RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXXXXX                                                                    BRANCH OF SERVICE:  ARMY  
CASE NUMBER:  PD1101131 
SEPARATION DATE:  20031215 
BOARD DATE:  20120925    
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  Reserve  1LT/0-2  (70B/Medical  Service  Corps,  Administrative 
Specialist), medically separated for rheumatoid arthritis.  The CI developed painful swelling in 
his  joints  during  deployment  to  Iraq  in  2003.    The  condition,  determined  to  be  acute 
rheumatoid arthritis, 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 L3 profile and referred for a Medical Evaluation Board (MEB).  The 
MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication.  The PEB 
adjudicated the rheumatoid arthritis condition as unfitting, rated 20% with application of the 
Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was 
medically separated with a 20% disability rating.   
 
 
CI CONTENTION:  “I should have been medically retired instead.  I did not know at the time that 
I was waiving my retirement benefits and that my VA disability money would be withheld.  I 
would  simply  like  to  apply  for  Army  Reserve  medical  retirement.    I  am  giving  my  separation 
money  back  monthly  anyway  through  my  VA  disability.    Also,  I  should  have  been  rated  and 
additional 10% for painful scar to the left elbow.  The Army did 4 surgeries on my left elbow in 
mistake.  Also, I should have had a 10% rating for tinnitus from the Army.  Although, I did not 
know what the ringing was at that time.  I just dealt with it.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (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 painful scar of left elbow and tinnitus conditions contended by the CI were not 
addressed by the PEB and are, therefore, not within the Board’s purview.  Any conditions or 
contention not requested in this application, or otherwise outside the Board’s defined scope of 
review, remain eligible for future consideration by the Army Board for Correction of Military 
Records. 
  
 
RATING COMPARISON: 
 

VA (11 Mos. Post-Separation) – All Effective Date 20031220 

Condition 

Reactive Rheumatoid Arthritis, Both 
Knees, LS Spine, Left Elbow, Both Ankles 

Code 
5002 

Rating 
20% 

Exam 

20041001  

 

Service IPEB – Dated 20031103 
Condition 

Code 
5002 

Rating 
20% 

Rheumatoid Arthritis 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

 

↓No Additional VA Entries 

Combined:  20% 

 
 
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 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 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  Veteran  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 his 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 his case or the quality of care rendered.  
 
Rheumatoid  Arthritis  Condition.  The  CI  developed  a  febrile  illness  with  gastrointestinal 
symptoms while in Iraq in April 2003.  At Landstuhl Regional Medical Center the diagnosis of 
acute  rheumatoid  arthritis  was  confirmed  and  disease  specific  medication,  infliximab,  was 
instituted on 7 May 3003 with immediate improvement in symptoms.  At the time of CONUS 
return, 14 May 2003, the CI had full range-of-motion (ROM) of the cervical spine and shoulders, 
some swelling of the right second digit, slight limitation of ROM of the left hip, swelling of the 
left knee and both ankles and midfeet.  By 28 May 2003 symptoms had improved, but persisted 
in  the  elbow,  ankle  and  finger.  With  continued  treatment,  the  condition  improved  further.  
Evaluation by the internal medicine service 9 September 2003, 3 months prior to separation, 
the CI reported only that his knees ached a bit.  Examination revealed no swelling of any joint 
and  no  tenderness  in  the  spine.    At  the  MEB/narrative  summary  (NARSUM)  evaluation, 
performed  20  November  2003,  one  month  prior  to  separation,  the  CI  reported  minimal 
intermittent  pain  in  many  joints  in  the  morning,  improving  with  movement  throughout  the 
course of the day.  No specific joint was identified.  On physical examination motor strength, 
reflex  and  sensation  in  hands,  arms  and  legs  were  normal.    Goniometric  ROM  of  the  neck, 
shoulders, elbows, wrists, hand, hips, knees and ankles was normal.  No mention of swelling or 
painful ROM was recorded.  On evaluation by the rheumatology service performed 9 February 
2004, two months after separation, swelling was absent from all joints, with normal ROM and 
strength throughout with no back tenderness.  Condition was described as asymptomatic and 
quiescent.  At the VA Compensation and Pension (C&P) examination, performed October 2004, 
approximately 10 months after separation, the CI reported stiff joints with occasional flare-ups 
of  pain,  especially  knees  and  back  in  the  early  morning.    He  had  received  no  infliximab 
treatment  for  approximately  10  months.    The  CI  was  working  as  a  real  estate  agent.    On 
examination gait was normal with no effusion or swelling in any joint.  ROM was reported as 
normal  throughout  and  lower  back  tenderness  was  absent.    No  reference  to  painful  ROM  is 
recorded.   The condition was noted to be ‘clinically quiescent.’   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB and VA both rated the condition 20% under the same code, 5002, rheumatoid arthritis.  A 
higher rating of 40% would require incapacitating episodes three or more times a year.  The 
Board  unanimously  agreed  that  preponderance  of  evidence  in  record,  as  discussed  above, 
documents excellent response of the rheumatoid arthritis condition to medication resulting in a 

quiescent clinical status at the time of separation with no acute exacerbations or flares since 
initiation  of  the  treatment  in  May  2003.    The  Board,  therefore,  unanimously  agreed  that  a 
higher rating under 5002 was not appropriate.  The Board agreed that rheumatoid arthritis was 
rated by both the PEB and VA as a systemic condition code 5002 but, that IAW §4.71a, involved 
joints may be individually rated.  Individual ratings may be combined for final rating, but, not 
added with diagnostic code 5002.  Findings such as limitation of ROM will be rated under the 
appropriate diagnostic codes for the specific joints involved.  Where, however, the limitation of 
motion of the specific joint or joints involved is non compensable under these codes, a rating of 
10%  is  appropriate for each  such  major  joint  or  group  of  minor  joints affected by  functional 
limitation of motion.  Limitation of motion must be objectively confirmed by findings such as 
swelling,  muscle  spasm,  or  satisfactory  evidence  of  painful  motion.    The  Board  opined 
symptomatic joints involved in this condition were left elbow, thoracolumbar back, both knees, 
both ankles and left second hand digit.  The Board agreed that the preponderance of proximate 
clinical evidence, discussed afore, documents normal ROM, absence of joint pain and painful 
motion, swelling and effusions of all joints under concern at the time separation.  The Board 
notes  a  report  on  the  MEB  evaluation  of  intermittent  morning  joint  stiffness  improving  with 
activity, without definition of a specific joint, and opines this not to achieve a level for rating 
under §4.71a or §4.59.  The Board notes the CI to specifically report early morning back pain on 
the C&P exam, 10 months after separation, but concluded this to be minor given the normal 
back exam and related to the interval between infliximab treatments.  The Board unanimously 
agreed  that  no  higher  rating  for  the  condition  could  be  achieved  through  individual  joint 
ratings.    The  Board  was  unable  to  find  any  pathway  to  a  higher  rating  given  any  applicable 
VASRD code.  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 rheumatoid arthritis 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 and IAW VASRD §4.71a, the 
Board  unanimously  recommends  no  change  in  the  PEB  adjudication.    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 

VASRD CODE  RATING 

5002 

COMBINED 

 20% 
 20% 

Rheumatoid Arthritis  

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111207, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 

 
 
 
 
 
 
 
  

           XXXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

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, AR20120018081 (PD201101131) 
 
 
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 
 
 

     XXXXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)