RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200919 SEPARATION DATE: 20020516 

BOARD DATE: 20130213 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (11B10 / Infantryman), medically separated 
for chronic right flank pain, status post (s/p) laceration of right kidney secondary to blunt 
trauma from a fall from a third story balcony. Despite treatment, the CI did not meet the 
physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board 
(MEB). The MEB forwarded right flank pain s/p laceration of (the) right kidney secondary to 
blunt trauma to the Physical Evaluation Board (PEB) as medically unacceptable. The MEB 
forwarded no other conditions to the PEB. The PEB adjudicated the chronic right flank pain s/p 
laceration of (the) right kidney secondary to blunt trauma condition as unfitting and rated it 0% 
with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made 
no appeals and was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “In 4-2000, while leaning over to talk to a fellow soldier, I fell off a 3rd story 
balcony in the barracks and hit the second story railing. I was in the ICU and hospital for 
approximately 10 days. My right kidney received severe blunt force trauma. My right lung was 
also badly damaged. I had sever [sic] internal bleeding that lasted for approximately 10 days. 
My right kidney now only works at about 20%, my right lung has since recovered. Due to this 
injury, I become dehydrated faster. I become sick readily easily and the symptoms are more 
severe than normal and last longer. I have lingering pain to my right flank area. I urinate 
approximately every two hours (even at night during sleep). I have to follow a strict diet and am 
unable to consume any medications that are digested through the kidneys (ie, ibuprofen). What 
really makes this injury more severe is the unknown as I grow older. With the proper function 
of only one kidney, I am more susceptible to illness and disease. As compared to other injuries 
that qualify for a 10% rating, I feel that this injury is more severe. The kidneys help remove 
wastes and extra fluid from your blood, control your body's chemical balance, help control your 
blood pressure, help keep your bones healthy, and help you make red blood cells. I feel that as I 
grow older these functions will decrease at a much faster rate than someone without this form 
of injury. I ask that you please reevaluate my rating and not only consider my current situation, 
but the long term affects of this type of injury. I loved the four years I was able to serve my 
country and it was one of the sadist days of my life to have to terminate my obligation. I was 
unable to re-up or to re-c1ass due to this injury. Thank you for your help.” 

 

 

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, 
paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for 
continued military service and those conditions identified but not determined to be unfitting by 
the PEB when specifically requested by the CI. The rating for the unfitting right flank condition 
is addressed below; and, no additional condition is within the DoDI 6040.44 defined purview of 
the Board. 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. 

 


The Board acknowledges the CI’s information regarding the significant impairment with which 
his service-connected condition continues to burden him; but, must emphasize that the 
Disability Evaluation System has neither the role nor the authority to compensate members for 
anticipated future severity or potential complications of conditions resulting in medical 
separation. That role and authority is granted by Congress to the Department of Veterans 
Affairs, operating under a different set of laws. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20020403 

VA (4 Mos. Pre -Separation) – All Effective Date 20020517 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Rt Flank Pain, S/P 
Laceration Rt Kidney 

5099-5003 

0% 

Rt Kidney Post 
Fracture/Laceration 

7599-7501 

10% 

20020129 

No Additional MEB/PEB Entries 

Not Service-Connected x 1 

20020129 

Combined: 0% 

Combined: 10% 



 

 

ANALYSIS SUMMARY: 

 

Right Flank Condition. In April 2001, a year prior to separation, the CI fell approximately 10 to 
12 feet off a balcony and landed on his right side without loss of consciousness. He was 
admitted for a week and then released to convalescent leave. A right pulmonary contusion was 
noted; it resolved without sequelae. He also had a right renal fracture with a retroperitoneal 
hematoma and gross hematuria. The latter two findings cleared over time, but a follow up 
ultrasound on 7 September 2001, 5 months post-injury, showed a wedge shaped area of 
atrophy and a slightly smaller right kidney (9.2 cm vice 10.6 cm left kidney) consistent with the 
history of renal fracture. Of note, a renal scan on 31 July 2001, 3 months post-trauma, showed 
relative renal function of 22% on the right and 78% on the left, consistent with some loss of 
function on the right side. At a nephrology consultation on 6 September 2001, he was noted to 
still have normal renal function including the urine microscopic examination. No dietary 
restrictions were in place, but he was advised to avoid high impact activities and not to 
continue a high protein diet (for bodybuilding). He was also told that his flank pain might take 
1-2 years to resolve. A repeat renal ultrasound on 6 February 2002, 3 months prior to 
separation, showed a persistent right renal scar from the prior trauma. The narrative summary 
(NARSUM) was dictated on 27 December 2001 (5 months prior to separation). The CI reported 
right flank pain with prolonged sitting, occasionally upon awakening and with running or other 
exertional activities. He used Tylenol for the pain and occasionally used narcotics when the 
pain was severe. He denied any genitourinary symptoms or problems breathing. The 
examination was unremarkable with clear lungs, a benign abdomen and no edema. Laboratory 
findings including a urinalysis were normal. His current status was thought to be good, but 
prognosis poor secondary to the flank pain. At the MEB examination on 14 January 2002, 4 
months prior to separation, the CI reported that he had a history of a lacerated kidney and 
“crushed” lung. The MEB examiner noted that the abdomen and back were normal. Urinalysis 
on 14 January 2002 (4 months prior to separation) was normal. At the VA Compensation and 
Pension (C&P) evaluation on 29 January 2002 (4 months prior to separation), the CI reported 
pain if he ran over two miles and with road marching and ruck-sacking. The abdominal 
examination was benign; there was mild right flank costovertebral tenderness to percussion. 
Urinalysis and blood markers for renal function were normal. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB rated 0% via analogous code 5099-5003 (Arthritis) using the USAPDA pain policy. The VA 
rated 10% via analogous code 7599-7501 (Kidney abscess). The Board notes that this disability 
is not specifically rated in the VASRD. The CI had tenderness on the VA examination, but not 


the NARSUM or MEB examinations. He described pain with exertional activities, but did not 
report pain with the normal activities of daily living. Renal markers remained normal and the 
urinalysis was also normal indicating normal renal function, although there was an area of 
atrophy documented. He was on no treatment other than occasional analgesics and the 
nephrology recommendation to follow a normal diet and avoid high impact activities. The 
Board considered various analogous codes available for rating. Application of VASRD §4.59 
(Painful motion) by analogizing the kidney flank pain with exertional movement to the painful 
motion of arthritic joints would rate zero percent (coded 5099-5003) since the CI only had pain 
after significant exertion or prolonged sitting. The Board then considered analogizing the 
kidney damage to the damage to muscles by under VASRD §4.56 (Muscle disabilities). The 
Board concluded that longstanding pain with physical activity, the CI would rate no more than 
"moderate" via §4.56. The closest muscle group to analogize to the kidney scarring would be 
muscle group XIX (Abdominal wall and lower thorax, code 5319). A "moderate" rating under 
this muscle group would rate 10% coded 5399-5319. The Board also considered code 7509 
(Renal colic) as being analogous to CI's kidney pain. The Board noted that the CI described he 
gets flank pain only with exertion and the MEB and C&P examinations showed only mild flank 
pain on the latter examination. The Board concluded that since the CI's flank pain occurred 
only with exertion or prolonged sitting, he would not meet the threshold for a 10% rating, 
coded 7599-7509. The Board also noted that while there was differential in the function of the 
two kidneys, the CI's overall renal function was preserved (normal BUN, creatinine, urinalysis); 
the CI would thus rate zero percent under VASRD §4.115a (Renal dysfunction) of the VASRD. 
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable 
doubt), the Board, by majority vote, concluded that there was insufficient cause to recommend 
a change in the PEB adjudication for the stress fracture of right sacrum 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. As discussed above, PEB 
reliance on the USAPDA pain policy for rating the right flank pain was operant in this case and 
the condition was adjudicated independently of that policy by the Board. In the matter of the 
chronic right flank pain condition, the Board, by a vote of 2:1, recommends no change in the 
PEB adjudication. The single voter for dissent (who recommended 10% coded 5399-5319) did 
not elect to submit a minority opinion. 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 

Chronic Right Flank Pain, Status Post Laceration of Right Kidney 

5099-5003 

0% 

COMBINED 

0% 



 

 

 

 

 

 

 

 

 

 


The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120625, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXX, 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 
XXXXXXXXXXXXXXXXXXX, AR20130006086 (PD201200919) 

 

 

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 XXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)