RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE: ARMY 
SEPARATION DATE:  20060301 

 
NAME: XXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200318 
BOARD DATE:  20121109 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  Soldier,  SPC/E-4(11B/Infantryman),  medically 
separated  for  major  depressive  disorder  (MDD)  with  some  features  of  posttraumatic  stress 
disorder  (PTSD)  and  minor  compression  fracture  of  L1.    The  first  recorded  entry  for  mental 
health conditions was in April 2004 when the CI did not want to return to his assignment in 
Korea after 2 weeks of leave with his wife in CONUS (continental United States).  A chapter 5-17 
discharge  IAW  AR  635-200  begun,  but  was  terminated  on  21  December  2004  when  he  was 
diagnosed with PTSD and a Medical Evaluation Board (MEB) was initiated.  Despite continued 
treatment for his MDD, PTSD and back conditions, he did not improve adequately to meet the 
physical  requirements  of  his  Military  Occupational  Specialty  (MOS)  or  satisfy  physical  fitness 
standards.  The MEB submitted PTSD, major depression, and chronic low back pain (LBP), status 
post  (s/p)  vertebral  compression  fractures  as  medically  unacceptable  IAW  AR  40-501.    Six 
additional conditions, identified in the rating chart below, were also identified and forwarded 
by the MEB.   
 
The Physical Evaluation Board (PEB) initially adjudicated the major depressive order with some 
features of PTSD which will not be rated separately due to overlapping symptoms and minor 
compression fracture of L1 as unfitting, rated 10% and 0% respectively, with application of the 
Veteran’s  Affairs  Schedule  for  Rating  Disabilities  (VASRD).    The  remaining  conditions  were 
determined to be not unfitting.  The CI concurred with this assessment.  Subsequently, the PEB 
conducted a review and issued an administrative correction, identifying the major depression 
as  follows:  “major depressive  order,  with  some  features  of  PTSD  which  is  not  independently 
unfitting and will not be separately rated due to overlapping symptoms.” The remainder of the 
adjudication was unchanged.  The CI made no appeals and was medically separated with a 10% 
disability rating.   
 
 
CI  CONTENTION:  The  CI  states:  “The  Physical  Evaluation  Board  (PEB)  failed  to  separately 
consider and rate Mr. E----'s posttraumatic stress disorder and major depressive disorder and to 
appropriately  assess  the  severity  or  each  condition,  and  failed  to  appropriately  assess  the 
severity  of  Mr.  E----'s  back  injury.    In  addition,  the  PEB  should  have  found  the  following 
conditions  unfitting:  migraine  headaches,  chondromalacia  of  the  right  knee,  and  left  ankle 
fracture.”  Legal counsel for the CI also submitted a 69 page appeal including attachments.   
 
 
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  MDD  and  PTSD,  LBP,  migraine 
headaches, chondromalacia right knee, and left ankle fracture 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  of  MDD  and  L1  compression 
fracture.  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 Admin PEB – Dated 20060110 

VA (2 Mos. Post-Separation) – All Effective Date 20060302 

Condition 

MDD w/some Features of 
PTSD 
Minor Compression 
Fracture of L1 
History of Alcohol 
Dependence, in remission 
Post-concussion 
Headaches 
Chronic Intermittent R 
Knee Pain 
Chronic L Ankle Pain 
Chronic R 2nd Finger Pain 
Smoking 

Code 
9434 

Rating 
10% 

5235 

0% 

Not Unfitting 

Condition 

PTSD w/Dysthymia 
Chronic LBP due to fractures at 
L1,L2 and T12 
No VA Entry 

Not Unfitting 

Migraine Headaches 

Not Unfitting 

Not Unfitting 
Not Unfitting 
Not Unfitting 

Chondromalacia, R Knee 
L Ankle Fracture w/Limitation of 
Motion 
Right Index Finger Fracture 
No VA Entry 
R Shoulder Strain w/Painful and 
Limited Motion 
Bilateral Tinnitus 

Code 

9433-9411 

Rating 
50%* 

Exam 

20060531 

5235 

10%** 

20060531 

 

8100 

5099-5014 

5271 
5229 

 

5201-5024 

6260 

 

30% 

10% 

10% 
0% 
 

10% 
10% 

 

20060531 

20060531 

20060531 
20060531 

 

20060531 
20060531 
20060531 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

0% X 5 / Not Service-Connected x 0 
Combined:  80%*** 

*100% 20100215 for hospitalization.  70% from 20100510.  **20% from 20100303.  ***Includes bilateral factor of 1.9%. 
 
 
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 
mere  presence  of  a diagnosis  at  separation  is not  sufficient  evidence  that the  condition  was 
unfitting for continued military service, even if the MEB determined the condition not to meet 
retention  standards.    The  DES  has  neither  the  role  nor  the  authority  to  compensate  service 
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  Veteran  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.  The Board utilizes DVA evidence proximal to separation 
in arriving at its recommendations; and, DoDI 6040.44 defines a 12 month interval for special 
consideration to post-separation evidence.  The Board’s authority as defined in DoDI 6044.40, 
however, resides in evaluating the fairness of DES fitness determinations and rating decisions 
for disability at the time of separation.  Post-separation evidence, therefore, is probative only 
to  the  extent  that  it  reasonably  reflects  the  disability  and fitness  implications  at  the  time  of 
separation.   
 

Major Depressive Disorder with some features of PTSD.  The CI deployed to Iraq on 4 April 2003 
and returned early on 17 October 2003 to prepare for an OCONUS (outside continental United 
States) move.  On the post-deployment health assessment 10 days later on 27 October 2003, he 
denied any mental health symptoms and noted that he had no concerns about his health and 
that it was good.  However, he also checked “yes” that he planned to seek mental health care.  
That December, the CI married a woman 15 years his senior with three children from a prior 
marriage.  He then moved to the Republic of Korea (ROK) for an unaccompanied assignment.  
His medical in-processing was on 28 January 2004.  The first visit for mental health available for 
review  in  the  records  in  evidence  was  19  April  2004  when  he  requested  evaluation  for  a 
compassionate reassignment.  He was on 2 weeks of leave back stateside and he did not wish 
to  leave  his  pregnant  wife  and  return  to  the  ROK.    He  was  diagnosed  with  an  adjustment 
disorder with depressed and anxious mood.  The CI sought to “sign in” vice being AWOL (absent 
without leave), but was not allowed to do so.  On 26 April 2004, he was admitted for psychiatric 
observation with the complaint “I contemplated suicide” after locking himself in a bathroom 
with  a  knife.    He  also  noted  significant  financial  stress  after  a  friend  stole  his  truck  and 
“trashed”  his  house  in  addition  to  assaulting  his  wife.    He  was  discharged  2  days  later  on 
28 April  2004  with  the  diagnosis  of  a  single  episode  of  MDD.    The  CI  again  requested  a 
compassionate reassignment.  It was noted on 4 May 2004 that his prognosis was thought to be 
poor if he were returned to ROK.  An administrative separation IAW AR 635-200 Chap 5-17 was 
initiated.  There were two mental health visits on 4 May 2004.  On one, with a psychologist, he 
stated that his symptoms were secondary to the thought of leaving his spouse.  On the other, a 
psychiatric visit, he noted that his symptoms had started in Iraq, a history inconsistent with the 
prior  note  and  with  the  post  deployment  health  assessment.    A  history  of  alcohol  abuse 
beginning at age 14 or 15 was noted as well.  It was also noted that he had received non-judicial 
punishment for underage drinking.  The CI was later enrolled in a substance abuse treatment 
program.  He was begun on an anti-depressant on 6 May 2004.  His diagnosis changed between 
appointments and was variously listed as PTSD, MDD and adjustment disorder.  He was noted 
to meet retention standards, though.  Several notes documented difficulty contacting the CI by 
both medical and command authorities and a 16 May 2004 email from the battalion surgeon 
noted that the CI would be placed on AWOL if he did not contact the unit.  This was again noted 
in an email to the CI from his commander directing the CI to contact him or be placed on AWOL 
status.  The next recorded visit was 6 October2004 when the diagnosis was indeterminate and 
PTSD,  acute  stress  disorder  and  adjustment  disorder  were  all  under  consideration.    On 
6 December 2004 the CI returned to Behavioral Health to resume treatment.   
 
On 15 December 2004 the CI reported to a social worker that he was being “Chaptered” out 
and that he thought that he should meet an MEB.  On 21 December 2004, he was noted to be 
depressed; PTSD was diagnosed and MEB recommended.  At the 11 January 2005 social work 
visit the CI reported that things were going much better and that he was happy about the MEB.  
He endorsed startle, avoidance, mistrust and looking for a weapon when he awoke at night.  
The MEB psychiatric narrative summary (NARSUM) was dictated the next day, 12 January 2005, 
14  months  prior  to  separation.    It  diagnosed  both  PTSD  and  MDD  and  noted  borderline 
personality traits.  His symptoms were improved on medications.  The examiner assigned these 
symptoms  to  PTSD:  “avoid  activities  that  arouse  recollections,  feeling  of  detachment  from 
others,  sense  of  a  foreshortened  future,  difficulty  falling  asleep, 
irritability,  difficulty 
concentrating,  hyper  vigilance,  and  exaggerated  startle  response.”    The  following  were 
attributed  to  the  MDD:    “insomnia,  depressed  mood,  history  of  suicidal  ideation,  poor 
concentration.”    The  CI  was  seen  multiple  times  over  the  next  few  months  for  marital 
counseling,  dealing  with  an  alleged  domestic  violence 
long  standing 
communications issues.  At this time, the spouse’s parents and brothers lived with the CI and 
his wife.  Compliance with treatment was poor and contacting the CI remained difficult.  The 

incident  and 

medical hold commander noted that the CI was “emotionally unstable” in the 1 August 2005 
assessment, 7 months prior to separation, but that he had been assigned as a driver for a short 
period.  There is another gap in treatment until the CI was seen 3 October 2005 and noted to 
have PTSD symptoms from both Iraq and a motor vehicle accident (MVA) the previous summer.  
He was seen multiple times that October and diagnosed with a chronic anxiety disorder, PTSD 
and MDD, all by the same examiner.  The examiner noted an essentially normal mental status 
examination at these appointments, including memory, other than pressured speech with an 
anxious  and/or  depressed  mood.    The  general  NARSUM  was  dictated  3  November  2005,  4 
months  prior to  separation.    It  noted  that the CI  had  been  doing  secretarial  work  as  well  as 
working as a driver.  He noted that his medications kept him “dazed and groggy.”  The examiner 
noted that the CI had stopped all psychiatric medications the previous May since he did not 
“want to have a long-term reliance on them.”  The CI was still taking medications, including a 
narcotic, for his LBP.  He reported anxiety when he was in groups of more than five people.  It 
was thought that he would improve with time, but that it was unlikely that he would ever meet 
all his duty requirements.  Mental health diagnoses were PTSD and MDD.  When asked if he 
wished to remain in the military, he stated “no”.  At the VA Compensation and Pension (C&P) 
exam performed on 31 May 2006, 3 months after separation, the CI reported that he had been 
under fire from small arms, rocket propelled grenades and mortars while in Iraq.  This history 
was not found elsewhere in the records.  He stated that he developed a sleep disorder with 
recurrent dreams of Iraq, irritability and anhedonia which lead to him seeking treatment and 
the diagnosis of PTSD in April 2004.  This history is not consistent with the contemporaneous 
records.  His symptoms persisted despite treatment and he also developed agoraphobia.  Again, 
the Board noted that the CI improved on medications, but stopped on his own initiative due to 
concerns of becoming dependent.  He endorsed memory problems since the MVA in July 2004.  
He reported that he had stopped treatment after separation as he was no longer covered by 
insurance.   
 
The Board notes that medical coverage lasts for 180 days after separation from the military and 
that he was still within this window at the time of the C&P examination.  The CI also stated that 
he began the use of alcohol in the summer of 2004, contrary to the history of an Article 15 and 
beginning alcohol use at 14.  He noted that he typically awoke around 0700 to 0730 and would 
work on the computer and was searching for a job.  He also took care of his oldest daughter.  
He  was  interested  in  obtaining  an  associate’s  degree  and  working  as  a  park  ranger  doing 
historical reenactments.  In the evening, he cooked supper, called his parents and played with 
his  children  before  putting  them  to  bed.    He  then  spent  time  with  his  wife  before  retiring 
around 2200 to 2230.  He endorsed poor sleep with recurrent dreams of being mortared.  He 
also stated that his sleep was poor secondary to recurrent LBP.  He stated that he had crying 
spells and “gets down.”  He was upset that he could not work and that he could not receive 
treatment.  He occasionally felt hopeless, but denied suicidal ideation.  He endorsed irritability.  
He had been in one fight over one year prior to separation.  The CI reported that he was unable 
to  return  to the military.    He  was  able  to  enjoy  himself  and  was  interested  in  antique  guns.  
However, his energy was low and motivation sometimes lacking.  His friends and father were 
understanding.    He  endorsed hyper  vigilance  and being  anxious  in  crowds.    Both  the  mental 
status examination and mini-mental status were both normal.  The examiner noted that “his 
presentation is consistent with post traumatic stress disorder.”  He was hyper vigilant, irritable, 
anxious and had agoraphobia in crowds.  The examiner also noted that the CI had been treated 
for  depression  which  was  manifested  by  sleep  difficulty,  low  motivation,  and  irritability.    He 
noted that the full criteria for a MDD were not met currently, but had been during his service.  
“I  am  somewhat  at  a  loss  to  explain  this,  since  the  veteran  at  this  point  is  not  taking  any 
antidepressant medication.”  He was diagnosed with PTSD and dysthmia caused by PTSD as well 
as alcohol dependence in remission.  He deferred making an Axis II diagnosis.   

 
The Board first considered the two overlapping conditions, PTSD and MDD, to determine if each 
was separately unfitting.  The CI, through counsel, contended that the two conditions should 
have  been  rated  separately.    The  psychiatric  impairment  from  both  conditions  must  be 
combined under a single §4.130 rating since the VASRD does not allow otherwise, unless the 
symptoms and impairment are distinctly apportioned by the examiner.  Such was not the case 
and the Board must rate the total psychiatric impairment as if the two Axis I conditions were a 
single  unfitting  condition.    The  Board  did  note  that  the  MEB  NASUM  did  attribute  some 
symptoms separately to PTSD and to MDD; however, there was also overlap of symptoms.  The 
C&P examiner did apportion symptoms between the two disorders, but determined that the 
MDD had resolved a finding which he could not explain.  The Board also noted, though, that the 
history  provided  to  the  C&P  examiner  was  not  entirely  supported  by  the  record.    After  due 
deliberation, the Board determined that the preponderance of evidence does not support the 
CI’s  contention  that  the  two  mental  health  conditions  should  be  considered  as  separately 
unfitting for disability rating purposes.   
 
The Board next considered if the application of VASRD §4.129 was appropriate.  It was agreed 
that this case did not meet the requirements for application of a retroactive TDRL rating IAW 
VASRD  §4.129,  as  directed  by  DoD  for  PTSD  and  similar  cases.    The  primary  psychiatric 
condition was judged to be of an intrinsic nature, and not a result of a “highly stressful event” 
(as per §4.129).  The PEB determined that the unfitting condition was MDD with some features 
of  PTSD  which  is  not  independently  unfitting.   The MEB  psychiatric  examination  was  remote 
from separation.  The general MEB examination on 3 November 2005 did not determine one 
condition predominate.  The final treatment note documents an anxiety disorder characterized 
by PTSD and mixed anxiety and depression.  The C&P examiner thought PTSD predominate, but 
could not  explain the  improvement  in the  MDD  which he noted had been  present  on  active 
duty.  After careful consideration of the evidence, the Board concluded that the preponderance 
of evidence does not support a change in the PEB adjudication of MDD with some features of 
PTSD which is not separately unfitting.  Accordingly, the provisions of VASRD §4.129 are not 
applicable and a constructive six month TDRL period is not applied.   
 
The Board then directed attention to its rating recommendation based on the above evidence.  
The  PEB  coded  the  MDD  condition  as  9434,  MDD,  and  rated  it  at  10%  for  mild  industrial 
impairment.    The  VA  coded the PTSD  condition  as  9433-9411,  dysthymic  disorder and PTSD, 
and rated it 50%.  The Board is left to consider that the CI’s accounts of his symptoms and their 
severity,  which  constitute  most  of  the  psychiatric  evidence,  are  subject  to  probative  value 
compromise.  In such cases, the Board leans more heavily on the well-grounded evidence such 
as actual performance and functioning, objective elements of the MSE and symptoms which are 
consistently  reported  and  compatible  with  clinical  expectations.    In  so  doing,  however,  the 
Board  remains  cognizant  of  VASRD  §4.3  (reasonable  doubt)  and  favorably  concedes  matters 
which it cannot opine to a “more likely than not” standard.  The VA examiner noted the sleep 
disturbances,  low  motivation,  hyper  vigilance,  tearfulness,  anxiety,  avoidance  behavior  and 
history of suicidal ideation.  It noted that the mental status examination was normal.  The MEB 
NARSUM  performed  on  3  November  2005  documented  that  the  CI  was  performing  office 
duties.  No impairment in these duties was noted in the summary other than difficulty working 
in groups greater than five.  He did have some side effects from medications, but these were 
not psychiatric medications.  The last outpatient visits on active duty noted that he was anxious 
and  depressed  with  occasional  pressured  speech.    He  was  working  prior  to  separation  as  a 
driver  and  doing  administrative  tasks.    After  separation,  he  was  goal  directed,  interested  in 
further education, seeking a job and taking care of himself and his family while he was at home.  
He had outside interests and friends.  The mental status exam and mini mental status exam 

were  both  normal.    The  Board  agreed  that  the  disability  in  evidence  did  not  meet  the 
requirements  for  a  50%  rating.    The  description  for  a  30%  rating is  “Occupational  and  social 
impairment with occasional decrease in work efficiency and intermittent periods of inability to 
perform occupational tasks (although generally functioning satisfactorily, with routine behavior, 
self-care,  and  conversation  normal).”    The  description  for  a  10%  rating  is  “Occupational  and 
social impairment due to mild or transient symptoms which decrease work efficiency and ability 
to perform occupational tasks only during periods of significant stress, or; symptoms controlled 
by  continuous  medication.”    It  is  not  clear  if  the  CI  was  ever  asymptomatic  on  medications; 
however, the record clearly documents that the CI improved on medications and that he self-
initiated discontinuation due to his concerns of long-term dependency.  It is also noted that the 
CI  frequently  did  not  show  for  scheduled  appointments.    The  Board  determined  that  the 
description  for  the  10%  rating  best  describes  the  level  of  disability  observed.    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 mental health condition.   
 
Minor Compression Fracture of L1.  There were 2 goniometric ROM evaluations in evidence, 
with  documentation  of additional  ratable  criteria,  which  the  Board  weighed  in  arriving  at  its 
rating recommendation; as summarized in the chart below.  However, the Board noted that the 
MEB measurements were obtained prior to the radiofrequency denervation on 29 September 
2005.   
 

MEB ~8 Mo. Pre-Sep 

VA C&P ~3 Mo. Post-Sep 

Prior to denervation  

No painful motion 

 
The CI was in a MVA in July 2004 when he was struck from behind and went off the road to the 
side.    He  was  consistently  noted  to  have  a  minimal  compression  fracture  of  L1  and  also, 
dependent on the note reviewed, of T12 and L2.  He was treated with a back brace and limited 
duty.  His pain persisted and a magnetic resonance imaging (MRI) performed on 11 April 2005; 
it  was  unremarkable.    His  neurological  examination  was  consistently  normal  including 
sensation, strength and reflexes.  On 1 June 2005 he had injections over the facets with a 90% 
reduction in pain for several hours.  This lead to a radiofrequency denervation of L1-2 and L2-3, 
performed  on  29  September  2005.    The  MEB  physical  exam  was  accomplished  prior  to  the 
denervation and therefore has reduced probative value.  The ROM is above.  At the orthopedic 
NARSUM, 4 months prior to separation, the CI reported that the denervation, done  5 weeks 
earlier, only provided temporary relief of his LBP.  He also reported falling 6 to 7 times a week 
and an inability to walk over 2 minutes.  On examination, he had normal sensation, strength 
and reflexes.  Extension was reduced and flexion limited to his fingertips to mid-tibia (near 90 
degrees).    X-rays  showed  no  increase  in  the  fracture  pattern.    This  examination  was  more 
proximate  to  separation  than  the  MEB  goniometric  measurements  and  also  was  after 
denervation.  At the C&P joint and back examination performed on 31 May 206, 3 months after 
separation, the CI reported that he could not sit over 2 minutes.  The examiner wrote, though 
“easily sat for about 45 minutes while I took his complete history”.  He was observed to have a 
limp, but it was not assigned to any particular complaint.  He was also seen for a right knee, 
bilateral ankle and right foot complaints at that appointment.  No assistive devices were in use.  
The ROM was normal without pain as above without loss from repetition.  Sensation, strength 
and reflexes were normal.  Neither spasm nor abnormal contour was documented.  The Board 

Thoracolumbar ROM 

Degrees 

Flexion (90 Normal) 

Combined (240) 

Comment 

§4.71a Rating 

 
50  
165 

20% 

 
90 
240 

0% 

directs attention to its rating recommendation based on the above evidence.  It noted that the 
ROM measurements obtained for the MEB in July 2005 were prior to the denervation and do 
not  represent  his  motion  after  treatment.    The  orthopedic  NARSUM  examination  ROM  was 
near  normal.    The  PEB  rated  the  back  condition  at  0%,  coded  5235,  vertebral  fracture, 
apparently  relying  on  the  MEB  orthopedic  examination.    The  VA  rated  the  back  condition  at 
10%, also coded 5235, but relied on the MEB examination rather than the VA C&P examination.  
The Board noted that the VA examination documented a normal ROM in all planes as well as an 
absence of DeLuca criteria and painful motion.  This examination was more proximate to the 
date  of  separation  than  the  MEB  orthopedic  examination  and  more  remote  from  the 
denervation.    It  is  therefore  assigned  a  higher  probative  value.    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 
were the right knee, left ankle and 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.   
 
Right Knee.  The records in evidence for the right knee are all within the DES period.  The CI 
complained of falling secondary to his back pain at the orthopedic examination and was issued 
a  cane  by  the  brace  shop;  the  orthotic  technician  noted  that  it  was  for  knee  pain.    The 
orthopedic examination was silent for knee complaints; however, the general NARSUM 2 days 
later on 3 November noted that knee pain had been present for several years, but had he had 
never pursued an evaluation.  He was pending an orthopedic evaluation later that month.  X-
rays  on  17  November  2005  were  normal.    An  orthopedic  examination  that  same  day  was 
notable for anterior knee pain.  The CI denied swelling, locking, instability or giving way.  The 
examination  was  normal  without  instability  or  tenderness.    The  C&P  exam  on  31  May  2006 
noted that he did not use an assistive device or have flares.  He had a limp not further specified.  
On  examination,  ROM  was  normal,  ligaments  stable  and  tests  for  meniscal  injury  negative.  
DeLuca criteria were negative.  He was diagnosed with chondromalacia.  The condition was not 
profiled, other than one time in 2001, noted by the commander as duty limiting or determined 
to be medically unfitting. 
 
Left Ankle Fracture.  The CI fell onto his left ankle in November 2000 with a sprain and fracture.  
He was managed with a splint and duty limitations.  He continued to be seen periodically for 
left  ankle  pain  over  the  next  2  years,  but  there  are  no  entries  in  the  available  records  after 
3 December  2002 for  the  left  ankle.    The  MEB examiner  noted  the  past  history  of  left  ankle 
pain.  The C&P examiner documented a history of daily pain and the use of a brace.  He was 
noted to have dorsiflexion reduced to 10 degrees from the VA normal of 20, but with normal 
plantar  flexion  and  negative  DeLuca  criteria.    He  was  given  one  profile  for  the  left  ankle  on 
5 May 2002 which expired 6 August 2002.  The ankle was not cited by the commander as duty 
limiting or determined to be medically unfitting by the MEB. 
 
Migraines.    The  CI  was  first  seen  for  headaches  in  February  2002  when  he  also  had  viral 
symptoms.  A CT scan was performed on 1 July 2004 after he struck his head; it as normal.  A 
second CI was performed on 3 August 2005 for increasing headaches; again, it was normal.  The 
MEB NARSUM noted that the CI had complained of headaches occurring once a week since the 
head  trauma.    The  CI  self-medicated  with  over  the  counter  analgesics.    At  the  C&P,  the  CI 

reported that he had migraines which began in 2003, occasionally associated with nausea and 
vomiting and always associated with photophobia.  He noted that they occurred one to 2 times 
a  week  and  were  incapacitating,  requiring  him  to  leave  work.    The  commander’s  letter  was 
silent for headaches, there is no evidence in the record that the CI left work because of them, 
he was not profiled for headaches and the MEB found that these met retention standards.   
 
All of these 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  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.    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 MDD with some features of PTSD, the Board unanimously 
recommends no change in the PEB adjudication.  In the matter of the back condition and IAW 
VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the 
matter of the contended right knee, left ankle and 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, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:   
 

VASRD CODE  RATING 

9434 
5235 

COMBINED 

10% 
0% 
10% 

UNFITTING CONDITION 

MDD with Features of PTSD 
Minor Compression Fracture L1 with LBP 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120306, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXXXX 
           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 
XXXXXXXXXXXXXXXXXXXXXXXXXXX, AR20120021213 (PD201200318) 
 
 
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 
 
 

     XXXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)