RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

 
 
 
 

 
NAME:  XXXXXXXXXXXXXXX                                                                       BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1101097                                                             
 SEPARATION DATE:  20040715 
BOARD DATE:  20120927               

 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was a mobilized Reserve SPC/E-4 (97E10 / Human Intelligence Collector), 
medically  separated  for  right  ankle,  posttraumatic  arthritis  and  chronic  right  wrist  pain  with 
ganglion  cyst.    The  CI  suffered  a  sprain  of  the  right  ankle  which  progressed  to  an  arthritic 
condition  and  spontaneous  appearance  of  a  small  cyst  of  the  right  wrist  in  2001.    Both 
conditions  could  not  be  adequately  rehabilitated  with  treatment  to  meet  the  physical 
requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  
He was issued a permanent U3/L3 profile and referred for a Medical Evaluation Board (MEB).  
Nine other conditions, identified in the rating chart below, were also identified and forwarded 
by the MEB as medically acceptable.  The Physical Evaluation Board (PEB) adjudicated the right 
ankle, posttraumatic arthritis and the chronic right wrist pain with ganglion cyst conditions as 
unfitting,  rated  10%  and  10%,  with  application  of  the  US  Army  Physical  Disability  Agency 
(USAPDA) pain policy.  The CI appealed to the USAPDA, which affirmed the PEB findings; and 
was then medically separated with a 20% combined disability rating. 
 
 
CI CONTENTION:  “PEB (2004) with only 2 of 7 conditions considered during process resulting in 
20%  separation:  1)  Posttraumatic  Osteoarthritis  (right  ankle);  2)  Chronic  Scapholunate 
Dissociation  (right  wrist).  PEB  erroneously  excluded  5  conditions  (non-deployable/unfit-for-
duty): A) stomach conditions [Angiodysplasia with Gastro Esophageal Reflux Disease, 10% from 
7/04]; B) back conditions [Degenerative Disc Disease including Schmorl's Nodes, 10% 3/09]; C) 
eye/vision  conditions  [Deuteranopia  (currently  appeal)  and  Vitreous  Floaters,  0%  7/04];  D) 
heart  condition  [Hypertension,  10%  from  7/01];  E)  wrist  injury  [Chronic  Scapholunate 
Dissociation With Instability, Left Wrist, 10% from 7/01.  Please see attached 3 pages – Thank 
you.” The attached three page statement in support of the CI’s application was reviewed by the 
Board and considered in its recommendations. 
 
 
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 not unfitting conditions deuteranopia, 
hypertension, right knee pain, left wrist pain, recurrent sinusitis, recurrent tonsillitis, keloid on 
back,  buccal  nerve  damage  and  vitreous  floaters,  as  requested  for  consideration,  meet  the 
criteria  prescribed  in  DoDI  6040.44  for  Board  purview;  and,  are  addressed  below.    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 (20050523) – All Effective Date 20010704* 
Condition 

Posttraumatic Arthritis, Right 
Ankle 
Ganglion Cyst, Right Wrist 
Chronic Scapholunate 
Dissociation w/Instability, Right 
Wrist 
Chronic Scapholunate 
Dissociation…, Left Wrist 
Hypertension 
Excision, Nevus, Residual Scar… 
Not Service Connected 
No VA Entry 
Sinusitis 
Tonsillitis 
Paresthesias of Gingiva… 
Vitreous Floaters 
DDD, L5-S1; Schmorl’s Nodes 

 

Exam 

20020506 
20020506 

Rating 
10% 
10% 

10% 
10% 
10% 

20020506 
20020506 
20020506 

5215 

10% 

20020506 

Code 
5010 
7819 

5215 
7101 
7804 

 
 

6513 

 
 
0% 
0% 
0%** 
0%** 
0%** 
0% x 1 / Not Service-Connected x 5  

6599-6516 
9903-8207 
6006-6009 

5237 

Combined:  50% 

 
 

20020506 
20020506 
20050216 
2002511 
20050216 
 

RATING COMPARISON: 

Service IPEB – Dated 20040420 
Condition 

Code 
5010 

Rating 
10% 

Right Ankle, Posttraumatic 
Arthritis 

Chronic Pain, Right Wrist 
w/Ganglion Cyst 

5099-5003 

10% 

Left Wrist Pain 
Hypertension 
Keloid on the Back 
Deuteranopia 
Rt. Peripatellar Knee Pain 
Recurrent Sinusitis 
Recurrent Tonsillitis 
Buccal Nerve Damage 
Vitreous Floaters 

Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

  .    

*Original VA C&P examinations and rating decision in 2002 while CI in Reserve status; ratings effective 20010704, the day after 
separation from active duty.  **Rating effective 20040716. 

 
ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force.  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.  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. 
 
Right Ankle, Posttraumatic Arthritis Condition.  The CI suffered a sprain of the right ankle while 
on active duty in April 2001.  X-rays revealed a probable small avulsion fracture of the medial 
maleolus.  A bone scan in June 2001 was consistent with posttraumatic arthritis.  According to 
the  orthopedic  MEB  narrative  summary  (NARSUM),  May  2003,  the  right  ankle  pain 
subsequently interfered with the CI’s ability to run, jump, march, carry a ruck sack, and traverse 
uneven  ground.    On  examination,  the  ankle  was  non-tender  with  normal  range-of-motion 
(ROM)  (“full  and  symmetrical”,  equal  to  the  uninjured  left  ankle),  normal  strength,  and  no 
instability.  At a physical therapy (PT) evaluation 20 January 2004, 6 months before separation, 
the  CI  reported  ankle  pain  4-5/10  increased  with  time  on  feet  or  performing  stairs.    On 
examination,  ROM  of  the  right  ankle  demonstrated  dorsiflexion  of  seven  degrees  (mildly 
decreased compared to 12 degrees on the left ankle), plantar flexion of 45 degrees (the same as 
on  the  left),  inversion  of  40  degrees  (the  same  as  on  the  left),  and  eversion  of  20  degrees 
(decreased compare to the left with 40 degrees).  Strength about the right ankle was minimally 
decreased.    Specific  testing  for  right  ankle  instability  was  negative.    PT  noted  pain  should 
improve with an exercise program.  The CI was actively using Nordic Track at the time.  There 
were no VA Compensation and Pension (C&P) examinations which were proximate to the time 
of  separation.    However,  the  VA  rated  the  right  ankle  condition  10%  based  on  VA  C&P 

   2                                                           PD1101097 

examinations and the VA rating remained unchanged following separation.  The Board directs 
attention to its rating recommendation based on the above evidence.  Both PEB and VA rated 
this  condition  10%  coded  5010,  traumatic  arthritis.    The  Board  unanimously  agreed  that  the 
condition was ratable for painful ROM IAW VASRD §4.59.  The Board unanimously agreed that 
the  condition  was  not  compensable  under  §4.71a  given  normal  strength  and  ROM  on 
proximate MEB/NARSUM and PT evaluations (near normal ROM when compared to un-injured 
side).    The  Board  considered  VASRD  5284,  foot  injury,  but  the  moderately  severe  condition 
required for 20%, was not supported by the record.  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  right  ankle 
condition. 
 
Chronic Right Wrist Pain with Ganglion Cyst Condition. The Board notes the CI to be right hand 
dominant.  The CI had a small ganglion cyst of the right wrist first documented in the service 
records in 2001.  No traumatic event or injury was identified other than the rigors of military 
training.  He received local injections and compression therapy and was offered an option for 
surgical treatment for cyst removal in 2002 (a simple outpatient procedure with a high success 
rate).    At  a  VA  examination  in  May  2002,  CI  noted  slight  discomfort  limiting  ability  to  do 
pushups, but denied any other significant limitation relative to the wrist.  On examination, the 
right wrist had full ROM that was equal to the left wrist.  The examiner also diagnosed bilateral 
chronic scapholunate dissociation of the wrists associated with diffuse congenital laxity of the 
ligaments of both hands and wrists.  X-rays of both wrists showed symmetric changes.  At that 
time, the ganglion was palpable at the scapholunate area.   On the MEB orthopedic NARSUM 
examination, May 2003, the cyst was described as small with slight tenderness, however the 
associated pain interfered with performing push-ups.  The right wrist ROM was normal.  At an 
orthopedic evaluation January 2004, 6 months before separation, pain on dorsiflexion of the 
wrist  at  the  cyst  site  was  noted.    The  Board  directs  attention  to  its  rating  recommendation 
based  on  the  above  evidence.    The  PEB  rated  the  wrist  condition  10%,  coded  5003,  with 
application of the USAPDA pain policy.  The VA rated the ganglion  cyst condition 10% coded 
7819,  skin  lesion  benign,  and  granted  an  additional  10%  rating  for  right  wrist  scapholunate 
dissociation,  code  5215,  wrist  limitation  of  motion.    The  Board  noted  that  the  ganglion  cyst 
itself  was  not  unfitting  for  military  service  as  these  are  commonly  diagnosed  and  treated  in 
active duty members without interference with duties.  It was right wrist pain, whether due to 
the ganglion or the scapholunate dissociation condition, that was unfitting.  In accordance with 
VASRD §4.14 (avoidance of pyramiding), giving two ratings under two diagnoses for the same 
manifestation  is  prohibited.   Therefore, the  Board  considered  the rating  based  on  wrist  pain 
with  use.    The  Board  agreed  the  normal  wrist  ROM  did  not  attain  a  minimum  rating  for 
limitation  of  wrist  motion  (code  5215),  but  concluded  the  right  wrist  pain  condition  was 
compensable  IAW  VASRD  §4.59  (painful  motion)  and  §4.40  (decreased  function).    No  higher 
rating  under  this  VASRD  diagnostic  code  or  any  other  code  is  achievable  given  the  mild 
impairment of function on the MEB/NARSUM examination.  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 right wrist 
condition. 
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were deuteranopia (mild red-green color vision deficiency), hypertension, right knee pain, left 
wrist  pain,  recurrent  sinusitis,  recurrent  tonsillitis,  keloid  on  back,  buccal  nerve  damage  and 
vitreous floaters.  The Board’s first charge with respect to these conditions is an assessment of 
the appropriateness of the PEB’s fitness adjudications.  The Board’s threshold for countering 
fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its 
rating  recommendations,  but  remains  adherent  to  the  DoDI  6040.44  “fair  and  equitable” 
standard.    Deuteranopia  (DEU-red-green  color-blindness):    The  CI  “passed”  color  vision 
screening at the enlistment medical examination (MEPS) in February 2000.  The fact that he 

   3                                                           PD1101097 

passed  the  examination  has  been  interpreted  as  meaning  the  color  vision  examination  was 
normal and that the CI had normal color vision at the time of entrance into military service.  
However,  this  is  not  the  case.    The  results  of  the  color  vision  test  was  recorded  as  4/14, 
meaning  the  CI  correctly  identified  4  out  of  14  pseudo-isochromatic  plates  indicating  the 
presence of color vision deficiency (DEU).  Since the examination was to ascertain if the CI met 
Army accession medical standards under Chapter 2 of AR 40-501, the CI “passed” because, IAW 
AR  40-501  2-13.f.,  failure  to  pass  a  color  vision  test  is  not  an  automatic  disqualification.  
Because  some  military  specialties  require  “adequate”  color  vision,  testing  is  performed  at 
accession  (for  example  OCS  programs  require  the  ability  to  distinguish  vivid  red  from  vivid 
green, but not completely normal color vision).  An optometry evaluation on 8 June 2001 (“for 
physical / flying”), diagnosed mild DEU deficiency (based on multiple tests).  An ophthalmology 
examination,  in  May  2002,  revealed  normal  vision,  and  normal  dilated  eye  and  retina 
examination that showed no evidence of eye disease.  Color vision testing confirmed DEU.  The 
ophthalmologist noted: “color blindness- more likely congenital and I suspect the MEPS station 
made a mistake when they reported the color vision was normal.”  The Board noted the CI to 
have taken no medication associated with acquired color vision deficiency.  The Board noted 
that DEU is not a medically disqualifying condition for general army service, but that normal 
color vision was a requirement for the CI’s MOS.  The Board opined that cross training into a 
new MOS, an acceptable option, was prevented in this case by the other unfitting conditions. 
Hypertension:    The  CI  had  mild  hypertension  with  untreated  blood  pressure  measurements, 
never  reaching  critical  levels.    Hypertension  was  easily  controlled  with  standard  doses  of 
routine anti-hypertensive medication.  The record contains no documentation of complications 
of uncontrolled hypertension, hospitalizations, emergency room or unscheduled clinic visits for 
this condition. Right Knee Pain:  The CI noted right knee pain since 2003.  X-rays demonstrated 
early to middle stage arthritis.  Tests of strength were normal.  Tenderness of the knee facet 
was reported at the MEB evaluation.  Gait was normal with no other entries for this condition 
noted in the C&P exam, or contended by the CI in his application.  The Board notes the inclusion 
of  the  condition  in  a  profile  in  March  2004  along  with  the  documented  more  clinically 
symptomatic wrist and ankle conditions.  The MEB NARSUM noted an L2 profile allowing the 
alternate PT test and that the knee pain met medical retention standards.   Left Wrist Pain:  The 
CI noted left wrist pain beginning 2003.  On examination, normal ROM without pain and normal 
stability  were  documented.    Left  wrist  pain  was  not  a  complaint  that  interfered  with  duties.  
Recurrent  Sinusitis:    The  CI  developed  pain  in  the  maxillary  sinus  area  of  the  face  with 
associated post nasal drip and drainage of clear nasal mucous occurring approximately every six 
months.    Episodes  responded  to  antihistamines  and  did  not  require  antibiotics  or  extensive 
treatment.    Recurrent  Tonsillitis:  The  Board  notes  one  reference  to  tonsillitis  in  the  record.  
There is no record of recurrent episodes requiring multiple antibiotic or extensive treatments.  
Keloid  on  the  Back:    Following  removal  of  a  benign  mole  from  the  upper  back  area,  a  small 
keloid (hypertrophic scar) developed.  Scar was tender to touch and caused some itching and 
discomfort from clothing, irritation without recurrent infection or hemorrhage.  Buccal Nerve 
Damage:    The  CI  suffered  injury  to the buccal  nerve  of the  left  lower  outer  gum  during oral 
surgery in February 2003.  This was manifest by numbness of a small area somewhat impeding 
brushing and dental flossing.  Vitreous floaters:  The CI reported vitreous floaters in both eyes in 
February 2003 after falling on ice.  These were documented on funduscopic exam, but had no 
impact on vision, eye anatomy or function.  None of these conditions were profiled, excluding 
the  right  knee  pain  condition,  as  noted  above;  none  were  implicated  in  the  commander’s 
statement; and, none were judged to fail retention standards.  All were reviewed by the action 
officer and considered by the Board.  There was no indication from the record that any of these 
conditions significantly interfered with satisfactory duty performance.  After due deliberation in 
consideration  of  the  preponderance  of  the  evidence,  the  Board  concluded  that  there  was 
insufficient cause to recommend a change in the PEB fitness determination for the any of the 
nine contended conditions discussed above; and, therefore, no additional disability ratings can 
be recommended. 
 

   4                                                           PD1101097 

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.  As discussed above, PEB 
reliance on the USAPDA pain policy for rating the wrist condition was operant in this case and 
the condition was adjudicated independently of that policy by the Board.  In the matter of the 
right ankle, posttraumatic arthritis condition and IAW VASRD §4.71a, the Board unanimously 
recommends no change in the PEB adjudication.  In the matter of the chronic pain, right wrist 
with  ganglion  condition  and  IAW  VASRD  §4.71a,  the  Board  unanimously  recommends  no 
change in the PEB adjudication.  In the matter of the contended deuteranopia, hypertension, 
right knee pain, left wrist pain, recurrent sinusitis, recurrent tonsillitis, keloid on back, buccal 
nerve damage and vitreous floaters conditions, the Board unanimously recommends no change 
from  the  PEB  determinations  as  not  unfitting.    There  were  no  other  conditions  within  the 
Board’s scope of review for consideration.   
 
 
RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:  
 

VASRD CODE  RATING 

10% 
10% 
20% 

5010 

5009-5003 
COMBINED 

UNFITTING CONDITION 
Right Ankle, Posttraumatic Arthritis  
Chronic Pain, Right Wrist with Ganglion 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111111, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 

 

 

   5                                                           PD1101097 

 
 
 

 
 

 
 
 

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 
XXXXXXXXXXXXXXXXXXXXXXX, AR20120019881 (PD201101097) 
 
 
I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD 
PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under 
the authority of Title 10, United States Code, section 1554a,   I accept the Board’s 
recommendation and hereby deny the individual’s application.   
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 
 
 BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 

   6                                                           PD1101097