RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY  
SEPARATION DATE:  20020930 

 
NAME:  XXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1100958 
BOARD DATE:  20130206 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SGT/E-5  (98J20/Non-communicator  Interceptor 
Analyst),  medically  separated  for  chronic  pain,  low  back,  right  shoulder,  bilateral  heels  and 
knees.  The CI experienced bilateral foot pain during a road march, and right shoulder pain after 
a shoulder dislocation and was later diagnosed as right shoulder impingement syndrome.  His 
evaluation and treatment included a right shoulder arthroscopy.  Additionally he had low back 
pain (LBP) and knee pain that began while walking and road marching.  Lastly, he had bronchial 
asthma and chronic headaches.  The chronic pain, low back, right shoulder, bilateral heels and 
knees  conditions  could  not  be  adequately  rehabilitated.    The  CI  did  not  improve  adequately 
with treatment to meet the physical requirements of his Military Occupational Specialty (MOS) 
or satisfy physical fitness standards.  He was issued a permanent P3, U3 ,L3, E2, S2 profile and 
underwent a Medical Evaluation Board (MEB).  Heel spurs, bilateral plantar fasciitis, bronchial 
asthma,  generalized  anxiety  disorder,  major  depressive  disorder,  panic  disorder  with 
agoraphobia and headaches, migraines condition(s), identified in the rating chart below, were 
also identified and forwarded by the MEB.  The Physical Evaluation Board (PEB) adjudicated the 
chronic pain, low back, right shoulder, bilateral heels and knees conditions as unfitting, rated 
10%, with likely application of the Department of Defense Instruction (DoDI) 1332.39 and cited 
application of the United States Army Physical Disability Agency (USAPDA) pain policy.  The CI 
made no appeals, and was medically separated with a 10% disability rating.   
 
 
CI  CONTENTION:    “Department  of  Veterans  Affairs  Decision:  migraine  headaches  30%, 
impingement syndrome right shoulder 10%, calcaneal spur right foot 10%, calcaneal spur left 
foot  10%,  plantar  fasciitis  bilateral  10%,  limitation  of  motion/LS  spine/Lower  Back  pain  10%, 
anxiety disorder with depressive disorder 10%.” 
 
 
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  conditions:  migraine  headaches, 
plantar fasciitis bilateral, anxiety and depressive disorder, 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  conditions.    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 20020619 
Condition 

Code 

Rating 

Chronic  Pain,  Low  Back, 
Right  Shoulder,  Bilateral 
Heels And Knees 

5099-5003 

10% 

Exam 
20021126 

20021126 
20021126 
20021126 
20021126 
20021126 

Syndrome, 

Rating 
10% 

Code 
5299-5295 

8599-8516 
5299-5279 
7819-5271 
7819-5271 
5299-5260 

VA (4 Mo. After Separation) – All Effective Date 20021001 
Condition 
Limitation  Of  Motion,  LS 
Spine With History Of LBP 
Impingement 
Right Shoulder 
Plantar Fasciitis, Bilateral 
Calcaneal Spur, Right Foot 
Calcaneal Spur, Left Foot 
Patellofemoral 
R/Knee 
Patellofemoral 
L/Knee 
COPD w/History of Asthma 
Generalized 
Disorder 
Disorder 
No VA Entry 
Migraine Headaches 

10% 
10% 
10% 
10% 
0% 

5299-5260 
6604 

 
30% 

Syndrome, 

Syndrome, 

0% 
0% 

10% 

20021126 
20021202 

9400 

Anxiety 

Disorder 

20021204 

20021203 

 
8100 

Combined:  60% 

Anxiety 
w/Depressive 

 
20021126 

0% x 9/Not Service Connected x 13  

Not Unfitting 
Asthma 
Generalized 
Not Unfitting 
Disorder 
Major Depressive Disorder  Not Unfitting 
Panic 
Not Unfitting 
w/Agoraphobia 
Headaches 
Not Unfitting 
 
↓No Additional MEB/PEB Entries↓ 
 
Combined:  10% 
Based on 19 June 2003 VARD 
 
 
ANALYSIS SUMMARY:  The PEB bundled chronic pain, low back, right shoulder, bilateral heels 
and knees as unfitting and assigned a single 10% rating under the USAPDA pain policy as slight 
and  constant.    This  approach  by  the  PEB  reflected  its  judgment  that  the  constellation  of 
conditions  was  unfitting,  not  a  judgment  that  each  condition  was  independently  unfitting.  
When  combining  conditions  in  this  manner,  the  PEBs  concluded  that  there  was  no  need  for 
separate  fitness  adjudications.    When  considering  a  separate  rating  for  each  condition,  the 
Board first must satisfy the requirement that each unbundled condition was unfitting in and of 
itself based on a preponderance of evidence.  When the Board recommends separate fitness 
recommendations  in  this  circumstance,  its  recommendations  may  not  produce  a  lower 
combined  rating  than  that  of  the  PEB.    The  Board’s  initial  charge  in  this  case  was  therefore 
directed at determining if the PEB’s approach of combining conditions under a single rating was 
justified in lieu of separate ratings.  As detailed below, the Board concluded that each of the 
bundled conditions, when considered alone separate from the other conditions did not arise to 
a  level  to  be  considered  individually  unfitting  based  on  the  preponderance  of  evidence.  
However, the Board agreed, considered in their totality, the overall effect resulted in a situation 
that prevented performance of duties.  The Board noted that DoDI 1332.38 provides for this 
circumstance  (DoDI  1332.38,  paragraph  E3.P3.4.4.;  “Overall  Effect”)  and  the  Board  therefore 
recommended no change to the adjudication of the PEB. 
 
Chronic  Low  Back  Pain Condition.   Service treatment  record  (STR)  reflects  the  CI  first  sought 
care for LBP in February 1999 associated with physical training, particularly performing sit-ups.  
There  was  no  history  of  injury,  associated  neurological  complaints  or  signs  or  symptoms  of 

radiculopathy.    Examinations  documented  full  range-of-motion  (ROM)  and  X-rays  of  the 
lumbosacral spine were normal.  Orthopedic surgery consultation concluded the back pain was 
most likely mechanical in nature and the CI was provided physical therapy (PT).  A duty limiting 
profile was issued in January 2000 that listed all the CI’s conditions including LBP.  No care for 
back pain is evident in the STR during 2000.  An orthopedic evaluation on 11 December 2000 
recorded LBP with certain routines and positions such as lifting and sit-ups.  On examination, 
the CI was able to bend over and touch his toes.  There are no other medical encounters for 
back pain in the STR other than the MEB narrative summary (NARSUM).  The NARSUM, 30 July 
2001, noted onset of back pain in 1998 with walking and road marching which later became 
worse.  No further detail regarding the back pain is provided.  On examination (performed 26 
July 2001) there were no signs of radiculopathy and strength was normal.  Low back ROM was 
moderately reduced (flexion 45 degrees, extension 10, right side bending 10, left side bending 
15, and right and left rotation 30).  A PT examination for the MEB on 30 July 2001 recorded 
back  flexion  of  70  degrees,  extension  of  10  degrees,  and  side  bending  of  30  degrees  each 
direction.  The NARSUM addendum 16 January 2002 makes no mention of LBP at all.  A repeat 
PT  examination  for  the  PEB  on  1  May  2002  recorded  back  flexion  of  40  degrees  lacking  20 
degrees  from  normal  (60  degrees  is  normal  lumbar  flexion),  extension  20  degrees  lacking  5 
degrees from normal, side bending 15 degrees and rotation of 20 degrees in each direction.  A 
clinic encounter 15 July 2002 noted the CI was undergoing an MEB and complaining of spine 
pain.  On examination he was tender to palpation.  He could flex to four inches from the floor 
(full flexion), perform full rotation and laterally flex to 75% of normal with report of pain.  The 
VA Compensation and Pension (C&P) examination 26 November 2002, approximately 2 months 
after separation, recorded a history of stable chronic LBP with variable severity aggravated by 
lifting or carrying.  On examination there was no muscle spasm or tenderness.  Flexion was 75 
degrees  (pain  from  60  degrees),  extension  25  degrees,  and  25  degrees  of  lateral  bending.  
Motion was noted to be slow and guarded.  Posture and gait were normal (also reported as 
normal  in the  general  examination  4  December  2002).    He  was  able  to  fully  squat  and  arise 
again.    X-rays  (26  November  2002)  of  the  lumbosacral  spine  were  normal.    The  Board 
considered  if  the  chronic  LBP  condition  rose  to  the  level  of  being  separately  unfitting  when 
considered alone.  The Board noted the CI was diagnosed with mechanical LBP with normal X-
rays and unremarkable examinations.  Following PT treatment in 1999, there were no further 
STR entries for care of LBP.  The NARSUM provides only minimal mention of back pain.  After 
due deliberation, the Board concluded that the preponderance of evidence does not support a 
finding that the back condition was separately unfitting when considered alone. 
 
Right Shoulder Condition.  The CI injured his right shoulder in a fall down stairs in December 
1994.    Due  to  persisting  symptoms  diagnosed  as  impingement  syndrome,  the  CI  underwent 
arthroscopic sub acromial decompression of the right shoulder in March 1998 to address the 
impingement  condition.    The  post-operative  profile  restriction  expired 11  May  1998.    The  CI 
sought care for recurrent right shoulder pain on 27 September 1998 after he fell off a horse.  
The STR falls silent for care of right shoulder pain after this date.  A May 1999 profile report 
indicated a U1 for no restrictions for the upper extremity.  In January 2000, an MOS Medical 
Review Board was recommended in the setting of complaints of knee pain and back pain and a 
U3 profile was issued listing right shoulder impingement syndrome along with other conditions; 
however STR does not show the shoulder was a focus of clinical attention or record shoulder 
complaints prior to or after this time.  An orthopedic evaluation on 11 December 2000 for LBP 
noted the presence of a profile (no push-ups; lift up to 20 pounds) for the right shoulder but 
that “he can do job well.”  The next shoulder examinations were in the setting MEB evaluation 
beginning in July 2001.  The NARSUM 30 July 2001 recorded some improvement in pain after 
surgery with persistent limitation of mobility and lifting.  The examiner recorded examination 
performed  26  July  2001  with  right  shoulder  flexion  of  130  degrees,  and  abduction  of  45 

degrees.  PT examinations on 30 July 2001 and 1 May 2002 recorded similar results (flexion of 
110 degrees, abduction of 65 degrees; flexion of 120 degrees, abduction of 60 degrees).  The 
C&P examination on 26 November 2002, 2 months after separation, recorded right shoulder 
pain  with  overhead  use  at  the  shoulder  level  and  above.    Examination  noted  a  positive 
impingement  sign,  intact  strength  (5/5),  flexion  to  140  degrees  (with  pain  at  100  degrees), 
abduction  to  100  (with  pain  at  90),  internal  rotation  of  60  degrees,  external  rotation  of  90 
degrees.    An  X-ray  performed  that  day  showed  some  spurring  of  the  distal  clavicle  but  was 
otherwise  normal.    The Board  considered  if  the  right  shoulder  condition  rose  to  the  level  of 
being separately unfitting when considered alone.  The Board noted the absence of any care for 
the right shoulder after the September 1998 encounter.  Although there was report of pain and 
limitation  of  motion  with  overhead  activities,  there  was  not  any  evidence  the  shoulder 
condition prevented performance of duties.  After due deliberation, the Board concluded that 
the preponderance of evidence does not support a finding that the right shoulder condition was 
separately unfitting when considered alone. 
 
Heel Condition.  The STR reflects problems with right plantar foot pain in the arch region next 
to  the  heel  beginning  in  1990  treated  with  injections  and  orthotics.    Recurring  right  foot 
symptoms prompted a permanent L3 profile in December 1991 for no running more than three 
quarters of a mile after which the STR falls silent with regard to treatment for the condition.  A 
MEB and PEB in July 1997 included the condition and returned the CI to duty.  In October 1997 
the CI presented for care of left arch pain diagnosed as plantar fasciitis with a history of the 
same  on  the  right  in  the  past.    A  January  1998  PT  evaluation  recorded  the  first  step  in  the 
morning was the worst and an antalgic gait when walking barefoot.  No care for foot pain is in 
evidence of the STR since the January 1998 PT evaluation other than a November 1998 orthotic 
lab entry for orthotics.  The CI passed the 2 mile walk portion of the fitness test in September 
1998,  November  1999,  May  2000  and  October  2000.    The  11  December  2000  orthopedics 
evaluation for back pain noted the profile for plantar fasciitis and that the CI could perform his 
job well and pass the fitness test walk.  The CI passed the 2 mile walk portion of the fitness test 
in May 2001 just prior to entry into the Disability Evaluation System (DES).  At the NARSUM 
examination in July 2001, the CI was slightly tender on the heels and could walk on his toes and 
heels.    Podiatry  evaluation  on  21  August  2001  noted  bilateral  plantar  fasciitis  present  since 
1989-1990 with significant relief with custom boots and orthotics (“Patient relates 90-95% relief 
after  initial  Rx  with  boots  and  orthotics”).    The  CI  reported  worse  pain  when  barefoot.    On 
examination  there  was  tenderness  of  the  plantar  fascia  and  a  high  arch.    The  diagnosis  was 
plantar fasciitis.  A Haglund’s deformity (Achilles insertion bump) was also noted (and seen on 
X-rays).  On follow up with podiatry on 13 December 2001, the plantar fasciitis was considered 
stable with pain and tenderness in the arches near the heels.  Examination of the Haglund’s 
deformity, the posterior aspect of the heel, was without redness, warmth, swelling, or evidence 
of  bursitis  on  both  sides.    The  16  January  2002  NARSUM  addendum  recorded  CI  report  of 
worsened pain.  The C&P examination on 26 November 2002 recorded plantar pain on arising 
and use of custom shoes and inserts which were reported to be helpful and enabled the CI to 
walk “okay.”  On examination gait pattern was “satisfactory,” and the CI would walk on heels 
and toes.  The heel pads were tender.  There were no abnormal callosities observed.  X-rays of 
both feet were normal.  At the 4 December 2002 C&P examination, gait was normal.  The Board 
considered if the plantar fasciitis and heel pain condition rose to the level of being separately 
unfitting  when  considered  alone.    Board  members  noted  the  plantar  fasciitis  and  heel  pain 
condition was a long standing chronic condition over several years during which time the CI was 
able pass the alternate walking fitness test and performs most of his duties.  After entry into 
the DES, there was no objective evidence of worsening of the condition.  After due deliberation, 
the Board concluded that the preponderance of evidence does not support a finding that the 
heel pain condition was separately unfitting when considered alone. 

 
Bilateral Knee Condition.  STRs from March 1997 to July 1999, document periodic care for right 
knee pain with running and stairs diagnosed as retropatellar pain syndrome.  No specific injury 
or  trauma  was  identified.    A  magnetic  resonance  imaging  (MRI)  scan  in  1999  demonstrated 
some  degenerative  changes  of  the  posterior  horn  of  the  medial  meniscus  without  tear;  the 
remainder  of  the  MRI  was  normal.    Evaluation  by  orthopedics  on  4  January  2000  recorded 
report of bilateral knee pain for the prior four to 12 months, right greater than left, without a 
history of injury.  On examination, ROM was normal with minimal crepitus, and an equivocal 
patellar compression test.  There was no instability, joint line tenderness, swelling, or meniscus 
signs.    The  10  January  2000  profile  was  updated  to  include  the  knee  condition.    The  STRs 
contain no further entries for care or complaint of knee pain.  The CI passed the 2 mile walk 
portion of the fitness test in May 2000, and October 2000.  The 11 December 2000 orthopedics 
evaluation for back pain noted the profile for plantar fasciitis and that the CI could perform his 
job well and pass the fitness test walk, but made no reference to problems or complaints with 
the knees.  The CI passed the 2 mile walk portion of the fitness test in May 2001 just prior to 
entry into the DES.  The NARSUM on 30 July 2001, recorded report of knee pain since 1998 with 
walking and road marching and later it became worse with swelling at times.  On examination 
ROM of both knees was flexion to 110 degrees, and extension 0 degrees.  The MEB examination 
of the lower extremities noted on DD Form 2807 dated 26 July 2001 was checked as normal.  PT 
examination  on  1  May  2002  documented  normal  ROM  (flexion  130  degrees,  extension  0 
degrees).    The  C&P  examination  on  26  November  2002,  2  months  after  separation,  noted 
bilateral patellofemoral syndrome since 1998.  The CI reported pain with stairs and squatting.  
On examination the gait was “satisfactory” and ROM essentially normal (flexion 135 degrees, 
extension full with five degrees of hyperextension, “recurvatum” within normal range) with an 
occasional click but without pain on motion, or crepitus.  There was tenderness, but patellar 
grind test for patellofemoral pain was negative and there was no swelling or instability.  X-rays 
of the knees were normal.  The Board considered if the knee pain condition rose to the level of 
being  separately  unfitting  when  considered alone.    The  Board noted that  the  STRs  fell  silent 
with regard to the knee condition after January 2000, and that the CI completed and passed his 
2 mile walk.  The Board also noted there was a pre-existing profile since 1991 limiting running 
due to the CI’s foot condition.  Although the knee pain complaint was subsequently added to 
the profile, the preponderance of evidence does not support a finding that the right and left 
knee condition was separately unfitting when considered alone.   
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were  migraine  headaches,  and  anxiety  disorder  with  depressive  disorder  (anxiety  disorder, 
panic  disorder  and  depressive  disorder).    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  Veterans  Affairs 
Schedule for Rating Disabilities (VASRD) §4.3 (Resolution of reasonable doubt) standard used 
for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” 
standard.    The  CI  had  a  history  of  migraine  headaches  that  worsened  in  2000.    The  CI  was 
evaluated  and  treated  by  neurology.    The  neurology  evaluation  dated  19  November  2001 
concluded  the  headache  condition  was  medically  acceptable  noting  daily  headache  with 
episodic worsening that did not require acute treatment and did not result in any missed duty 
time.    The  MEB  psychiatry  NARSUM  dated  6  December  2001  recorded  daily  headaches  that 
were bothersome but did not prevent daily activities.  The NARSUM addendum dated  
16  January  2002  reported  that  the  headaches  were  much  improved  on  medication  and  not 
disabling.  With respect to anxiety disorder with depressive disorder, the psychiatry NARSUM of 
6 December 2001 recorded a history of symptoms of depression and panic since 1997 related 
to  a  prior  to  service  traumatic  experience.    The  psychiatrist  concluded  the  CI  met  retention 

standards  for  these  psychiatric  conditions  noting  response  to  treatment.    The  mental  health 
C&P examination on 3 December 2002 noted “He progressed from E-3 to E-5 and is not aware 
of  any  impairment  in  his  work  life  because  of  his  nervous  problems.”    Neither  of  these 
contended conditions were implicated in the commander’s statement and none were judged to 
fail retention standards.  All 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.  The migraine headaches, anxiety and depressive disorders 
each  responded  to  medication  and  appropriate  treatment.    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 any 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, the 
PEB bundled the chronic pain low back, right shoulder, bilateral heels and knees as unfitting 
apparently  based  on  the  overall  effect  on  fitness,  determining  no  single  condition  was 
separately unfitting but combined caused the member to be unfit.  The Board considered each 
condition separately with regard to fitness.  In the matter of the chronic pain, low back, right 
shoulder, bilateral heels and knees conditions, the Board unanimously recommends no change 
from the PEB adjudication and that it cannot recommend a finding of separately unfit for any of 
the combined conditions for additional rating at separation.  In the matter of the contended 
conditions  of  migraine, and  anxiety  and  depression,  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 
Chronic Pain, Low Back, Right Shoulder, Bilateral Heels And Knees 

VASRD CODE  RATING 
5099-5003 

10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111001, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 
 
 

 

xxxxxxxxxxxxxxxxxxxxxxxxxxxx, 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 xxxxxxxxxxxxxxxxxx, AR20130003815 (PD201100958) 
 
 
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 
 
 
 
 

     xxxxxxxxxxxxxxxxxxxxxxxxxx 
     Deputy Assistant Secretary 
         (Army Review Boards)