RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20070116 

 
NAME:    
CASE NUMBER:  PD1200270 
BOARD DATE:  20121121     
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  Active  Guard  Reserve  (AGR)  SGT/E-5  (42A/Human  Resources 
Specialist),  medically  separated  for  chronic  low  back  pain.    The  covered  individual  first 
developed low back pain while deployed in Iraq in 2004.  The low back condition could not be 
adequately  rehabilitated  to  meet  the  physical  requirements  of  her  Military  Occupational 
Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent L3/E2 profile 
duty and referred for a Medical Evaluation Board (MEB).  Endometriosis, migraine headaches, 
right wrist pain, right knee pain and overweight conditions, identified in the rating chart below, 
were  also  identified  and  forwarded  by  the  MEB.    The  Physical  Evaluation  Board  (PEB) 
adjudicated  the  chronic  low  back  condition  as  unfitting,  rated  10%  with  application  of 
regulations.  The CI made no appeals, and was medically separated with a 10% disability rating.   
 
 
CI CONTENTION:  “I was given a 10% medical discharge for Chronic Back Pain however when I 
was discharged I had several other conditions which were not considered. I was airlifted out of 
Iraq  due  to  severe  pelvic  pain  to  Landstuhl,  Germany  where  I  found  out  I  had  severe 
Endometeriosis (sic) and then was flown to GA where I underwent surgery.  After many years of 
pain and surgery while in service I had to receive a hysterectomy at the age of 29, two years 
after discharge, because of the condition.  I am currently rated for both the endometriosis as 
well  as  the  hysterectomy.    I  also  began  to  have  severe  Migraines  while  in  Iraq  which  are 
documented and later received (sic) a 50% rating from the VA soon after discharge.  I had my 
gall bladder removed in 2006 which gave me significant trouble while on duty as well as after 
discharge.” 
 
 
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 endometriosis and migraine headache 
conditions  as  requested  for  consideration  meet  the  criteria  prescribed  in  DoDI  6040.44  for 
Board purview; and, are addressed below.  Obesity is not a physical disability IAW DoDI 1332.38 
and will be discussed no further.  The remaining conditions rated by the VA at separation and 
listed on the DA Form 294 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 20061109 

VA (6 Mos. Post-Separation) – All Effective Date 20070117 

Condition 

Chronic Low Back Pain 
Endometriosis 
Migraine Headaches 
Chronic Right Wrist Pain 
Chronic Right Knee Pain 
Overweight  

Rating 
10% 

Code 
5237 
Not Unfitting 
Not Unfitting  
Not Unfitting  
Not Unfitting  
Not Unfitting  

Condition 

Lumbar Strain 
Endometriosis 
Migraine Headaches 
Tendonitis Right Wrist 
Right Knee Condition 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

No Corresponding VA Entry 

0% X 5 / Not Service-Connected x 3 

Combined:  40% 

Code 
5237 
7629 
8100 
5215 
5261 

Rating 
20% 
10% 
10% 
0% 
0% 

Exam 

20070709 
20070709 
20070709 
20070709 
20070709 

20070709 

 
 
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. 
 
Low Back Condition.  The CI first developed low back pain while deployed in Iraq in 2004 after 
falling  when  carrying  a  rucksack.    A  magnetic  resonance  imaging  (MRI)  study,  performed  on 
12 July  2005,  documented  small  discs  at  the  T12-L1  (midback)  and  L5-S1  (low  back)  levels 
without nerve compression and a mild wedge fracture of the edge of T12.  The CI was treated 
with physical therapy and medication with unsustained improvement.  A follow-up MRI study, 
performed  on  2  January  2007,  2  weeks  before  separation,  was  unchanged  from  the  MRI 
performed  in  July  2005,  but  noted  the  small  healed  compression  fracture  to  be  chronic 
(healed).    The  CI  was  evaluated by  neurosurgeons,  22 February  2006 and  12  July  2006,  who 
recommended conservative treatment without surgical intervention.  There were four range-of-
motion (ROM) evaluations, three goniometric, in evidence, with documentation of additional 
ratable  criteria,  which  the  Board  weighed  in  arriving  at  its  rating  recommendation;  as 
summarized in the chart below. 
 

Thoracolumbar ROM  

(In degrees) 

Flexion (90 Normal) 

Extension (30) 
Combined (240) 

 Comment 

MEB ~4 Mo. 

Pre-Sep 

(20060920)  

45  
25  
190 

 Normal gait  
motor, sensory 
and reflexes; 
No spasm/ pain     
SLR neg 

Private Clinic 
~2 Mo. Pre-Sep 
(20061208)  

VA Neuro 
~5 Mo.- Post 
Sep(20070613)  

FAROM 
FAROM 

- 

50 
20 
- 

 Full active ROM 
Spinal  tenderness; 
motor/sensory/ 
reflexes wnl 
 
 

Motor, sensory, 
reflexes ,gait wnl 
No spasm, fatigue; 
Pain with ROM; slt 
spinal tenderness        

VA C&P 

~6 Mo. Post-Sep 

(20070709)  

80 
30 
190 

 No change with 
repetition;no pain 
spasm,weakness;
motor/sensory 
wnl; gait and 
posture wnl 

§4.71a Rating 

20% 

10% 

20% 

10% 

 
At  the  MEB/narrative  summary  (NARSUM)  evaluation,  performed  on  20  September  2006,  4 
months  before  separation,  the  CI  reported  back  pain  without  radiation  averaging  6/10 
increasing to 8/10 with any strenuous activity.  She reported taking only Tylenol for pain control 
as  she  was  breast  feeding  4  months  post  partum.    Findings  on  physical  examination  are 
recorded above.  On a clinic exam performed 8 December 2006, 2 months before separation, 
ROM of the back was reported as “full” (see findings above).  On VA Compensation and Pension 
(C&P) neurologic examination performed on 13 June 2007, 5 months after separation, ROM of 
the back was reduced to flexion of 50 degrees without spasm (see findings above).  At the C&P 
general exam, 9 July 2007, 6 months post-separation and 3 weeks after the prior exam, the CI 
reported persistent, localized back pain without radiation, but noted no impact on activities of 
daily living or occupation.  Findings on physical examination are recorded above and are noted 
for  markedly  improved  ROM  compared  to  the  previous  examination.    The  Board  directs 
attention to its rating recommendation based on the above evidence.  The PEB and VA (initially) 
rated the back condition 10% code 5237, lumbar-sacral strain.  A higher rating, 20% under this 
code, requires forward flexion of the thoracolumbar spine of 30 to 60 degrees, combined ROM 
of  not  greater  than  120  degrees  or  muscle  spasm  or  guarding  severe  enough  to  result  in 
abnormal  gait  or  abnormal  spine  contour.    The  Board  noted  a  panoply  of  disparate  ROM 
evaluations on examinations proximate to separation as noted in the ROM chart above.  The 
Board was unable to ascertain a reasonable explanation for this disparity based on intermittent 
medication use, physical therapy or physical activity.  After review of the available evidence and 
discussion the Board unanimously agreed that a rating of 20% was appropriate.  A higher rating 
of 40% requiring flexion of 30 degrees or less or favorable ankylosis of the entire lumbosacral 
spine  was  not  supported  by  the  record  in  evidence.    There  was  no  evidence  of  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 recommends a disability rating of 20% for the low 
back pain condition.   
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were endometriosis and migraine headache conditions.  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.    Endometriosis  Condition;  The  CI  developed 
chronic  abdominal  pain  in  1999.    Laparoscopy  at  that  time  revealed  only  hydrosalpynx, 
evidence of chronic infection.  She was admitted in 2004 for recurrent abdominal pain and a 
diagnosis of endometriosis was made at laparoscopy.  Ablation of the disease was performed at 
this  procedure  and  patient  begun  on  appropriate  suppressive  medication  with  subsequent 
adequate control of symptoms.  The CI was admitted to the hospital June 2006 for right upper 
abdominal pain related to gallstones not endometriosis.  The treatment record contains no ER 
or  emergent  visits  or  hospitalizations  for  treatment  of  the  endometriosis  condition  after 
diagnosis  in  2004.   Migraine  Headache  Condition;  The  CI  had  migraine headaches  as  a  child.  
Headaches  reappeared  in  2004  after  deployment.    At  time  of  separation  headaches  were 
responding to simple analgesic medication (Excedrin).  On the MEB/NARSUM evaluation, the CI 
reported a headache ‘once in a while.’  The record in evidence contains no emergent clinic, ER 
visits or loss of work for this condition and no treatment with any migraine specific medication 
at time of separation.  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  the 
endometriosis  and  migraine  headache  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  PEB  reliance  on 
service regulations for rating the chronic back pain condition was operant in this case and the 
condition was adjudicated independently of that instruction by the Board.  In the matter of the 
chronic low back pain condition, the Board unanimously recommends a disability rating of 20%, 
coded 5237 IAW VASRD §4.71a.  In the matter of the contended endometriosis and migraine 
headache  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 recommends that the CI’s prior determination be modified as 
follows, effective as of the date of her prior medical separation:   
 

VASRD CODE  RATING 
20%  
20% 

COMBINED 

5237 

             
           President 
           Physical Disability Board of Review 

Chronic Low Back Pain 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120505, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

 

 
 
 

 
 
 

 
 
 

 

 

 
 
 

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  
 
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 
 
 
 
 
 
 
 
 
 
 
 

       
     Deputy Assistant Secretary 
         (Army Review Boards)