RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

 

 
NAME:  XXXXXXXXXXXXXXXX                                                                  BRANCH OF SERVICE:   ARMY  
CASE NUMBER:  PD1200394                                                                   SEPARATION DATE:  20070726 
BOARD DATE:  20121031   
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SPC/E-3  (11B/Infantry),  medically  separated  for 
bilateral patellofemoral pain, bilateral ankle pain, bilateral foot pain, and for chronic low back 
pain.    The  CI  developed  bilateral  ankle  and  shin  pain  following  a  hard  parachute  landing  at 
airborne school and he was separated from airborne school.  Pain continued through training 
and included both feet.  “He was diagnosed variously with stress reaction, stress fractures and 
shin  splints”  and  he  developed  bilateral  knee  pain.    Pain  was  predominately  in  the  anterior 
knee, anterior tibia, bilateral lateral ankle, and midfoot.  Back pain was not related to the initial 
injury proximate to the bilateral lower extremity pain, but was attributed to the gait changes 
from  the  bilateral  lower  extremity  conditions.    Bilateral  patellofemoral  pain,  bilateral  ankle 
pain, bilateral foot pain and chronic low back pain conditions did not improve adequately with 
foot inserts and extensive physical therapy treatment to meet the physical requirements of his 
Military  Occupational  Specialty  (MOS)  or  satisfy  physical  fitness  standards.    He  was  issued  a 
permanent L4 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded 
nonradicular pain of the lumbar spine, bilateral patella-femoral pain, bilateral ankle pain, and 
bilateral foot pain as four medically unacceptable conditions.  There were no other conditions 
for Informal Physical Evaluation Board (IPEB) adjudication.  The IPEB adjudicated the bilateral 
patellofemoral pain, bilateral ankle pain and bilateral foot pain as a single unfitting condition, 
and  a  separate  chronic  low  back  pain  condition  as  unfitting,  rated  10%  and  0%,  with  cited 
application of the US Army Physical Disability Agency (USAPDA) pain policy for the combined 
knees, ankles and feet pain rating and with the Veteran’s Affairs Schedule for Rating Disabilities 
(VASRD)  for  the  back.    The  CI  appealed  to  the  Formal  PEB  (FPEB),  which  affirmed  the  IPEB 
findings; and was then medically separated with a 10% disability rating.   
 
 
CI  CONTENTION:    “There  was  a  significant  difference  from  the  decision  rating  of  the  Army 
Medical  Board  at  10%  in  2007, from the  VA Medical  decision  rating of  90%  within  a  year  of 
being  medically  separated  from  me  US  Army.    Currently,  as  of  2012  there  are  still  ongoing 
ratings of 90%.”   
 
 
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 remaining conditions rated by the VA 
at separation and listed on the DA Form 294 application 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.   
 
 

VA (10 Mos. Post-Separation) – All Effective Date 20070727 

Code 

Rating 

Exam 

 
 
 
RATING COMPARISON:   
 

Service FPEB – Dated 20070404 
Condition 

Code 

Rating 

Bilateral Patella-Femoral 
Pain (PFS), Bilateral Ankle 
Pain, Bilateral Foot Pain 

5099-5003 

10% 

Chronic LBP 

5237 

0% 

↓No Additional MEB/PEB Entries↓ 

Condition 

Right Lower Extremity, Medial 
Tibial Plateau Stress Fracture 
with Shin Splints and Peroneal 
Tendon Subluxation 
Left Lower Extremity, 
Incomplete Distal Tibia Fracture 
With Shin Splints 
Right Knee, PFS 
Left Knee, PFS 
Right Foot/Ankle, Arthropathy, 
Instability, Tenderness, Clicking, 
And Popping 
Left Ankle/Foot, Arthropathy, 
Instability, Tenderness, Clicking, 
And Popping 
DDD w/Disc Bulges at L4-5, L5-
S1 Lumbar Spine 
Sleep Apnea w/RAD 
Adjustment Disorder 
Fibromyalgia 
Temporomandibular Joint 
Dysfunction 

5299-5262 

20%* 

20080114 

5299-5262 

10%* 

20080114 

5099-5014 
5099-5014 

5299-5271 

NSC 
NSC 

NSC 

20080114 
20080114 

20080114 

5299-5271 

NSC 

20080114 

5243 

6602-6847 
5025-9440 

5025 

10% 
50% 
30%* 
20% 
10% 

20080114 
20080114 
20080110 
20080114 
20080114 

 

9999-9905 
0% X 2 / Not Service-Connected x 6 

Combined:  90% 

Combined:  10% 

*Adjustment disorder increased to 50% effective20100326; Right LE decreased to 10% and left LE decreased to 0% effective 
20110728 (combined remained 90%)  
 
 
ANALYSIS SUMMARY:  Although, the VA records within 12-months of separation documented 
and compensated fibromyalgia (a chronic pain syndrome), fibromyalgia is outside of the Board’s 
scope.   
 
Patella-Femoral  Pain  (PFS),  Bilateral  Ankle  Pain  and  Bilateral  Foot  Pain  Condition.    The  PEB 
combined  patella-femoral  pain  (PFS),  bilateral  ankle  pain  and  bilateral  foot  pain  as  a  single 
unfitting and rated condition, coded analogously to 5003 citing use of the USAPDA pain policy.  
The  Board  must  apply  separate  codes  and  ratings  in  its  recommendations,  if  compensable 
ratings for  each  condition  are  achieved  IAW VASRD  §4.71a.    If  the  Board  judges that two  or 
more separate ratings are warranted in such cases, however, it must satisfy the requirement 
that  each  ‘unbundled’  condition  was  unfitting.    Not  uncommonly  this  approach  by  the  PEB 
reflects its judgment that the constellation of conditions was unfitting; and, that there was no 
need for separate fitness adjudications, not a judgment that each condition was independently 
unfitting.  Thus the Board must exercise the prerogative of separate fitness recommendations 
in  this  circumstance,  with  the  caveat  that  its  recommendations  may  not  produce  a  lower 
combined rating than that of the PEB.   
 
There  were  three-range-of  motion  (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.   
 

 

 

 

Knee ROM 

Flexion (140⁰ Normal) 
Extension (0⁰ Normal) 

Comment 

PT ~7 Mo. Pre-Sep 
Right 
Left 
140⁰ 
142⁰ 
5⁰ 
4⁰ 

“No (+) Lachman’s test”; 
normal knee stability; see 

text 

MEB ~5 Mo. Pre-Sep 
Right 
Left 

“bilaterally with a full range 

of motion”  

No effusion, no TTP, and a 
stable ligamentous exam 

bilaterally 

VA C&P ~7 Mo. Post-Sep 
Right 
Left 
114⁰ 
120⁰ 
13⁰ 
20⁰ 

Uses cane; no limp without 

cane; no instability; 

exaggerated pain behavior; see 

text 

§4.71a Rating 

0% 

0% 

0% 

0% 

0% 

0% 

Ankle ROM 

Dorsiflexion (0-20⁰) 
Plantar Flexion (0-45⁰) 

PT ~  7 Mo. Pre-Sep 
Right 
Left 
2⁰ 
4⁰ 
20⁰ 
36⁰ 

MEB ~5 Mo. Pre-Sep 
Left 
Right 
“full range of motion 

bilaterally” 

VA C&P ~7 Mo. Post-Sep 
Right 
Left 
8⁰ 
4⁰ 
20⁰ 
20⁰ 

Demonstrates a right lateral leg 
crepitus or subluxation of the 
peroneal muscular tendon; see 

text 

0% 

0-10% 

Comment 

“No abnormal limitation of 

motion”;  see text 

§4.71a Rating 

0% 

0% 

No deformity, swelling, or 
crepitus; Min tender R. 
peroneal tendon area 
0% 

0% 

 
The narrative summary (NARSUM) exam indicated a non-antalgic gait, with full symmetric hip 
ROM with minimal anterior tenderness to palpation (TTP).  He had normal strength and light 
touch sensation throughout his lower extremities.  ROMs of the ankles and knees were noted 
as  “full  range  of  motion”  absent  any  specific  numbers  of  degrees  or  planes  tested.    PT 
goniometric  ROM  measurements  two  months  prior  and  appended  to  the  NARSUM,  were 
normal for each knee and documented <5 degrees of dorsiflexion (normal 20 degrees) for each 
ankle.    NARSUM  positive  findings  of  the  lower  extremities  included  minimal  anterior  calf 
tenderness along the lateral border of his tibia bilaterally and on the lateral aspect of the right 
ankle over the peroneal tendons (non-tender left ankle).  Motor, sensory, neurovascular and 
reflex  exams  were  normal.    The  MEB  DD  Form  2808  exam  noted  “ankles  pop/click,  no 
instability”  as  well  as  moderate  asymptomatic  pes  cavus.    Plain  radiographs  of  the  right hip, 
bilateral knees, bilateral ankles, and right foot were normal.  Bone scan in March with repeat in 
December 2006 indicated a final impression of:  1. Persistent radiotracer accumulation at the 
distal  left  tibia  which  is  decreased  from  the  prior  examination  and  may  represent  an 
incompletely  healed  stress  fracture.    The  scintigraphic  findings  may  lag  behind  the  patient's 
clinical symptoms; 2. Bilateral shin splints; 3. Likely stress and/or gait-related changes at the left 
proximal  tibiofibular  joint;  and  4.    No  new  stress  fracture  identified.    Magnetic  resonance 
imaging (MRI) performed in December 2006 was negative.   
 
At the VA Compensation and Pension (C&P) exam, the CI reported an injury history similar to 
that in the service treatment records (STR).  Symptoms included ankle popping (predominately 
right); shin pain knees pop and can swell; with “knees and ankles are stiff and weak and his legs 
can give out.”  The examiner stated “He has generalized and multiple symptoms regarding the 
lower  extremities  and  it  is  difficult  to  sort  them  out  specifically  on  taking  the  history.”    The 
examiner indicated there was no foot condition; there was bilateral shin pain and right ankle 
peroneal tendon subluxation with a normal left ankle exam, and some mild patellofemoral pain 
syndrome, with exam symptoms “more suggestive of knee pain being chronic pain syndrome 
…”    The  examiner  noted  “exaggerated  pain  behavior”  and  “unusual,  non-anatomic  pain 
symptoms.”  The examiner listed the formal ROMs from Kinesitherapy, which are summarized 
in the charts above.  For the overall exam the examiner stated “The (CI) does have multiple 

tender  points  on  exam  and  may  have  fibromyalgia.  …  However,  I  am  concerned  that  he 
demonstrates exaggerated pain behavior today and his complaints are far out of proportion to 
any  objective  findings  on  exam  or  imaging  studies,  and  this  may  be  more  consistent  with 
chronic pain syndrome.”   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board  first  considered  if  any  of  the  single  components  of  the  “Bilateral  Patella-Femoral  Pain 
(PFS),  Bilateral  Ankle  Pain,  Bilateral  Foot  Pain”  condition,  having  been  de-coupled  from  the 
combined  PEB  adjudication,  remained  independently  unfitting  as  established  above.    All 
members  agreed  that  none  of  the  specific  lower  extremity  joints,  as  an  isolated  condition, 
would  have  rendered  the  CI  incapable  of  continued  service  within  his  MOS.    The  Board 
discussed  the  probative  values  of  the  lower  extremity  exams  and  stated  functional  loss  and 
impact  on  performance  in  light  of  examiner  comments  on  “exaggerated  pain  behavior”  and 
“unusual,  non-anatomic  pain  symptoms.”    Given  the  profile  limitations  and  treatment  notes 
with consideration of provider-noted likely chronic pain syndrome, as well as a post-separation 
diagnosis  of  fibromyalgia,  the  Board  majority  considered  the  record  was  consistent  with 
functional  loss  and  impairment  as  noted  in  the  profile  restrictions.    The  Board  majority 
adjudged that both the left lower extremity and the right lower extremity conditions rose to 
the level of being unfitting.  The Board deliberations focused on fairly and equitably coding the 
CI’s bilateral lower extremity symptoms IAW VASRD criteria only and absent the USAPDA pain 
policy.    The  PEB  combined  both  lower  extremities  into  a  single  5099-5003  (analogous  to 
arthritis) rating of 10%.  The VA rated the right and left lower extremity separately coding each 
under 5299-5262 (analogous to Tibia and fibula, impairment) as charted above.  The CI’s lower 
extremity pain affected both the ankle and knee with primary abnormal imaging and pain in the 
shins.  The Board majority adjudged that each extremity was at the “slight” 10% level, and that 
the  right  lower  extremity  (with  peroneal tendon  popping/crepitus),  although  worse than  the 
left, did not rise to the higher “moderate” 20% level of disability.   
 
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), the Board majority recommends that the right lower leg and joint pain symptoms be 
separated from the left lower leg and joint pain symptoms and recommends a disability rating 
of 10% for the right leg condition coded 5299-5262; and 10% for the left leg condition coded 
5299-5262.   
 
Chronic Low Back Pain Condition.  Low back pain was a separately rated unfit condition by the 
PEB.    The  PEB  disability  description  stated:  “Chronic  low  back  pain  Soldier  reported  a  hard 
parachute landing.  Physical exam notes the Soldier can touch his toes and has full ROM, as 
demonstrated to the NARSUM examiner.  There is no tenderness noted and no spasms were 
reported.    While  the  plain  X-rays  were  normal,  the  MRI  showed  mild  facet  degenerative 
changes.  Soldier was issued a cane to assist in ambulation.”  The goniometric ROM evaluations 
in  evidence  which  the  Board  weighed  in  arriving  at  its  rating  recommendation,  with 
documentation of additional ratable criteria, are summarized in the chart below.   
 

Thoracolumbar ROM 

(in Degrees) 

Flexion (90 Normal) 

Extension (30) 
R Lat Flexion (30) 
L Lat Flexion (30) 
R Rotation (30) 
L Rotation (30) 
Combined (240) 

PT ~7 Mo. Pre-Sep 

MEB ~5 Mo. Pre-Sep 

VA C&P ~7 Mo. Post-Sep* 

90 (85, 87, 88) 
25 (22, 25, 25) 
20 (22, 25, 22) 
30 (28, 30, 32) 
30 (26, 30, 28) 
30 (30, 28, 32) 

225 

“He is able to touch his 
toes and has full (ROM) 
of his spine without any 

pain.” 

45 (43) 
15 (13) 

30 
30 

10 (11) 
5 (7) 
135 

No localized tender, 

muscle spasm or 

guarding; no abnormal 

gait due to 

spasm/guarding; 

increased lordotic curve 

10% 

Gait non-antalgic; no 

tender; 

motor/sensory/SLR 

without deficit; able to 

heel and toe walk 

0% (PEB 0%) 

cane; 

*“ROM 

+ Tender; Gait mild bilateral limp use 
of 
normal” 
“demonstrated  exaggerated  pain 
behavior … complaints are far out of 
proportion 
objective 
findings”; gait normal without cane 

any 

to 

10% (see text) 

Comment:  

§4.71a Rating 

 
At the NARSUM exam, the CI reported a 4 month history of lower back pain without radicular 
symptoms, which the CI attributed to his “walking ‘funny’ from his lower extremity injuries.”  
Pain was daily with walking and sitting.  Back brace and PT were not effective and medication 
included  occasional  tramadol  and  Valium.    The  NARSUM  exam  is  summarized  above  with 
imaging as described in the PEB description.  The DD Form 2808 MEB exam indicated “mild low 
paraspinal tender  on  ext”  with tandem  gait, negative  SLR  and  otherwise  normal.   Treatment 
notes  following  the  FPEB  and  2  months  prior  to  separation  indicated  an  epidural  steroid 
injection  for  pain  control,  increased  gabapentin  medication  dosage  and  a  treatment  note 
indicating abnormal extension on ROM testing.   
 
At the C&P exam the CI reported back pain that was not specifically tied to his hard parachute 
landing noted for his other musculoskeletal conditions.  He complained of constant generalized 
LBP with non-radicular pain in the legs, and numbness in the legs at times.  Pain was “at best a 
7”  with  flare-ups  to  10/10.    There  was  no  evidence  of  incapacitating  episodes  IAW  VASRD 
§4.71a.  The examiner listed the formal ROMs from Kinesitherapy, but commented that “The 
(CI’s) exaggerated pain behavior and lack of effort on back range of motion during my exam 
makes it difficult to assess his actual range of motion.  However, on active duty, November 17, 
2006, he had (ROM) results showed no significant loss of motion.”   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
Board discussed the mixed picture of symptoms and complaints with considerations similar to 
those already discussed in the bilateral lower extremity analysis above.  The PEB indicated the 
MEB exam was used for rating (“full ROM”) and that there was mild facet degeneration and the 
CI was issued a cane to assist in ambulation.  Numerous exams and treatment notes indicted 
lower back pain, painful motion, or limited lower back ROM.  The Board considered the tenants 
of VASRD §4.7 (higher of two evaluations), §4.40 (functional loss), §4.45 (the joints) and §4.59 
(painful motion) for rating the chronic low back pain condition considering the entirety of the 
record.    After  due  deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3 
(reasonable doubt), the Board majority recommends a disability rating of 10% for the low back 
pain condition.   
 
 
BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent  with  the  VASRD  in  effect  at  the  time  of  the  adjudication.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were exercised.  As discussed above, PEB reliance on the USAPDA pain policy for rating bilateral 
patellofemoral pain, bilateral ankle pain, and bilateral foot pain condition was operant in this 
case  and  the  condition  was  adjudicated  independently  of  that  policy  by  the  Board.    In  the 
matter  of  the  bilateral  patella-femoral  pain  (PFS),  bilateral  ankle  pain and  bilateral foot  pain 
condition, the Board majority recommends by a vote of 2:1 that it be rated for two separate 
unfitting conditions as follows:  right PFS, ankle pain and foot pain coded 5299-5262 and rated 
10% and left PFS, ankle pain and foot pain coded 5299-5262 and rated 10%; both IAW VASRD 

§4.71a.  The single voter for dissent (who recommended no recharacterization) submitted the 
appended minority opinion.  In the matter of the low back pain condition, the Board by a vote 
of 2:1 recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  The single voter 
for  dissent  (who  recommended  no  recharacterization)  submitted  the  appended  minority 
opinion.  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;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of his prior medical separation:   
 

UNFITTING CONDITION 

Right Patella-Femoral Pain, Ankle Pain and Foot Pain condition 
Left Patella-Femoral Pain, Ankle Pain and Foot Pain condition 
Chronic Low Back Pain 

VASRD CODE  RATING 
5299-5262 
5299-5262 

10% 
10% 
10% 
30% 

5237 

COMBINED (w/ BLF) 

           XXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120425, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
MINORITY OPINION:   
 
My dissent with the majority vote was on two fronts, both of which were recognized by the 
Board  at  large  as  areas  where  opposing  positions  were  each  reasonable  and  the  attendant 
decisions were difficult for all members.   
 
My  first  area  of  divergence  from  the  majority  position  in  this  case  was  in  regard  to  the 
suitability  of  “unbundling”  bilateral  knee,  ankle  and  foot  pain  (coded  analogously  to 
degenerative arthritis of the involved joints by the PEB, and rated IAW the USAPDA pain policy) 
to  achieve  separate  rating  recommendations.    My  position  is  that  the  separately  derived 
“conditions” were not justified as separately unfitting, and thereby are not eligible for separate 
rating.    Along  with  the  majority  members,  I  carefully  deliberated  the  option  of  deriving 
separately compensable ratings for each or any of the 6 joints/joint groups encompassed in the 
single unfitting condition which the PEB rated together at 10%.  My conclusion based on the 
totality  of  the  evidence  was  that  no  single  joint  (or  subset  of  joints)  could  be  defended  as 
autonomously unfitting.  All members agreed that none of the specific lower extremity joints as 
an isolated condition rendered the CI incapable of performing his MOS duties.  Yet the majority 
concluded that the consolidated right lower and consolidated left lower extremity “conditions” 
each  rose  to  the  level  of  being  separately  unfitting.    The  majority further  conceded  that the 
right  was  worse  than  the  left,  but  nevertheless  concluded  each  lower  extremity  rose  to  the 
level of a “slight” disability for separate 10% ratings.  The minority position is that no single joint 
was  associated  with  distinctly  separate  unfitting  clinical  features  in  the STR  entries.    Despite 
radiographic  evidence  of  old  or  healing  bilateral  stress  fractures,  there  was  no  residual 
functional impairment that rose to the level of separately unfitting.   
 
Given  the entirety  of  the  record,  there  was  not  reasonable  justification  that  any  of the  joint 
conditions was separately unfitting.  However, the PDBR cannot lower the PEB combined 10% 
rating.    Therefore,  the  minority  voter  firmly  concludes  that  there  was  insufficient  cause  to 
recommend a change from the PEB adjudication.   
 
My second area of divergence from the majority position is in regards to the recommendation 
that  the  minimum  compensable  rating  was  justified  for  the  back  condition.    Although  the 
majority  recommendation  invokes  tenants  of  multiple  VASRD  sections  (as  cited  in  the 
proceedings)  and  “the  entirety  of  the  record”,  the  recommendation  rests  on  assignment  of 
considerable  probative  value  to  subjective  evidence  which  the  minority  voter  believes  was 
unreasonably  weighted.    As  per  some  of  the  evidence  cited  in these  proceedings,  as  well  as 
more un-cited evidence in the record, there is significant incongruity of the subjective evidence 
with the objective findings and facts in this case.  With respect to such incongruity, the Board’s 
default posture regarding the accuracy of history and severity of symptoms as reported by the 
applicant  in  the  medical  record  is  one  of  acceptance  as  fact.    The  Board,  however,  should 
reasonably assign limitations to that principle in cases such as the one at hand.  If there are 

provider notes questioning the accuracy of the history, logical inconsistencies of the reported 
and subjective history with the overall evidence, and/or significant inconsistencies in the history 
given to different medical providers, the Board should take these into account in arriving at its 
recommendations.  The minority voter takes note that such factors were evidenced in this case.  
The CI’s subjective reporting of the severity of his back pain symptoms was discordant with the 
objective  findings;  and,  was  reported  in  the  context  of  an  expressed  loss  of  motivation  to 
continue  to  serve  in  the  Army,  and  mindful  of  the  ongoing  disability  evaluations.    Multiple 
examiners  pre  and  post  separation  noted  that the  reported  diffuse  pain  complaints  had  “no 
obvious  basis,”  were  disproportionate  to  the  mild  clinical  abnormalities  noted,  or  were 
“exaggerated  far  exceeding  objective  findings.”    One  examiner  expressly  noted  the  CI  had 
stated  he  was  “unhappy”  with  the  likely  10%  disability  rating  he  expected  to  receive.    The 
VASRD principles cited by the majority, including reasonable doubt, rest on the probative value 
of the evidence under consideration.  Since the probative value of the subjective evidence in 
this case is compromised to the point that all conclusions derived from it are speculative, the 
objective  evidence  should  be  predominantly  weighed  as  the  basis  of  the  Board’s 
recommendation.    The  objective  evidence  does  not  support  a  compensable  rating  and  the 
minority voter finds insufficient cause to recommend a change from the PEB determination that 
the low back condition was appropriately rated 0%.   
 
Having  drawn  these  conclusions  and  applied  these  assumptions  to  my  recommendation,  the 
minority  voter  respectfully  recommends  that  there  be  no  recharacterization  of  the  CI’s 
disability and separation determination, as follows: 
 

 
 
 

 

 

UNFITTING CONDITION 

Bilateral Patella-Femoral Pain, Ankle Pain and Foot Pain 
Chronic Low Back Pain 

VASRD CODE 
5099-5003 

5237 

COMBINED 

RATING 

10% 
0% 
10% 

 
 
 

 
 

 
 
 

 
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 
XXXXXXXXXXXXXXXXXXXXXXXX, AR20120021790, (PD201200394) 
 
 
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 reject the Board’s recommendation and accept the Board’s minority opinion as accurate that 
the applicant’s final Physical Evaluation Board disability rating remains unchanged.  There is 
insufficient justification to support the Board’s recommendation in accordance with Army and 
Department of Defense regulations.   
 
2.  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)