RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03465
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20030903

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Aviation Electronics Technician, medically separated for low back pain (LBP) rated at 20%.

CI CONTENTION:  The applicant has asked for consideration of all conditions.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON 

SERVICE PEB - 20030211	VARD - 20040122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5295	20%	Lumbosacral Disc Disease	5243	20%	20040122	
Chronic Myofascial Low Back Pain, Status Post Laminectomy with Persistent Lower Back Pain	Cat II					
Congenital Lumbar Spinal Stenosis						
Status Post L3-L4 Decompressive Laminectomies						
Low Core Lumbar Pelvic Stability Strength						
Congenital Cervical Spinal Stenosis	EPTS	Neck Pain	5237	NSC	20040122	
Chronic Neck Pain	Cat III					
Bilateral Subacromial Tendinopathy	Cat III	Left Shoulder Sprain	5201	20%	20021022	
		Right Shoulder Sprain	5201	20%	20021022	
Iliotibial Band Syndrome	Cat II	Right Knee Sprain	5260	0%	20040122	
		Left Knee Sprain	5260	0%	20040122	
		Hip Tendonitis	5024	NSC	20021022	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2 (equals SC, NSC & deferred)	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP) Condition.  The narrative summary (NARSUM) noted the CI had a history of LBP.  Notes in the service treatment record (STR) indicated the CI initially reported LBP with radiation to the bilateral lower extremities (LEs) and occasional numbness and tingling.  A neurosurgery evaluation on 27 August 2001 noted the CI had congenital spinal stenosis and lumbar spine magnetic resonance imaging (MRI) on 22 August 2001 showed degenerative disc disease (DDD) and degenerative joint disease (DJD), which combined to cause moderate central spinal stenosis and encroachment on the spinal nerve exits.  The CI underwent surgery (lumbar laminectomies for decompression) in September 2001 and initially had decreased LE symptoms, but in a few months had return of LBP, with intermittent radiation to the LEs, and frequent muscle spasms.  A repeat lumbar MRI noted multi-level DDD with residual encroachment of the spinal nerve exits at L4-5, left greater than right, but the neurosurgeon did not recommend additional surgery due to the CI’s young age and low probability of benefit.  At a neurosurgery visit on 24 July 2002, the CI was noted to have chronic LBP, with normal strength, sensation, and reflexes in all extremities.  The neurosurgeon initiated a Medical Evaluation Board (MEB) and referred the CI to physical medicine for additional treatment.  An initial physical medicine evaluation on 26 August 2002 diagnosed chronic mechanical and myofascial LBP due to DDD and sacroiliac joint pain, as well as being status post surgery for congenital spinal stenosis.  The evaluation also noted bilateral hip bursitis, inflammation of multiple pelvic muscle insertions, and poor core stability and strength.  Changes were recommended to the physical therapy (PT) prescription, with focus on strengthening and stabilization, as well as consideration of acupuncture and biofeedback.  The original limited duty (LIMDU) medical board paperwork is not available in the records, but notes in the STR regarding the LIMDU referred to back pain and LE radiculopathy.  However, a LIMDU update visit in August 2002 noted only LBP.  The non-medical assessment (NMA) letter from the CI’s command in September 2002 noted that the CI’s duty performance had recently improved dramatically following medication adjustments.  The neurosurgery narrative summary (NARSUM) dated 24 July 2002 noted the CI’s low back condition was degenerative and not likely to improve and cited the July neurosurgery evaluation above, which noted normal strength, sensation and reflexes of the LEs.   

At the MEB examination on 24 September 2002, 11 months before separation, the CI reported no improvement in his symptoms.  The MEB physical examination noted normal reflexes and TTP of the hips and iliotibial bands, left greater than right.  The MEB examiner indicated that the expectation was that the CI would return to duty after appropriate treatment duration with the physical medicine recommendations.  A primary care visit on 2 January 2003 noted back flexion of “2 feet from floor with hands” and normal extension, lateral flexion and rotation bilaterally, with normal strength, sensation, and reflexes of the LEs.  At a primary care visit on 24 February 2003, the CI reported worsening symptoms with right sciatica.  A PT note dated 14 April 2003 indicated the CI reported discomfort with the exercises, but noted benefit from acupuncture treatments.  The CI presented to primary care on 17 March 2003 and requested a second opinion to refute the findings of the PEB; he desired to remain in the Navy and seek a commission.  At the neurosurgery evaluation on 26 March 2003, 5 months before separation, the CI reported LBP with radiating pain to both legs with intermittent numbness and tingling N/T and daily use of pain medications.  The examination noted back range-of-motion (ROM) of flexion 10 degrees and extension 5 degrees, with muscle spasm noted.  There was decreased sensation in the L5 and S1 distributions and mild weakness of foot dorsiflexion (DF) bilaterally graded 4+/5, with positive straight leg raise (SLR) bilaterally.  A note by the acupuncturist indicated that there had been improvement with the treatment and back pain was decreased in intensity and localized to the vertebrae and surgical site.  The final treatment note in the STR was a visit for medication refills and noted LBP and “lower back doing much better.”  

At the VA Compensation and Pension (C&P) General examination on 22 October 2002, 10 months before separation, the CI reported constant LBP and weakness, with pain that radiated to both legs.  The examination noted normal gait and posture, with normal strength and reflexes of the LEs, but noted “numbness in the right leg.”  The examination noted radiation of pain to BLE with movement and muscle spasm was present.  There was numbness over the lateral right thigh and SLR was positive bilaterally.  Lumbar ROM was 80 degrees (normal 90) and combined ROM of 230 (normal 240).  Lumbar X-rays noted post-surgical changes.  At the VA C&P Joints examination the CI reported daily LBP that was not incapacitating.  The CI was noted to be in school full-time.  The examination noted lumbar flexion of 40 degrees (normal 90) and the CI could not walk on heels or toes.  There was positive SLR bilaterally with normal reflexes and good strength of the great toes (extensor hallucis longus).  Decreased sensation was noted in the RLE in multiple dermatomes (spinal nerve distributions).  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5295 (lumbosacral strain), a 2003 VASRD code, and the VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome), a current VASRD code.  The PEB also adjudicated five conditions as category II conditions, which are conditions that contribute to the unfitting condition - “chronic myofascial low back pain, pain status post laminectomy with persistent lower back pain,” “congenital lumbar spinal stenosis,” “status post L3-L4 decompressive laminectomies,” “low core lumbar pelvic stability strength,” and “iliotibial band syndrome.”  The Board noted that there was some redundancy in the listed conditions, and that, with the exception of the iliotibial band syndrome condition, all four other conditions clearly related to the same low back disability and two or more ratings are not sanctioned IAW VASRD 4.14 (Avoidance of pyramiding).  The iliotibial band syndrome condition will be addressed further below in the contended conditions section.

The Board first considered coding as 5295 and agreed with that the evidence could be interpreted to support a 20% rating coded as 5295, for “muscle spasm on extreme forward bending”, but not the next higher evaluation of 40%, which requires evidence of `severe’ lumbosacral strain, not present in this case, such as listing of the whole spine to the opposite side, marked limited flexion, loss of lateral spine motion, or abnormal [spinal] mobility.  

The Board next considered coding as 5292 and noted that the rating criteria are subjective with 10% for `slight’, 20% for `moderate’ and 40% for `severe’ limited motion.  The Board noted that evaluations in record between 10 and 5 months before separation beginning with the pre-separation C&P examination noted flexion of 80 degrees, flexion of “2 feet from the floor,” “decreased” and flexion of 10 degrees (with muscle spasm noted) months and the post-separation C&P examination noted flexion of 40 degrees.  The Board deliberated whether this limitation of lumbar motion was best characterized as `moderate’ or `severe.’  The Board noted that 80 degrees of flexion is consistent with (c/w) `slight’ limited motion, “2 feet from the floor,” c/w `moderate’ (ROM likely between 30 and 60 degrees flexion) “decreased,” c/w `moderate’ 10 degrees flexion, c/w `severe’ and post-separation 40 degrees flexion, c/w `moderate.’  The Board agreed the majority of ROM evaluations in record were consistent with `moderate” limitation of motion, and the `severe’ limited ROM of 10 degrees flexion was associated with acute muscle spasm.  Therefore, the Board concluded the evidence supports that the limited lumbar motion was best characterized as `moderate’ and rated 20% at the time of separation.  Therefore, the Board found that this coding choice provided no ratings benefit to the CI.

The Board next reviewed to see if a higher rating than 20% was supported coded as 5293.  The Board first considered if coding as 5293 (intervertebral disc syndrome) based on incapacitating episodes, defined by the VASRD as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician, resulted in a higher rating.  However, there were no incapacitating episodes as defined documented in record.  

The VASRD in effect on the date of separation notes that intervertebral disc syndrome may be alternatively rated based on ‘‘chronic orthopedic and neurologic manifestations’’ and the separate orthopedic and neurologic disabilities are to be evaluated under the most appropriate orthopedic and/or neurologic codes and combined IAW VARSD §4.25.  Members agreed above that the limited back motion warrants a 20% rating coded as 5292 and noted that the CI reported chronic bilateral LE pain.  The Board reviewed to see if a preponderance of the evidence in record supports recommending radiculopathy of either or both LEs as separately unfitting at the time of separation and therefore, eligible for individual rating.  The first LIMDU was for back pain and LE radiculopathy, but the LIMDU update visit in August 2002 noted LBP and did not reference LE radicular symptoms.  The commander’s statement noted that the CI’s duty performance had recently improved.  Notes in the STR in April and May 2003 referenced only LBP and noted the CI reported doing much better and at the post-separation C&P examination, the CI reported LBP, without mention of LE pain or weakness.  The Board found that the evidence indicates there was improvement in bilateral LE radicular symptoms after surgery and other treatment interventions.  The C&P examination noted the CI to unable to walk on his heels or toes without further comment, but the VA examiner noted normal LE reflexes and did not note any LE weakness, which provided evidence against significant worsening of the radiculopathies.  The Board concluded there was insufficient evidence to recommend radiculopathy of either LE as a separately unfitting condition at separation and therefore, no additional rating IAW §4.124a can be recommended.  The Board thus determined that the evidence supports a 20% rating for the low back condition and no higher.  Although, the Board deliberations favored coding as 5292 versus 5295, the Board found this resulted in no ratings benefit to the CI and therefore no change to the PEB’s code is recommended.  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 low back condition.

Congenital Cervical Spine Stenosis and Chronic Neck Pain Conditions.  The Board makes note that the PEB adjudicated two neck conditions.  “Congenital cervical spinal stenosis” was adjudicated as an unfitting Category I condition, but existed prior to service (EPTS), and not eligible for rating; and, “chronic neck pain,” was adjudicated as a not unfitting Category III condition.  The Board judged that the adjudication of a neck condition as Category I and not rated because EPTS, mandated the review of the neck for evidence of service aggravation.  Therefore, the Board agreed that both conditions – congenital cervical stenosis and chronic neck pain - must be considered together in its deliberations to determine whether the evidence supports the unfitting EPTS neck condition was service aggravated, and if so, a rating recommendation provided.

The NARSUM did not address the neck condition.  The neurosurgery NARSUM noted the CI reported increasing neck and upper back pain in April 2002, with bilateral radiating arm pain.  Thoracic X-rays in July 2001 noted reversal of the cervical curvature and thoracic MRI in August 2001 also noted this, but was otherwise normal.  Cervical MRI 29 May 2002 was reported as degenerative facet joint disease (DJD) with neuroforaminal (bony canal through which the spinal nerves exit) narrowing at C3-4 and C4-5 and the neurosurgeon indicated the MRI showed mild congenital spinal stenosis and a mild disc bulge at C3-4, without nerve compression.  The NARSUM examination noted normal strength, sensation and reflexes of the bilateral UEs.  Notes in the STR indicated at visits to PT 25 February 2002 and the PHYSICAL MEDICINE26 June 2002 the CI reported neck pain and full ROM of the neck was noted at both visits.  A physical medicine consultation on 26 August 2002 noted neck pain that radiated to the shoulder blades with intermittent numbness and tingling of the hands.  The diagnosis was myofascial neck pain and physical therapy, biofeedback, and acupuncture were recommended treatment modalities.  
An orthopedic evaluation for the shoulders indicated the C-spine was TTP and cervical ROM was moderately decreased.  A note from the acupuncturist in April 2003 indicated the CI was experiencing increased neck pain with right arm pain that was clinically diagnosed as carpal tunnel syndrome.  A physical medicine evaluation on 16 April 2003 noted full ROM of the neck with multiple trigger points in the upper back, posterior neck muscles, evidence of impingement of the shoulders, and tendonitis of the elbows and thumbs.  Strength was described as give-way and there was patchy decreased sensation of the right upper extremity.  The physical medicine diagnosis and recommendations remained the same and the physical medicine specialist noted there was no clinical evidence of cervical radiculopathy.  At a neurosurgery evaluation on 16 April 2003, the CI denied having cervical symptoms prior working in his Rating as an electronics technician.  He reported the symptoms of neck and bilateral upper extremity pain worsened after lifting heavy boxes repetitively since 2001.  The examination noted decreased cervical ROM with muscle spasm.  Strength and sensation were normal.  No surgery was recommended for the diagnoses of cervical spondylosis (degenerative changes of the discs, facet joints and other ligaments) and myofascial neck pain and the CI was referred to physical medicine for treatment.  

At the pre-separation VA C&P examination the CI reported neck pain radiating to both arms.  The CI was noted to be right hand dominant.  Pain radiated to the bilateral shoulders with movement.  There was no muscle spasm.  Neck ROM was full, with painful motion noted.

The Board first considered if the evidence supports the neck condition was service aggravated, which is defined by DoDI 1332.38 as the permanent worsening of a pre-service medical condition over and above the natural progression of the condition caused by trauma or the nature of Military Service.  The guidance for conceding service aggravation, applicable to the PEB's determination and to the Board's recommendation regarding its fairness, is excerpted below from DoDI 1332.38.

The presumption that a disease is incurred or aggravated in the line of duty may only be overcome by compelling evidence or medical judgment that the disease was clearly neither incurred nor aggravated while serving on active duty or authorized training. Such medical evidence or judgment must be based upon well-established medical principles, as distinguished from personal medical opinion alone.

E2.1.1 defines accepted medical principles as fundamental deductions, consistent with medical facts that are so reasonable and logical as to create a virtual certainty that they are correct. 

The Board noted that the CI was diagnosed with congenital cervical stenosis, but also with spondylosis during active duty.  As noted above spondylosis is a degenerative condition of the spine, which may include degenerative changes of the cervical (or thoracolumbar) spine joints and discs, as well as ligaments, which would combine with congenital stenosis to cause further compromise of the spinal canal and/or nerve root and exiting spinal nerves at each spinal level and the congenital stenosis noted would increase the CI’s vulnerability to symptoms due to these changes.  The Board concluded that the evidence in record of new onset of chronic neck pain during active duty, objective abnormal findings on exams, and degenerative disc and joint changes on imaging provides strong support that the cervical stenosis condition was service aggravated and therefore eligible for rating.  The Board therefore considered the rating of the neck condition based on the evidence considered above for SA and the VA C&P examination summarized below.

At the VA C&P Joints examination on 22 January 2004, the CI reported neck pain and numbness in the arms at night.  The VA examination noted cervical ROM of 20 degrees (normal 45).  Elbow reflexes (biceps reflex- C5-6) were reportedly absent bilaterally, but there was normal grip strength and sensation bilaterally.  Cervical spine X-rays were unchanged.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB adjudicated the neck condition EPTS and did not provide a rating, as already elaborated above.  However, there is no evidence in the record that an EPTS rating was assessed at the time of enlistment.  Therefore, the Board will apply an EPTS deduction of 0% to its rating recommendation.  The Board first considered coding as 5290 (limited cervical motion) and noted that the rating criteria are subjective with 10% for `slight,’ 20% for `moderate’ and 30% for `severe’ limited motion.  The Board readily agreed that the ROM evidence supports that the neck condition met a 10% rating coded as 5290 (limited cervical motion) and deliberated if the next higher evaluation of 20% rating was supported.  The Board noted that evaluations in record between 10 and 5 months before separation beginning with the pre-separation C&P examination noted full ROM c/w `slight’ limited cervical motion; moderate decreased ROM, c/w `moderate’ full ROM, c/w `slight’ decreased ROM with muscle spasm, likely c/w `moderate’ and 20 degrees of flexion, c/w `moderate.’  After deliberations, Member consensus was that the evidence supports that the cervical motion was frequently moderately limited proximate to separation and was best characterized as `moderate’ and rated 20% with consideration of VASRD §4.40 and §4.7 (Higher of two evaluations), but did not support the next higher evaluation of 40% for `severe’ limited motion.  

The Board next considered if coding as 5293 (intevertebral disc syndrome) based on incapacitating episodes as defined above.  However, there were no incapacitating episodes due to the neck condition as defined documented in record in the 12 months before separation.  

As noted in the rating discussion for the low back condition, according to the VASRD rating rules in effect on the date of separation, intervertebral disc syndrome may be alternatively rated based on ‘‘chronic orthopedic and neurologic manifestations’’ evaluated under the most appropriate orthopedic and/or neurologic codes and combined IAW §4.25.  Members agreed above that the CI had mild limited cervical motion which warrants a 20% rating coded as 5290, and the Board noted that the CI reported radiating pain of the arms with intermittent numbness.  However, at all exams in the record there was normal upper extremity strength and sensation, with the exception of patchy decreased sensation noted by the physical medicine specialist, which is not consistent with cervical radiculopathy and was not considered to be radiculopathy by the physical medicine specialist.  Absent elbow reflexes were noted at the post-separation C&P examination, but this finding was not corroborated at any other examination in the record.  There was no evidence of nerve encroachment on the MRI and no upper extremity radiculopathy was diagnosed by the neurosurgery or physical medicine specialists during active duty.  The Board concluded that there was insufficient evidence of neurological impairment due to the neck condition to recommend additional ratings IAW §4.124a.  Therefore, the Board determined that the evidence supports a 20% rating for the neck condition and no higher.  After due deliberation, considering all of the evidence the Board concluded the congenital cervical spinal stenosis condition was permanently aggravated by service and recommends a disability rating of 20%, with application of 0% EPTS deduction, for a combined rating of 20% for the neck condition, coded 5290.  

Contended PEB Conditions. 

Iliotibial Band Syndrome.  The NARSUM the CI developed lateral leg and thigh pain in November 2000.  Scant notes in the STR indicated that the CI was diagnosed with iliotibial band syndrome (at the knee) and the symptoms were nearly resolved in February 2001 with anti-inflammatory medications and stretching exercises.  A primary care note indicated that the CI had been evaluated by physical medicine and injection of the hips was recommended for pain related to bilateral iliotibial band syndrome.  Hip X-rays 15 October 2002 were normal.  Orthopedic evaluation 31 October 2002 agreed with the diagnosis of bilateral iliotibial band syndrome and recommended therapy.  

Bilateral subacromial tendinopathy.  The MEB examination noted bilateral shoulder impingement on examination and the NARSUM listed a diagnosis of bilateral subacromial tendinopathy.  The CI was evaluated by the Physical medicine specialist in August 2002 for his LBP and was diagnosed at the same time with bilateral subacromial tendinopathy and impingement.  Treatment recommendations included ice, therapy, acupuncture, biofeedback, and if needed subacromial steroid injections.  An orthopedic evaluation noted normal shoulder X-rays and full ROM of the shoulders and the assessment was that the CI’s shoulder pain was related to his neck.  At the second physical medicine evaluation in April 2003 (after the PEB), the CI specifically requested to discuss his neck, shoulder and upper extremity symptoms.  At that evaluation the CI reported occasional shoulder pain and the physical medicine diagnoses and treatment recommendations remained the same.

Chronic neck pain condition.  As noted in the discussion of the Category I unfitting neck condition of “congenital cervical spinal stenosis,” the Category III, not unfitting chronic neck pain condition was considered by the Board in its deliberations regarding the presence or absence of SA of the Category I neck condition.  Following these deliberation, Board consensus was that the chronic neck pain could not be separated from contributions from the effects of the cervical stenosis such that the former condition was symptomatic and not unfitting, while the latter condition was unfitting, EPTS, and not service aggravated, and therefore not eligible for rating.  Therefore, the Board unanimously recommends that there was a single unfitting neck condition, that was service aggravated and the chronic neck pain is subsumed in the Board’s rating recommendation for the cervical stenosis condition as elaborated above, and cannot be rated separately IAW VASRD 4.14 (Avoidance of pyramiding).

The iliotibial band syndrome and bilateral subacromial tendinopathy conditions did not result in any periods of LIMDU.  They were not implicated in the non-medical assessment and were not judged to fail retention standards.  They were reviewed and considered by the Board.  There was no performance based evidence from the record that these conditions significantly interfered with satisfactory duty performance.  The iliotibial band syndrome condition, usually a diagnosis related to knee pain, was adjudicated as a condition which contributed to the unfitting condition of low back pain, which the Board presumed was due to the secondary upper leg muscle and soft tissue effects related to iliotibial band syndrome.  Though iliotibial band syndrome is a distinct diagnosis from the four low back conditions also noted as Category II conditions, the physical medicine specialist indicated multiple soft tissue conditions contributed to the CI’s diffuse pelvic and low back pain.  There is no evidence in the record that the iliotibial band syndrome was by itself unfitting.  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 either condition and so no additional disability ratings are recommended.  

BOARD FINDINGS: In the matter of the cervical spinal stenosis condition, the Board unanimously concluded there was permanent service aggravation and recommends a Service disability rating of 20%, coded 5290 IAW VASRD §4.71a. In the matter of the contended iliotibial band syndrome and subacromial tendinopathy 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.  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Low Back Pain 	5295	20%	
Congenital Cervical Spinal Stenosis with Chronic Neck Pain	5290	20%	
RATING	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140715, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 21 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX 
	(c) PDBR ltr dtd 03 May 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 24 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 17 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 15 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 13 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 13 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 15 Apr 16 ICO XXXXXXXXXXXXXXXXXXXX
	(l) PDBR ltr dtd 22 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (l) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10 percent) effect date of discharge. 

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect date of discharge. 
 
     c. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.
     
     d. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

     e. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effect date of discharge. 
 
     f. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge. 

     g. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

     h. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

     i. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

     j. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effect date of discharge.

     k. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)