RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXXXXXX                                                         BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200623                                                            SEPARATION DATE:  20020611 
BOARD DATE:  20130117 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SSG/E-6 (95B/Military Police), medically separated for 
chronic left ankle pain and back pain.  The CI sustained a traumatic injury to her left ankle and 
unrelated  low  back  pain  (LBP)  in  1999.    Chronic  left  ankle  pain  and  back  pain  conditions 
developed  which  could not be  adequately  rehabilitated  with  treatment  to  meet  the physical 
requirements  of  the  CI’s  Military  Occupational  Specialty  or  satisfy  physical  fitness  standards.  
She was issued a permanent L4 and referred for a Medical Evaluation Board (MEB).  Four other 
conditions  (mood  disorder,  chronic  pelvic  pain,  endometriosis,  and  temporomandibular  joint 
dysfunction [TMJD]), recorded in the rating chart below, were also identified and forwarded by 
the MEB.  The Physical Evaluation Board (PEB) adjudicated the chronic left ankle pain and back 
pain conditions as unfitting, rated 10% and 10% with likely application of the Veterans Affairs 
Schedule  for  Rating  Disabilities  (VASRD)  and  AR  635-40.    The  remaining  conditions  were 
deemed  not  unfitting.    The  CI  made  no  appeals,  and  was  medically  separated  with  a  20% 
disability rating.   
 
 
CI CONTENTION:  “1. Chronic left ankle pain – without fracture evidence; first let me point out it 
was  not  my  ankle,  it  was  my  midfoot.    I  had  to  have  a  midfoot  fusion  because  there  was 
fracture evidence; I had a lisfanc’s injury that went mis-diagnosed for over 3 yrs as a class 5 
sprain.    Meanwhile  I  ran  and  kept  re-injuring  it.    I  had  to  have  2-3  surgeries  after  I  was 
discharged not to mention nerve ablation injections.  I cannot bend my toes and it precludes 
me from doing many everyday activities or activities I loved like hiking/running. 2.  “Back pain” 
– I have no space between my L5-S2 discs and spinal strenuous that is only getting worse.  I also 
have a herniated disc and can’t stand or sit for long periods of time without discomfort.  I feel, 
in an effort to push soldiers through a broken system, my injuries were not closely looked at 
and I have to live with them the rest of my life when I was on track to being a career soldier.”      
 
 
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 conditions “identified but not determined to be unfitting by the PEB.”  The ratings for 
unfitting conditions will be reviewed in all cases.  The chronic pelvic pain, endometriosis and 
temporomandibular joint dysfunction (TMJD) conditions are requested and will be reviewed by 
the Board.  The mood condition is not requested and is, thus, outside 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 20010910 
Condition 

Code 

Chronic Left Ankle Pain 

5271 

Rating 

10% 

Back Pain 

5299-5295 

10% 

Exam 

20010926  

20010926 

0% 

20% 

5283 

Code 

Rating 

VA (12 Mos. Pre-Separation) – All Effective Date 20020612 
Condition 
Residuals  of  Lisfranc’s  Fusion 
Left  Foot  (claimed  as  residuals 
of left ankle injury_ 
Degenerative  Disc  Disease, 
Lumbosacral  Spine  (claimed  as 
back pain) 
Major Depressive Disorder 
Endometriosis  and  Peritoneal 
Fibrosis 
Temporomandibular 
Syndrome with Malocclusion 
0% X 4 / Not Service-Connected x 2 
Combined:  50%* 

9434 
7629 

10% 
10% 

5293 

20% 

Joint 

9905 

20010926 
 

20011012 
20010926  

Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

Mood Disorder 
Chronic Pelvic Pain 
Endometriosis 
Temporomandibular  Joint 
Dysfunction 
↓No Additional MEB/PEB Entries↓ 
Combined:  20% 
*Numerous  VARD’s  changed  ratings,  to  summarize,  the  last  VARD  will  be  used  to  summaries  changes.  Per  VARD  dated 
20100421 combined rating changed as follows:  50% effective 20020612; 60% effective 20040617; 80% effective 20041007; 
100% effective 20050414; 80% effective 20050601; 90% effective 20051215; 100% effective 20060814; 90% effective 20061114 
and finally 100% effective 20091022. 
 
 
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 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 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.  The Board has neither the jurisdiction nor authority to scrutinize or render opinions 
in reference to the CI’s statements in the application regarding suspected DES improprieties in 
the processing of her case or quality of case. 
 
Chronic Left Ankle Pain.  The CI sustained an inversion injury to the left ankle in April 1997.  At 
ER  evaluation,  slight  swelling  of  the  lateral  ankle  was  noted.    X-rays  were  negative  and  a 
diagnosis of ankle sprain was made.  On physical therapy (PT) evaluation 22 April 1999, swelling 
had  resolved  and  gait  was  normal,  but  the  CI  had  slight  mid  foot  pain.    This  increased  with 
activity  and  CT  scan  revealed  a  LisFranc  injury  to  the  first  three  metatarsal  bones.    Surgical 
fusion of these bones was undertaken in March 2000 with successful healing.  Postoperatively 
the CI had continued mid-foot pain without evidence of instability or nonunion of the surgical 
repair.  At the MEB narrative summary evaluation 23 August, 9 months before separation, gait 
was antalgic due to pain.  The mid foot was stable with symmetrical range-of-motion (ROM) of 
20  degrees  inversion  and  10  degrees  eversion  with  tenderness.    The  arch  of  the  foot  was 
normal without change on weight bearing.  X-rays revealed the healing, screw placement and 
weight-bearing alignment to be satisfactory.  At the VA Compensation and Pension (C&P) on 
26 September  2001,  8  months  prior  to  separation,  the  CI  reported  being  unable  to  run, 
requiring  a  cane  for  prolonged  standing  but  able  to  comfortably  walk  one-quarter  of  a  mile 
without  pain,  to  sustain  heavy  physical  activity  without  immediate  distress  and  to  pursue 
recreational activities to include weight-lifting.  On physical examination there was no evidence 
of post-surgical complications.  ROM of the foot was decreased on the left (Inversion- RT 15/LFT 

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5; Everson- RT 30/ LFT 10) without atrophy or sensory change.  ROM of the both ankles was 
normal. 
 
The Board directs attention to its rating recommendation  based on the above evidence. The 
PEB rated the condition 10% code 5271, ankle limited motion, moderate.  Under this code a 
higher rating of 20% requires a marked condition.  The VA rated 20% code 5283, metatarsal 
bones, mal-union, moderately severe.  A higher 30% rating requires the condition to be severe, 
not supported by the record in evidence.  The Board noted the PEB to rate the condition as an 
ankle injury but agreed that the pathology was that of a foot condition.  The Board unanimously 
agreed that the condition was moderate given the stability of the surgical repair, presence of a 
normal arch with weight bearing, slightly reduced ROM of the foot expected from the surgical 
procedure  and  the  mild  to  moderate  impact  on  ambulation,  activities  of  daily  living  and 
exercise.  The Board opined that the condition was best rated at 10% under 5283 or 5284 but 
that  change  of  coding  would  provide  no  rating  benefit  to  the  CI.    After  due  deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the 
Board  concluded  that  there  was  insufficient  cause  to  recommend  a  change  in  the  PEB 
adjudication for the ankle (foot) condition. 
 
Back  Pain  Condition.    The  CI  developed  LBP  without  trauma  in  1999.    Magnetic  resonance 
imaging obtained 5 July 2001 demonstrated a small central disc at the L5 to S1 level without 
nerve impingement.  At multiple subsequent clinic visits for pain treatment, motor and sensory 
concomitants were not present.  At the MEB evaluation 23 August, 9 months before separation, 
the  CI  reported  difficulty  with  bending  and  lifting  heavy  objects.    On  physical  examination 
flexion was slightly reduced (80 degrees and extension 20 degrees) with pain.  Motor strength, 
sensation and spinal reflexes were normal.  At the C&P examination, the CI reported back pain 
with  activity.    On  physical  exam  flexion  and  extension  were  normal  without  pain,  spasm, 
weakness or lack of endurance.  Sensation and spinal reflexes were normal.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  rated  the  back  condition  10%,  coded  5295,  (lumbosacral  strain,  characteristic  pain  on 
motion).  A higher rating of 20% requires muscle spasm on extreme forward bending, loss of 
lateral  spine  motion,  unilateral,  in  the  standing  position,  not  supported  by  the  record  in 
evidence.  The VA rated the back condition 0% coded 5293, (intervertebral disc syndrome, post-
operative)  (asymptomatic).    The  Board  unanimously  agreed  the  ROM,  motor  and  sensory 
findings and absence of spasm supported a 10% rating.  After due deliberation, considering all 
of  the  evidence  and  mindful  of  VASRD  §4.3  (Resolution  of  reasonable  doubt),  the  Board 
concluded that there was insufficient cause to recommend a change in the PEB adjudication for 
the back pain condition. 
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were  chronic  pelvic  pain,  endometriosis  and  TMJD.    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 
(Resolution of reasonable doubt) standard used for its rating recommendations, but remains 
adherent  to  the  DoDI  6040.44  “fair  and  equitable”  standard.    Chronic  pelvic  pain  and 
endometriosis:  the CI had a history of pelvic abdominal pain since 1995.  Laparoscopy in 1998 
demonstrated  peritoneal  endometriosis,  to  be  the  cause  of  the  painful  condition.    This  was 
surgically  cauterized  and  successfully  controlled  postoperatively  with  specific  medication 
allowing  the  CI  to  work  without  interruption.    TMJD:  The  CI  underwent  jaw  surgery  without 
complication  to  correct  a  nontraumatic  mal-occlusion.    Post-operatively,  the  patient  noted 
some  decreased  opening  of  the  mouth,  without  effect  on  deglutition,  enunciation  or  social 
interaction.    Neither  of  these  conditions  were  permanently  profiled,  nor  was  judged  to  fail 
retention standards.  Both were reviewed by the action officer and considered by the Board.  
After  due  deliberation  in  consideration  of  the  preponderance  of  the  evidence,  the  Board 

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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.  In the matters of the left 
ankle  pain  and  the  back  pain  conditions  and  IAW  VASRD  §4.71a,  the  Board  unanimously 
recommends no change in the PEB adjudications.  In the matter of the contended chronic pelvic 
pain, endometriosis and TMJD conditions, the Board unanimously recommends no change from 
the PEB determinations as not unfitting.  There were no other conditions within the Board’s 
scope of review for consideration.   
 
 
RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:   
 

UNFITTING CONDITION 
Chronic Left Ankle Pain 
Back Pain 

VASRD CODE  RATING 
5271 
5299-5295 
COMBINED 

10% 
10% 
20% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120605, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

   4                                                           PD1200623 
 

 
 

 
 
 

 
 

 
 
 

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 XXXXXXXXXXXXXXXXX, AR20130002819 (PD201200623) 
 
 
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 
 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

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