RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

SEPARATION DATE:  20091027 

 
NAME:  XXXXXXXXXXXXXXX                                                                  BRANCH OF SERVICE:   ARMY  
CASE NUMBER:  PD1101080 
BOARD DATE:  20120801 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was a National Guard SSGT/E-6 (MOS 14J20/Air Defense C4I Tactical Ops 
Ctr  Enhanced  Operator  Maintainer),  medically  separated  for  polyarticular  inflammatory 
arthritis and coccidioidomycosis.  The two conditions could not be adequately rehabilitated and 
resulted in a severely restrictive profile.  The CI was unable to meet the physical requirements 
of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued 
a permanent P3, U3, L3, E2 profile and referred for a Medical Evaluation Board (MEB).  The MEB 
forwarded no other conditions for Physical Evaluation Board (PEB) adjudication.  The CI’s case 
was adjudicated as part of the DOD/Department of Veterans’ Affairs (DVA) Disability Evaluation 
System (DES) pilot program under the policy and procedural directive-type memorandum (DTM 
dated  21  Nov  2007).    The  PEB  adjudicated  the  polyarticular  inflammatory  arthritis  and 
coccidioidomycosis conditions as unfitting, rated 20% and 0%, with application of the Veteran’s 
Affairs  Schedule  for  Rating  Disabilities  (VASRD).    The  CI  appealed  the  0%  rating  and  an  PEB 
reconsideration memo stated not change was warranted and the case was forwarded to the US 
Army Physical Disability Agency.  No change was made and the CI was then medically separated 
with a 20% and 0% disability rating.  The CI continued his appeal at the DVA and his DVA ratings 
were increased to a combined 60%. 
______________________________________________________________________________ 
 
CI CONTENTION:  “Appealed rating through DOD/VA pilot program, rating increase to total 60% 
combined by DVA.  I went through a US Army Physical Evaluation Board at Ft Meade on April 
2009 and was found unfit for two conditions: 1) Coccidiomysocis [sic] 2) Inflammatory Arthritis.  
I concurred with the findings of unfit; however I disagreed with the rating from the VA on these 
two conditions.  I was told by my PEBLO at Ft Meade I had a onetime reconsideration while still 
on active duty from the VA.  If I was unsuccessful I would then have access to the robust VA 
appeal process, to dispute the rating once discharged.  I sent the VA a Notice of Disagreement 
(NOD) in early July 2009.  I asked to have my case appealed.  On August 10, 2011, I received a 
Decision Review Officer Decision.  This decision gave me a combined rating of 60% for both my 
service connected disabilities.  I now request the PDBR to review my discharge rating of 20% 
with severance and change it to 60% entitled for military retirement.” 
 
 
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.    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  the  Correction  of  Military  Records 
(BCMR).   
 
 

 

RATING COMPARISON: 
 

Service PEB – Dated 20090827 

VA (2 Mo. Pre-Separation) – All Effective Date 20060215 

Condition 

Rheumatoid Arthritis 
Coccidioidomycosis 

Code 
5002 
6835 

Rating 
20% 
0% 

↓No Additional MEB/PEB Entries↓ 

Rheumatoid Arthritis 
Coccidioidomycosis 

Condition 

Code 
5002 
6835 
Not Service-Connected x 4 

Rating 
10%* 
50%** 

Exam 

20090115 
20090310 
20090115 

Combined:  20% 

Combined:  60% 

*Initially not service connected and not associated with 6835.  After multiple appeals established as related to 6835 and rated 
at 10% effective 20060215. 
**Initially 0% effective 20060215.  After multiple appeals a 50% rating was granted effective 20060215. 
 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application, 
i.e., that the gravity of his condition merits consideration for a higher separation rating.  The 
Board wishes to clarify that it is subject to the same laws for disability entitlements as those 
under which the DES operates.  While the DES considers all of the service member's medical 
conditions,  compensation  can  only  be  offered  for  those  medical  conditions  that  cut  short  a 
service member’s career, and then only to the degree of severity present at the time of final 
disposition.  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 
reevaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the 
degree of impairment vary over time.  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 6040.44, 
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.  
 
Rheumatoid arthritis.  The CI was in the National Guard and had served on active duty from     
24 June 1982 to 25 April 1986 and 18 November 2005 to 14 February 2006.  During the second 
period  of  active  duty  he  became  acutely 
ill  and  was  eventually  diagnosed  with 
coccidioidomycosis and was treated with antifungal medication.  He also developed joint aches 
in this same timeframe, with mainly his bilateral knees, shoulders, wrists, and occasionally the 
small joints of his hands, elbows, ankles, and chest.  He was evaluated by rheumatology and 
diagnosed with polyarticular inflammatory arthritis.  His physical activity was severely restricted 
due to this condition along with the pulmonary residuals of the coccidioidomycosis infection as 
discussed below.  His profile was P3U3L3E2 and the only activity marked yes was walk at own 
pace and distance.  He was treated with two disease-modifying antirheumatic drugs (DMARDs), 
leflunomide  (Arava)  and  hydroxychloroquine  (Plaquenil),  as  well  as  carisoprodol  (Soma)  a 
muscle relaxant he took for the pain in his chest and diclofenac sodium topical (Voltaren) gel he 
also took for pain. 
 
As  part  of  the  DOD/VA  DES  pilot  program  the  CI’s  VA  Compensation  and  Pension  (C&P) 
examinations  were  the sole  examinations  used for  rating  his  conditions  by  the PEB.    The  VA 
DoD/VA pilot program consolidated narrative summary (NARSUM) was completed by an Army 
physician  in  April  2009  utilizing  the  VA  C&P  examinations  and  interviews  with  the  CI  from             
6 November 2008 and 2 April 2009.  The NARSUM states the CI continued to have pain affecting 
multiple joints and was unable to perform the duties required of his MOS secondary to the this 
condition. 
 

   2                                                           PD1101080 
 

 

 

Shoulder ROM 

Flexion (0-180⁰) 

Abduction (0-180⁰) 
Internal rotation 

Comments 
§4.71a Rating 

Knee ROM 

 

Flexion (140⁰ 

Normal) 

Extension (0⁰ 

Normal) 

Comment 

§4.71a Rating 

Ankle ROM 

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

Comment 

VA C&P ~ 9 Months Pre-Separation 

(20090115) 

Right 
0-125⁰ 
0-125⁰ 

80° 

10% 

Left 
0-125⁰ 
0-125⁰ 

80° 

10% 

No AC tenderness or muscle atrophy. 

VA C&P ~ 9 Months Pre-Separation 

(20090115) 

Left 

0-120⁰ 

0-5⁰ 

Right 

0-120⁰ 

0-5⁰ 

No swelling/effusion or deformity; able to walk on 
toes and heels without pain; squatting full but 
painful; no instability either knee; no pain or 
tenderness either knee. 

10% 

10% 

VA C&P ~ 9 Months Pre-Separation 

(20090115) 

Left 

Right 

20° (35⁰) 

0-40⁰ 

No swelling, effusion or deformity; no tenderness 
over either malleoli. 

20° (35⁰) 

0-40⁰ 

10% 

There  were  three  goniometric  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.   

§4.71a Rating 

10% 

 
The NARSUM noted this condition, along with the residuals of coccidioidomycosis, rendered the 
CI unable to perform any exercise whatsoever and noted he had not performed any drills with 
the military service since early 2006.  This was in contrast to the VA C&P examination which had 
noted there was no evidence of any impact on activities of daily living or his current occupation.  
Although  no  NARSUM  addendum  from  rheumatology  was  completed,  the  physician  who 
completed  the  NARSUM  stated  the  CI’s  rheumatologist  had  opined  the  arthritis  was  chronic 
and  not  responding  optimally  to  medication  or  treatment.    As  mentioned  above,  the  CI’s 
permanent profile was severely restrictive and the CI’s commander stated he was not able to 
perform his military duties.  
 
Although  the  PEB  determined  rheumatoid  arthritis  to  be  unfitting  and  associated  with  the 
coccidioidomycosis infection, the VA initially determined it was neither service-connected nor 
secondary to the fungal infection.  However, as part of the pilot program, the VA provided a 
rating  determination  for  the  PEB.    A  20%  rating  was  assigned  for  DES  purposes  based  on 
polyarticular inflammatory arthritis with one or two exacerbations a year in a well-established 
diagnosis.  After a series of appeals, the VA ultimately decided this condition was related to the 
coccidioidomycosis  after  a  VA  examiner  determined  in  August  2011  that  arthritis  of  the  left 
hand was associated with the fungal infection.  Only the hand joint complaints were included 

   3                                                           PD1101080 
 

and  a  10%  rating  was  applied  with  VASRD  code  5002,  rheumatoid  arthritis,  effective  on              
15 February 2006, the day after the CI separated from active duty.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
clinical  rating  criteria  for  code  5002  states  this  condition  can  be  rated  either  as  an  active 
process with the rating determined by the impact on the overall health and the frequency of 
exacerbations or by rating for chronic residuals based on limitation of motion or ankylosis, but 
not  both.    It  also  states  the  higher  evaluation  will  be  assigned.    There  is  no  evidence  in  the 
record  available  for  review  regarding  the  presence  or  frequency  of  episodes  of  rheumatoid 
arthritis  as  an  active  process,  other  than  the  initial  symptoms  described  at  the  time  of  the 
coccidioidomycosis  infection  in  January  2006.    However,  even  if  the  Board  had  access  to 
evidence  supporting  the  20%,  a  higher  rating  is  achieved  by  rating  the  chronic  residuals 
manifested by decreased ROM of the CI’s bilateral shoulders, knees, and ankles.  Each joint has 
limited motion at the noncompensable level and six 10% ratings are supported.  This results in a 
combined 50% rating and this rating must be applied as the higher rating IAW the code 5002 
rating criteria.  After due deliberation, considering all of the evidence and mindful of VASRD 
§4.3 (reasonable doubt), the Board recommends a disability rating of 50% for the rheumatoid 
arthritis condition.   
 
Coccidioidomycosis.  As  stated  above,  during  his  second  period  of  active  duty  the  CI  became 
acutely  ill  and  was  eventually  diagnosed  with  coccidioidomycosis  and  was  treated  with 
antifungal medication.  His physical activity was severely restricted due to this condition along 
with the arthritis as discussed above.  His profile was P3U3L3E2 and the only activity marked 
yes was walk at own pace and distance. 
 
The DoD/VA pilot program consolidated NARSUM from April 2009 stated the CI continued to be 
actively coughing sporadically and that this condition interfered with his ability to exercise and 
perform the duties required of his MOS.  Although no NARSUM addendum from pulmonology 
was completed, the physician who completed the NARSUM stated the CI’s pulmonologist had 
opined  the  coccidioidomycosis  was  chronic  and  not  responding  optimally  to  medication  or 
treatment.  The VA C&P general medical examination performed on January 2009 stated the CI 
continued  to  have  some  shortness  of  breath  and  coughing  and  required  symptomatic 
medication  but  had  no  diagnosed  pulmonary  condition.    The  record  reveals  the  use  of 
Benzonatate  (Tessalon  Perles)  for  cough.    The  VA  C&P  also  notes  yearly  chest  CT  scans  had 
documented persistent calcifications but no new nodules.  The lung exam noted equal breath 
sounds  bilaterally.    Pulmonary  function  tests  were  normal.    The  pulmonary  C&P  exam  also 
reported  the  presence  of  right  perihilar  adenopathy  on  the  chest  CT.    The  CT  report  is  not 
available for Board review.  This C&P also noted the CI had two days of incapacitating episodes 
over  the  past  12  months.    As  mentioned  above,  the  CI’s  permanent  profile  was  severely 
restrictive and the CI’s commander stated he was not able to perform his military duties.  
 
The VA had initially determined this condition was service-connected in 2006 and applied a 0% 
rating  effective  on  15  February  2006.    This  rating  was  increased  to  30%  effective  on                     
11  August  2006  based  on  the  findings  of  a  VA  C&P  examination  performed  on                                 
9 May 2007.  This examination noted the persistence of chest nodules and a cough, occasionally 
producing sputum, but managed with Tessalon Perles.  There was no evidence of hemoptysis or 
need  for  suppressive  therapy  and  although  the  CI  had  reported  wheezing  with  exertion, 
pulmonary function tests revealed no obstruction.  The CI reported he could walk two miles 
without problem but had missed three to four days of work secondary to fatigue and had been 
told to stay home by his doctor.  Physical examination was normal.  At the time of the PEB, the 
VA had determined the rating was to be decreased to 0% because no pulmonary diagnosis had 
been made by the 15 January 2009 VA C&P examiner.  Although the CI had symptoms and was 
unable  to  perform  any  type  of  exertion  as  evidenced  by  his  severely  restrictive  profile,  no 
diagnosis was provided by the VA examiner.  The PEB convened on  24 July 2009 applied the 0% 

   4                                                           PD1101080 
 

than  0% 

requires 

the  presence  of  chronic  coccidioidomycosis. 

to the unfitting condition of coccidioidomycosis.  The CI requested a reconsideration of the 0% 
rating but the PEB determined no change was warranted.  The case was also forwarded to the 
US Army Physical Disability Agency but no changes were made.  
 
After  a  series  of  appeals  to  the  VA,  the  rating  was  increased  to  50%  effective  on                          
15 February 2006.  The decision was based on the totality of the evidence to date and included 
a VA pulmonary C&P examination performed on 22 January 2011.  This decision stated the CI 
was taking suppressive therapy, itraconazole at the time of separation from active duty in 2006 
and the medications he later took, Advair and steroids, also constituted suppressive therapy.  
The  C&P  exam  noted  CI  also  had  chronic  shortness  of  breath  in  the  morning  and  the 
medications  were  mildly  effective  for  his  cough.    A  repeat  CT  scan  from  March  2010 
documented a stable calcified right upper lobe nodule and pleural thickening in the lung apices 
and  upper  hemithorax,  a  sign  of  inflammation.    This  examination  also  states  the  CI  was  72 
inches tall and weighed 118.  However, another exam on the same day stated his weight was 
188 and that is consistent with previously recorded weights. 
 
The Board directs attention to its rating recommendation based on the above evidence.  A 0% 
rating is applied for healed and inactive mycotic lesions in an asymptomatic person.  Any rating 
greater 
  Chronic 
coccidioidomycosis develops in 5-8% of patients following primary pulmonary disease. This is 
characterized  by  pulmonary  disease,  with  or  without  extrapulmonary  spread,  or  by 
extrapulmonary disease alone.  The most common forms are cavity or nodule formation, which 
frequently  represent  a  transition  from  acute  disease  to  resolution.    Approximately  5%  of 
pulmonary infections result in the formation of nodules.  These typically cause no symptoms.  
Approximately half of these nodules resolve spontaneously.  However, persistent nodules can 
eventually  degenerate  into  thin-walled  cavitations,  which  may  erode  into  adjacent  small 
airways or the pleural space, resulting in hemoptysis or pneumothorax.  Rupture of a peripheral 
coccidioidal cavity into the pleural space is a complication that is most common in young male 
patients.  While the CI’s nodules remained stable, they did not resolve and as such represent 
chronic disease, although not chronic active disease.  He continued to have a chronic cough, 
occasionally productive of light phlegm, especially in the morning and was not a smoker.  The CI 
also complained of shortness of breath with exertion and while pulmonary function tests at the 
time of separation were normal, the CI was not exerting himself at the time of testing. Although 
the VA decision stated the CI was on itraconazole at the time of separation, the military record 
shows  that  he  was  no  longer  taking  this  medication  on  the  day  of  separation.  The  only 
medication he was taking for this condition at the time of separation was Tessalon Perles and 
this  cannot  be  considered  suppressive  therapy.    This  information  supports  a  rating  of  30% 
based on chronic pulmonary mycosis with minimal symptoms of occasional productive cough.  
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), the Board recommends a disability rating of 30% for the coccidioidomycosis 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.   In  the matter  of the  rheumatoid  arthritis  condition,  the  Board  unanimously 
recommends a disability rating of 50%, coded 5002 IAW VASRD §4.71a.  In the matter of the 
coccidioidomycosis condition, the Board unanimously recommends a disability rating of 30%, 
coded 6835  IAW VASRD  §4.97.   There  were  no other  conditions  within the  Board’s  scope of 
review for consideration.   
 

   5                                                           PD1101080 
 

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 

VASRD CODE 

RATING 

COMBINED with BLF 5.7 

5002 
6835 

50% 
30% 
70% 

Rheumatoid arthritis 
Coccidioidomycosis 

 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111107, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

   6                                                           PD1101080 
 

 
 

 
 
 

a.  Providing a correction to the individual’s separation document showing that the 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXXXX, AR20120014318 (PD201101080) 
 
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed 
recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) 
pertaining to the individual named in the subject line above to recharacterize the individual’s 
separation as a permanent disability retirement with the combined disability rating of 70% 
effective the date of the individual’s original medical separation for disability with severance 
pay.   
 
2.  I direct that all the Department of the Army records of the individual concerned be corrected 
accordingly no later than 120 days from the date of this memorandum. 
 
 
individual was separated by reason of permanent disability retirement effective the date of the 
original medical separation for disability with severance pay. 
 
 
effective the date of the original medical separation for disability with severance pay. 
 
c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 
 
account for recoupment of severance pay, and payment of permanent retired pay at 70% 
effective the date of the original medical separation for disability with severance pay. 
 
 
medical TRICARE retiree options. 
 
 
 
 
 
 
 
3.  I request that a copy of the corrections and any related correspondence be provided to the 
individual concerned, counsel (if any), any Members of Congress who have shown interest, and 
to the Army Review Boards Agency with a copy of this memorandum without enclosures. 
 
BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 

b.  Providing orders showing that the individual was retired with permanent disability 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and 

 
 
 

 
 
 

 
 

 
 
 

 
 
 

 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

   7                                                           PD1101080 
 

 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

   8                                                           PD1101080