RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200796 DATE OF PLACEMENT ON TDRL: 19980610 

BOARD DATE: 20130207 DATE OF PERMANENT SEPARATION: 20021024 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SGT/E-5 (92A20/Automated Logistics Specialist), 
medically separated for post-traumatic arthritis right wrist status post (s/p) radial peri-lunate 
dislocation which was treated with open reduction and fixation (ORIF) as well as ligament repair 
and low back pain (LBP) with L5/S1 degenerative disc disease (DDD). He sustained a dislocation 
of his right wrist in 1996 and underwent closed reduction, but subsequently required an ORIF of 
the scapho-lunate ligament and fixation with pins. After recovery from surgery, he had pain to 
the radial side of the joint and a reduced range-of-motion (ROM). He also had a history of DDD 
at L5-S1 with chronic LBP. The CI could not be adequately rehabilitated 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). 
Gout, asthma, post traumatic headaches, right shoulder pain, and bilateral pes planus 
conditions, identified in the rating chart below, were also forwarded by the MEB to the Physical 
Evaluation Board (PEB) as medically unacceptable. Hypertension was forwarded as medically 
acceptable. The PEB adjudicated the right wrist, low back and asthma conditions as unfitting, 
rated 10% each, with probable application of the Veteran’s Affairs Schedule for Rating 
Disabilities (VASRD). The remaining conditions were determined to be not unfitting and 
therefore not ratable. CI was placed on the Temporary Disability Retired List (TDRL). In 
September of 2002, at his third TDRL re-evaluation, the PEB recommended permanent 
separation. It also determined that the asthma condition was no longer unfitting. The CI 
appealed to the Army Board for the Correction of Military Records (BCMR) requesting the 
addition of gout as unfitting and ratable. It determined that the applicant provided insufficient 
evidence that would warrant granting a relief request and denied his application. The CI made 
no further appeals and was separated with a 20% combined disability rating. 

 

 

CI CONTENTION: “gout and sleep apnea and DJD in lower back” 

 

 

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 gout condition requested for 
consideration and the unfitting low back and right wrist conditions meet the criteria prescribed 
in DoDI 6040.44 for Board purview, and are accordingly addressed below. The other requested 
condition, sleep apnea, is 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 of Correction of Military Records. The 

 

 

 


 

 

 

TDRL RATING COMPARISON: 

 

Service IPEB – Dated 20020903 

VA* – All Effective Date 19980611 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

On TDRL – 
19980610 

 

TDRL 

Sep. 

Rt Wrist Arthritis 

5010-5003 

10% 

10% 

Rt Wrist Injury S/P ORIF 

5211-5212 

20% 

19990416 

Back Pain DDD 

5299-5295 

10% 

10% 

DDD L-Spine 

5003-5292 

20% 

20000328 

Asthma 

6602 

10% 

Not Unfitting 

Asthma 

6602 

30% 

19990416 

Gout 

Not Unfitting 

NO VA ENTRY 

Post Traumatic HAs 

Not Unfitting 

Post Traumatic HAs 

9304-8045 

10% 

19990416 

Rt Shoulder Pain 

Not Unfitting 

Rt Shoulder Injury Post 
op 

5203-5024 

10% 

19990416 

Bil Pes Planus 

Not Unfitting 

Bilateral Pes Planus 

5003-5276 

30% 

19990416 

Hypertension 

Not Unfitting 

Hypertension 

7101 

10% 

19990416 

.No Additional MEB/PEB Entries. 

Rt Elbow Injury w/ DJD 

5010-5206 

10% 

19990416 

Sleep Disorder 

6899-6847 

50% 

20000309 

0% x 3/Not Service Connected x 4 

19990416 

Combined: 20% 

Combined: 90% 



* VA rating based on exam most proximate to date of permanent separation. 

 

 

ANALYSIS SUMMARY: 

 

Right Wrist Condition. In May 1996, the CI fell from a military vehicle when it moved forward 
while he was climbing aboard. He sustained a wrist fracture and dislocation and was treated 
with ORIF and casting. Despite occupational therapy (OT), he continued to have pain, 
limitations in ROM and grip weakness which prevented him from meeting duty requirements. 
He was issued a U3L3 profile and referred to a MEB. There were four ROM evaluations in 
evidence, proximate to TDRL entry, with documentation of additional ratable criteria, which the 
Board weighed in arriving at its rating recommendation; as summarized in the chart below. 

 

Right Wrist ROM 
Degrees 

MEB ~18 Mo. Pre-TDRL 
entry 

VA C&P ~2 Mo. Post-
TDRL entry 

First TDRL re-evaluation 
10 months after entry 

VA C&P ~10 Mo. Post-
TDRL entry 

Dorsiflexion (0-70) 

20 

- 

20 

10 

Palmar Flexion (0-80) 

35 

- 

10 

10 

Ulnar Deviation (0-45) 

15 

- 

10 

10 

Radial Deviation (0-20) 

5 

- 

10 

10 

Comment 

Grip strength decreased 

No motion. Wrist not 
fused on x-ray 

Grip 4/5. NVI. 

Motion observed when 
the CI was distracted 

§4.71a Rating 

10% 

30% 

 

10% 



 

The narrative summary (NARSUM) dictated on 11 December 1996, 18 months prior to TDRL 
entry. The scar was noted to be well healed, but there was tenderness over the wrist near the 
base of the thumb, the site of the prior injury and surgery. X-ray showed mild bone loss and 
early arthritis. The ROM was reduced as above. Two addenda to the NARSUM were dictated in 
the July 1997 timeframe. The CI complained of a painful hand and wrist with decreased ROM. 
Objectively, he was observed to be anxious. There was marked guarding of movement of the 
right wrist, but he had full passive ROM. Active motion was not measured as the CI refused to 
move his wrist. There was no wasting of the muscles of the hand. Under fluoroscopic 


examination, no instability was noted and there was no evidence of DDD although nonunion of 
the ulnar styloid was noted as well as a healed scaphoid (radial) styloid. A nerve conduction 
velocity electromyogram test (NCV/EMG), testing nerve and muscle function, was normal. The 
examiner noted “pain complaints far in excess of radiographic and physical findings.” A second 
note documented that the CI had progressive wrist pain, used a brace for functional activity and 
showed increased evidence of arthritis on x-ray. At the VA Compensation and Pension (C&P) 
examination on 13 August 1998, 2 months after TDRL entry, the CI reported continued pain. On 
examination, the right wrist was extremely painful to palpation without motion active or 
passive. He was noted to hold the wrist rigidly. No hand weakness was noted. On x-ray, he 
had nonunion of the ulnar styloid and an old fracture of the radial styloid. The Board noted 
that at a 9 November 1998 VA physical medicine functional evaluation for a job at the post 
office, the CI was cleared for employment. His review of symptoms was negative and the 
neurological examination normal with intact sensation, strength and reflexes. There was no 
muscle tenderness or atrophy noted. The gait was normal. The examiner specifically noted the 
history of LBP, the wrist surgery, gout and the diagnosis of asthma. The first TDRL re-evaluation 
was 9 April 1999, 10 months after TDRL entry. The CI noted continuous pain and reduced ROM 
with a weakened grip and decreased lifting ability. The ROM is above. His scar was well healed 
and the grip strength reduced at 4/5. The VA accomplished a second C&P on 16 April 1999, 10 
months after TDRL entry. It noted that he was an office manager. The CI reported that he had 
pain even at rest. There was no active motion of the wrist when directly examined, but during 
the rest of the examination it was noted that he had about 10 degrees (later 15 degrees was 
written) of motion. He was noted to hold the wrist rigidly during the “conscious part of the 
examination.” No atrophy of the forearm muscles was noted. X-ray showed degenerative 
changes of the wrist and non-union of fractures of the radial and ulnar styloid processes. The 
examiner noted that there was an immobile wrist (to active movement), although there was 
movement when the CI was distracted. The PEB rated the right wrist at 10% and utilized the 
codes 5010 and 5003 for traumatic and degenerative arthritis, respectively. The VA rated the 
wrist at 20% using the codes 5211 and 5212, for impairment of the ulna and radius, 
respectively. The ulnar styloid process was noted to have non-union of a fracture on both VA 
examinations and one NARSUM. However, this finding typically has no bearing on prognosis 
unless there is also instability present between the ulna and radius. The addendum in 1997 
specifically noted that there was no instability present. The finding on a non-union of a radial 
styloid process fracture was also not consistently present and noted only on one VA 
examination whereas the prior VA examination had documented that it was healed. The 
preponderance of evidence does not support the presence of separately unfitting conditions 
from either a non-union of the radial or ulnar styloid process. The Board determined that the 
code 5215, limitation of motion, would be most appropriate. This, however, provides no 
advantage to the CI. 

 

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 right wrist condition at TDRL entry. The Board then turned its attention 
to the TDRL exit (permanent) rating. There was one set of ROM measurements proximate to 
TDRL exit which is in the table below. The CI had his third TDRL evaluation on 17 May 2002, 4 
years after TDRL entry and 5 months prior to permanent separation. He noted mild pain on the 
radial (thumb) side of the wrist and stated that he had residual amount of motion and 
diminished grip strength. On examination, grip strength was 4/5 and there was tenderness 
over the radial aspect of the right wrist. No swelling or deformity was noted. The examiner 
noted that X-rays from May 2000 showed post-traumatic changes. No comment was made on 
residual non-union of the styloid processes. There were no other examinations proximate to 
TDRL exit in evidence. 


 

 

Right Wrist ROM Degrees 

MEB ~5 Mo. Pre-TDRL Exit 

Dorsiflexion (0-70) 

30 

Palmar Flexion (0-80) 

30 

Ulnar Deviation (0-45) 

10 

Radial Deviation (0-20) 

10 

Comment 

 

§4.71a Rating 

10% 



The PEB rated the right wrist at 10% and utilized the codes 5010. The VA did not re-evaluate 
the wrist condition after the initial rating. The Board noted that the CI endorsed less pain than 
at entry to TDRL status and that the ROM showed modest improvement. 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 right wrist 
condition at TDRL exit. 

 

Low Back Condition. The CI first met a MEB for LBP in 1994. He reported a year history of LBP 
with the increased physical training at his duty location and denied any history of trauma. 
Other than pain, he was relatively asymptomatic. His gait, strength and reflexes were all 
normal. There was diffuse tenderness to the lumbar region and flexion was limited to 60 
degrees. The MEB found him medically unacceptable, but the PEB found him fit for duty. He 
again was referred to MEB in 1996 in conjunction with his right wrist condition discussed above. 
The narrative summary (NARSUM) was dictated on 11 December 1996, 18 months prior to TDRL 
entry. The CI reported moderate LBP which precluded him from lifting, doing sit ups and 
running. He was noted to be free of spasm, but with tenderness in the lumbar region. X-rays 
were normal. The ROM was reduced slightly reduced in extension and flexion limited to fingers 
six inches from the floor. A provocative test for nerve root irritation was positive at the limit of 
the test. At the C&P examination on 13 August 1998, 2 months after TDRL entry, the CI 
reported continued pain aggravated by forward flexion, carrying over 20 pounds or standing 
over an hour. The ROM showed a restriction to flexion of 40 degrees vice the normal 90 with 
painful motion. No other comments on the examination were made, but the Xray was noted as 
showing DDD. The Board noted that at a 9 November 1998 VA physical medicine functional 
evaluation for a job at the post office, the CI was cleared for employment. His review of 
symptoms was negative and the neurological examination normal with intact sensation, 
strength and reflexes. There was no muscle tenderness or atrophy noted. The gait was normal. 
The examiner specifically noted the history of LBP, the wrist surgery, gout and the diagnosis of 
asthma. The first TDRL re-evaluation was 9 April 1999, 10 months after TDRL entry. The CI 
noted the inability to stand for long periods of time. On examination, the gait was normal and 
ROM full. He did note pain with flexion and extension. Strength and reflexes were normal. On 
X-ray, a narrowed disc space was noted at L5-S1. The VA accomplished a second C&P on 
3 March 2000, 10 months after TDRL entry. It noted that he was an office manager. The CI 
reported that he had spasms that involved the lower back to the gluteal region, but denied 
radicular symptoms. On examination, he had some straightening of the lumbar lordosis, but 
was without atrophy or spasm. The ROM was reduced in extension to 15 degrees and flexion to 
fingers ten inches from the floor. The neurovascular exam was intact without evidence of a 
radiculopathy. On X-ray, minimal narrowing of the T12-L1 and L4-5 disc spaces was noted, but 
without DJD. Magnetic resonance imaging (MRI) on 19 June 2000 showed L4-5 DDD without 
herniation or nerve impingement. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB rated the back condition at 10% and coded it 5299-5295, analogous to lumbosacral strain. 


The VA rated the back at 20% and coded it 5003-5292, degenerative arthritis and lumbar 
limitation in motion, citing the 40 degree limitation in flexion as consistent with moderate 
limitation in motion. The Board noted that this examination was an outlier from the other 
examinations and inconsistent with the minimal radiographic evidence and the remainder of 
the physical examinations. 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 back condition at TDRL entry. The Board then turned its 
attention to the TDRL exit (permanent) rating. The CI had his third TDRL evaluation on 17 May 
2002, 4 years after TDRL entry and 5 months prior to permanent separation. The CI noted 
continued LBP which was unchanged from his prior evaluation. There was tenderness to 
palpation over the lumbosacral spine. The CI was able to flex to his mid-shins, bend laterally to 
mid-thigh and extend 10 degrees. There was slightly increased tone of the paravertebral 
muscles. Strength, sensation and gait were all normal. There was narrowing of the L5-S1 disc 
space. The PEB continued the 10% rating and 5299-5295 code at permanent separation. The 
VA did not re-evaluate for several years, but did note ROM improvement in the 9 February 
2007 rating decision which would support a lower rating. However, it also noted that the rating 
criteria had changed and that this precluded a change in rating barring an overall change in the 
condition. The Board noted that the loss of flexion was slight and the neurological examination 
normal. The findings on X-ray were minimal and would not be uncommon in someone the age 
of the CI. 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 back condition at TDRL exit. 

 

Asthma. The CI was determined to have an unfitting asthma condition at TDRL entry and rated 
at 10% disability. At the initial MEB examination on 11 December 1996, 18 months prior to 
TDRL entry, he reported the used of an inhaler on a daily basis and limitations in activity. At a 
TDRL reevaluation on 28 September 1999, 15 months after TDRL entry, the CI reported that he 
used a rescue inhaler (Proventil) two times every 2 weeks. He noted shortness of breath even 
at rest. On examination, his lungs were clear and he was noted to have a thick neck and be 
moderately overweight. Pulmonary function tests (PFTs) showed no obstructive lung disease 
(which asthma is), but did show a restrictive defect which could be explained, at least partially, 
by his obesity. The examiner, a pulmonologist, opined that there was no evidence of asthma 
present. A re-evaluation on 3 May 2000 by a pulmonologist noted that the CI complained of 
shortness of breath after one flight of stairs and used an inhaler up to four times a day. It was 
noted that his weight had increased 11 pounds and the 65 inch CI now weighed 221 pounds. 
He was thought to have symptoms consistent with asthma. His PFTs showed no improvement 
with bronchodilators, though, and were consistent with a restrictive rather than obstructive 
defect. He nonetheless retained the diagnosis of asthma. The final TDRL evaluation on 13 June 
2002, 4 months prior to TDRL exit. He had not used any inhalers for over a year and had not 
noted a change in his symptoms since he discontinued his medications. He had no response to 
bronchodilators during PFTs and a Methacholine challenge test was negative for the diagnosis 
of asthma. The diagnosis of asthma was again excluded. The Board noted that the PEB and VA 
both coded the asthma condition as 6602, but rated it at 10 and 30%, respectively. The action 
officer opined that the diagnosis of asthma has been excluded by several pulmonologists and 
that the CI was using medications once a week at the examination closest to TDRL entry. 
However, the Board is charged not to reduce adjudication by the PEB and therefore 
recommends no change to the TDRL entry adjudication. Further, it recommends that the PEB 
determination for the TDRL exit also remain unchanged. 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 asthma 
condition at TDRL entry or exit. 


 

Contended PEB Conditions. The contended condition adjudicated as not unfitting by the PEB 
was gout. It was judged to be medically unacceptable by the MEB, but not unfitting by the PEB. 
The Board’s first charge with respect to this condition 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. 
The CI developed gout in 1995 and was treated with medications. There is no record of further 
attacks after the initial presentation other than a note, dated 8 August 1996, which 
documented that he had two gouty attacks in the past year. He had been placed on a 
temporary profile once, 3 years prior to TDRL entry. There was no specific mention by the 
commander of impairment from gout. The Board noted that at a 9 November 1998 physical 
medicine functional evaluation for a job at the post office, the CI was cleared for employment. 
His review of symptoms was negative and the neurological examination normal with intact 
sensation, strength and reflexes. There was no muscle tenderness or atrophy noted. The gait 
was normal. The examiner specifically noted the history of LBP, the wrist surgery, gout and the 
diagnosis of asthma. A 6 January 2000 rheumatology note documented that he had gone 
several months without a flare and was well controlled by medications. The gout condition was 
reviewed by the action officer and considered by the Board. There was no indication from the 
record that it 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 gout 
condition and, therefore, no additional disability rating 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. 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 right wrist, back and asthma conditions and IAW VASRD 
§4.71a and 4.100, the Board unanimously recommends no change in the PEB adjudication for 
either TDRL entry or exit. In the matter of the contended gout condition, the Board 
unanimously recommends no change from the PEB determination 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 

VASRD CODE 

RATING 

TDRL 

PERMANENT 

Post-Traumatic Arthritis Rt Wrist 

5010-5003 

10% 

10% 

Low Back Pain with L5-S1 DDD 

5299-5295 

10% 

10% 

Asthma 

6602 

10% 

Not Unfitting 

COMBINED 

30% 

20% 



 

 

The following documentary evidence was considered: 


 

Exhibit A. DD Form 294, dated 20120610, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


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 XXXXXXXXXXXXXXXXXXXXX, AR20130005092 (PD201200796) 

 

 

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 XXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)