation subsequent to an episode of binge alcohol use the week prior to her 
admission.  At this August admission, the CI noted stressors to be breakup of an extramarital 
relationship,  finances  and  first  admission  of  daily  marijuana  (“using  marijuana  heavily”  on  a 
daily basis since the July hospitalization) and episodic heavy alcohol use.  It was noted that she 
became  very  sad  when  she  drank  alcohol.    She  then  underwent  a  three  week  inpatient 
inpatient 
substance  abuse  rehabilitation  program. 
rehabilitation program, the CI reconciled with her husband and family and addressed financial 
issues. 
  Subsequently,  she  completed  a  work  therapy  program,  (16  October  through 

  After  completing  of  a  subsequent 

intense 

interpersonal  relationships, 

6 December 2006) and attended over 30 outpatient appointments for individual, group, alcohol 
and substance therapy.  Intermittent compliance with medication treatment was noted.  At the 
MEB/narrative  summary  (NARSUM)  evaluation  performed  segmentally  17  August  and 
12 December  2006,  approximately  5  months  before  separation,  the  CI  reported  some  mood 
lability,  and  intermittent  suicidal  ideation,  but  denied  current  intent  or  panic  attacks.    She 
reported  abstinence  from  alcohol,  but  had  started  and  stopped  marijuana  use  on  several 
occasions with varying success.  On examination her mood was depressed with some anger and 
irritability.  Thoughts were logical, linear and goal directed and the CI was noted at times to 
smile and use humor.  Memory was normal; insight was fair and impulsivity, mild to moderate.  
The  examiner  noted  the  CI’s  symptoms  of  depression,  mood  lability  and  chronic  suicidal 
ideation  to  be  ‘treated  and  partially  improved.’    Diagnoses  included  mood  disorder  partially 
improved,  polysubstance  abuse  partially  improved,  and  personality  disorder  not  otherwise 
specified  (manifested  by  unstable  and 
impulsivity, 
recurrent suicidal threats, and reactivity of mood).  He adjured social and industrial impairment 
to  be  considerable.    At  the  VA  Compensation  and  Pension  (C&P)  examination  performed  on 
27 April 2007, a week prior to separation, the CI reported a depressed mood 5 times a month 
lasting 2 days, but no suicidal ideation for 2 months.  She reported being under the care of a 
therapist,  receiving  medication and  being  clean and  sober  from  substance  abuse,  having  not 
used marijuana, for a year.  She stated she realized these drugs were worsening her mood.  She 
noted no panic attacks, memory loss or chronic sleep impairment.  The CI reported that she was 
working, had good relationships with supervisor and co-workers with no loss of time from work.  
She reported no difficulty performing activities of daily living.  On examination, her behavior, 
conversation,  judgment,  memory,  thought  processes  and  abstract  thinking  were  normal 
without suicidal or delusional ideation.  The CI had no difficulty understanding commands.  The 
VA C&P examiner concluded the polysubstance abuse was in remission and diagnosed chronic 
adjustment  disorder  and  personality  disorder  not  otherwise  specified  with  dependent  and 
borderline features.  Global Assessment of Functioning (GAF) was reported 60-65 (some mild 
symptoms  or  some  difficulty  in  social,  occupational  or  school  functioning,  but  generally 
functioning pretty well has some meaningful interpersonal relationships).  Both PEB and C&P 
rated the condition IAW §4.130, but with different coding and results.  The PEB rated at 10%, 
coded  9435,  mood  disorder  and  the  VA.  rated  at  30%,  coded  9440,  chronic  adjustment 
disorder.  A 10% rating requires occupational and social impairment due to mild or transient 
symptoms which decreases work efficiency and perform occupational tasks only during periods 
of significant stress or symptoms controlled by continuous medication.  A rating of 30% requires 
occupational  and  social 
in  work  efficiency  and 
intermittent periods of inability to perform occupational tasks (although generally functioning 
satisfactorily, with routine behavior, self-care and conversation normal), due to symptoms such 
as depression, anxiety, suspiciousness, panic attacks, chronic sleep impairment, mild memory 
loss.    All  members  agreed  that  a  higher  rating  of  50%,  was  not  supported  by  the  record  in 
evidence.  The Board then undertook a discussion of 10% vs. 30% rating.  The Board noted the 
CI  to  have  a  long  and  complex  history  of  psychiatric  issues  compounded  by  polysubstance 
abuse  which  worsened her  symptoms.   The  Board  agreed,  based on the  findings  of the  C&P 
exam, that the CI was at stable baseline condition with good occupational and social functional 
at the time of separation, resulting from extensive treatment, with sustained abstention from 
substance abuse.  The Board unanimously agreed the condition best met the criteria for a 10% 
disability IAW VASRD §4.130.  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 mood disorder condition. 
  
Chronic  Radiating  Low  Back  Pain  Condition:    The  CI  developed  mid  to  low  back  pain 
approximately 8 years prior to separation.  There is no history of trauma.  A magnetic resonance 

impairment  with  occasional  decrease 

imaging (MRI) study performed in 23 May 2005, revealed a small disc without impingement at 
the L5-S1 level.  The CI noted occasional numbness of the right foot; electro-diagnostic studies, 
15  November  2006,  were  normal.    Additionally,  the  CI  reported  a  long  history  of  bladder 
incontinence with excessive stress or straining.  Urologic evaluation revealed this to be an ob-
gyn  pelvic  muscle  weakness,  and  not  of  neurologic  origin.    At  the  MEB/NARSUM  exam 
4 October 2006, 7 months prior to separation, the CI reported intermittent mid and lower back 
pain, with occasional radiation to her thigh without weakness, numbness or tingling.  At the 
C&P exam performed on 20 April 2007, a month prior to separation, the CI reported localized 
low  back  pain,  rated  1-10/10  occurring  with  activity  and  relieved  by  rest.    She  noted  the 
condition to cause no incapacitation and was able to drive a car, walk, shop, perform gardening 
and push a lawn mower.  Findings on physical examination for both evaluations were similar 
with normal spinal ranges-of-motion (ROM) without pain, tenderness or spasm; normal motor, 
sensory and reflex functions.  The Board directs attention to its rating recommendation based 
on the above evidence.  The PEB rated 0%, code 5237, citing full ROM without tenderness or 
spasm.  The VA rated 10%, code 5242, with application of §4.59, citing subjective history of pain 
not  documented  on  examination.    The  Board  unanimously  agreed  the  condition  was  not 
compensable IAW §4.71a, ROM, and §4.59 was not applicable given the profound negativity of 
findings on both examinations.  There was no evidence or ratable peripheral nerve impairment 
in this case, since no motor weakness was present and sensory symptoms had no functional 
implication.  There was no evidence of incapacitating episodes for a higher rating under 5243.  
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 condition. 
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
and within the scope of the Board were history of pulmonary embolus/deep venous thrombosis 
(DVT) and restless leg syndrome.  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.   
 
Pulmonary embolism; The CI developed a right lung pulmonary embolus (PE) after a long airline 
flight in 2005.  She was treated with inpatient heparin and outpatient Coumadin therapy for a 
year (ended 7 April 2006).  Coagulation studies were negative for a hypercoagulable condition.  
A diagnosis of DVT was never confirmed.  On 2 June 2005 the CI had a small PE in the left lung 
felt  secondary  to  sub-therapeutic  Coumadin  therapy.    This  was  corrected  and  adequate 
Coumadin continued until completion of therapy 7 April 2006 without difficulty.  The service 
treatment records (STR) contained no further episodes of pulmonary difficulty or reference to 
pulmonary  symptoms,  [viz]  shortness  of  breath,  pleuritic  pain,  and  cough.    On  the  C&P 
examination, the CI reported for the first time chest pain on exertion, but noted this to cause 
no functional impairment, and to require no treatment.  Chest X-rays, pulmonary function tests 
(PFTs)  and  clinical  examinations  revealed  no  evidence  of pulmonary  dysfunction.    The  Board 
noted the CI’s report of doing gardening and mowing the lawn without chest symptoms and the 
profile of January 2007 permitting strenuous exercise without pulmonary restriction.   
 
Restless Leg Syndrome; This condition was diagnosed on polysomnogram study in 1995.  It is 
first  mentioned  in  the  record  in  evidence  in  May  2006  in  association  with  new  psychiatric 
medication.    The  CI  reported  increasing  daytime  somnolence  but,  this  was  felt  related  to 
depression  and  medication.    Neither  of  these  conditions  was  profiled,  implicated  in  the 
commander’s statement; nor judged to fail retention standards.  Both were reviewed by the 

action officer and considered by the Board.  There was no indication from the record that either 
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 either 
of  the  contended  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.  As discussed above, PEB 
reliance on DoDI 1332.39 for rating mood disorder condition was operant in this case and the 
condition was adjudicated independently of that instruction by the Board.  In the matter of the 
mood  disorder  condition  and  IAW  VASRD  §4.130,  the  Board  unanimously  recommends  no 
change in the PEB adjudication.  In the matter of the chronic radiating low back pain condition 
and  IAW  VASRD  §4.71a,  the  Board  unanimously  recommends  no  change  in  the  PEB 
adjudication.    In  the  matter  of  the  contended  pulmonary  embolus/DVT  and  restless  leg 
syndrome  conditions,  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, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:    
 

UNFITTING CONDITION 

VASRD CODE  RATING 

9435 

5299-5237 
COMBINED 

10% 
0% 
10% 

Mood Disorder 
Chronic Radiating Low Back Pain 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20110831, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXXXXX, AR20120021980 (PD201100863) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)