RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200921 DATE OF PLACEMENT ON TDRL: 20020219 

BOARD DATE: 20130207 DATE OF PERMANENT SEPARATION: 20031109 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (92R1P/Supply Sergeant), medically 
separated for status post (s/p) median nerve partial transection and repair (right upper 
extremity). The CI sustained a near amputation to his right upper extremity after a crush injury 
in a motor vehicle accident (MVA) in October of 1999 and underwent multiple surgeries for 
repair of nerve, tendon and vascular damage as well as forearm fractures. He 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). Four diagnoses related to the residuals of 
the right upper extremity to include the elbow, wrist, finger and median nerve laceration were 
forwarded to the PEB. Glaucoma and latus degeneration bilaterally conditions, identified in the 
rating chart below, were also forwarded by the MEB. The Informal Physical Evaluation Board 
(IPEB) adjudicated the median nerve laceration, reduced range-of-motion (ROM) at the wrist 
and muscular atrophy below the elbow, s/p near amputation of right upper extremity with 
multiple segmental fractures and nerve and vessel damage as unfitting, rated 30%. Glaucoma 
and latus degeneration conditions were determined to be not unfitting. The CI was placed on 
Temporary Disability Retired List (TDRL) with ratings as reflected in the chart below. At TDRL 
reevaluation approximately 17 months later, the PEB adjudicated the s/p median nerve partial 
transection and repair, as unfitting, rated 10% with likely application of the Veterans 
Administration Schedule for Rating Disabilities (VASRD). The IPEB was silent to the remaining 
right upper extremity residuals; the elbow, wrist and finger which they had adjudicated upon 
TDRL entry. The CI appealed to the United States Army Physical Disability Agency (USAPDA), 
which affirmed the PEB findings; and was then medically separated with a 10% disability rating. 

 

 

CI CONTENTION: “1.) Degenerated bone in the lumbar spine 2.) lower right arm and wrist was 
broken in half 3.) metal plate in right arm.” 

 

 

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 conditions lower right arm and wrist, 
and metal plate in right arm as requested for consideration meet the criteria prescribed in DoDI 
6040.44 for Board purview; and, are addressed below, in addition to a review of the ratings for 
the unfitting conditions. The degenerated bone in the lumbar spine condition 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 
Service Board for Correction of Military Records. Also IAW DoDI 6040.44, the Board’s authority 
is limited to making recommendations on correcting disability determinations. The Board’s role 
is thus 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 ratable severity at the 


time of separation; and, to review those fitness determinations within its scope (as elaborated 
above) consistent with performance-based criteria in evidence at separation. 

 

 

TDRL RATING COMPARISON: 

 

Service IPEB – Dated 20030926 

VA* – All Effective Date 20020220 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

On TDRL – 
20020219 

 

TDRL 

Sep. 

Median Nerve 
Laceration, Reduced 
Range of Motion at 
the Wrist and 
Muscular Atrophy 
Below the Elbow, 
Status Post Near 
Amputation of Right 
Upper Extremity 
with Multiple 
Segmental 
Fractures, Nerve 
and Vessel Damage 

8515 

30% 

-- 

Residuals of Right Arm Injury, 
Status Post Open Reduction, 
Internal Fixation, Fracture of 
Right Distal Ulna and Radius, 
with Degenerative Joint 
Disease 

5010-5213 

30% 

20020731 

Degenerative Joint Disease of 
The Right Wrist and Hand, 
Residuals of Injury from Motor 
Vehicle Accident 

5010-5215 

10% 

20020731 

Status Post Median 
Nerve Partial 
Transection and 
Repair, with Good 
Motor Function and 
Residual Painful 
Paresthesias 

8515 

 

10% 

Latus Degeneration 
Bilaterally 

Not Unfitting 

- 

Lattice Degeneration 

6099-6011 

0% 

20020731 

Glaucoma Suspect 

Not Unfitting 

- 

No VA Entry 

.No Additional MEB/PEB Entries. 

Degenerative Joint Disease Of 
The Lumbosacral Spine 

5003 

10% 

20020731 

Not Service Connected x 1 

20020731 

Combined: 10% 

Combined: 40% 



 

 

ANALYSIS SUMMARY: The Board acknowledges the CI's contention suggesting that ratings 
should have been conferred for other conditions documented at the time of separation and for 
conditions not diagnosed while in the service (but later determined to be service-connected by 
the VA). While the Disability Evaluation System (DES) considers all of the member's medical 
conditions, compensation can only be offered for those medical conditions that cut short a 
member’s career, and then only to the degree of severity present at the time of final 
disposition. The Department of Veterans Affairs (DVA), however, 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. In 
TDRL cases, the Board must also adhere to the DES standard that only those conditions which 
were present and unfitting at the time of temporary retirement may be considered for 
compensation and rating at the time of permanent separation or retirement. The Board wishes 
to clarify that, in cases involving a period of TDRL, its recommendations regarding the 
appropriateness of PEB fitness adjudications must be premised on evidence referable to the 
time of placement on TDRL. It should be noted, however, that conditions determined to be 
unfitting at the time of temporary retirement are subject to a change in that determination 
(i.e., no longer unfitting) at the time of permanent separation. In cases encompassing a period 
of TDRL, although the Board’s review of fitness adjudications is relevant to the time of 
temporary retirement, the Board’s rating recommendations are based on severity evidenced at 


the time of permanent separation. The Board must therefore judge whether the degree of 
physical impairment at the time of separation would render the CI unfit for continued military 
service within the broad requirements of his MOS. The PEB did not specifically adjudicate the 
remaining TDRL entry right upper extremity residuals; the elbow and finger. Thus a lengthy 
deliberation ensued if the evidence supports the right upper extremity residuals; the elbow 
finger as unfitting conditions on exit of TDRL and therefore should be included in the Boards 
permanent rating recommendation or if the Board should approach the residuals as a de facto 
service determination. The Board unanimously agreed the evidence supports the elbow and 
finger as unfitting on TDRL entry and remained unfitting as the PEB was silent to any 
adjudication thereafter. 

 

Right Upper Extremity Condition: The narrative summary (NARSUM), 2 years prior to 
separation, noted the CI had a near amputation of his right upper extremity after an MVA in 
October 1999. He suffered a complex open wound of his right elbow, right forearm with an 
open ulnar fracture and closed radial fracture both with segmental defects as well as a right 
wrist laceration with flexor tendon, median nerve, and ulnar artery injuries with closed right 3rd 
metacarpal interarticular fracture, right 4th metacarpal head fracture, and closed right 5th 
metacarpal phalangeal joint dislocation. He also sustained full thickness skin loss over his right 
antecubital fossa as well as approximately 25% of the dorsal aspect of his forearm. The profile 
on 25 October 2001 identified both arm and hand pain as the limiting conditions for the 
inability to carry and fire a rifle. The commander’s statement on 11 June 2001 stated the CI was 
able to perform his duties within the limits of his profile. There were three goniometric ROM 
evaluations in evidence, with documentation of additional ratable criteria, which the Board 
weighed in arriving at its rating recommendation; as summarized in the charts below. 

 

Right Wrist ROM 

in degrees 

(Normal) 

MEB ROM ~ 2 
years. Pre-Sep 

MEB to TDRL ~ 2 years. 
Pre-Sep 

VA C&P ~ 15 Mo. 

Pre-Sep 

TDRL Re-Eval ~ 4 Mo. 

Pre-Sep 

Flexion (80) 

70 

70 

60 

- 

Extension(70) 

70 

- 

40 

- 

Comment 

Wrist pain , 
stiffness 

Cannot type 

Cannot use 
manual 
screwdriver. 

 

+R 4th digit decreased 
sensation. 

Weaker R grip. 

 

Normal sensation 
and strength. 

No muscular deficit. 

No skeletal deficits. 

No vascular deficits. 

+Pain on pronation. 

+Pain with prolonged 
writing. 

Normal sensation. 

+Pain on extreme motion. 

+Tenderness. 

+Crepitus. 

Normal strength. 

Normal vascular exam. 

 

§4.71a Rating 

10%* 

10%* 

10% 

10%* 

§4.124 Rating 

30% 

30% 

10% 

10% 



*conceding §4.59 painful motion 

 

Right Elbow ROM 

in degrees 

(Normal) 

MEB ROM ~ 2 years. 
Pre-Sep 

VA C&P ~ 15 Mo. 

Pre-Sep 

TDRL ReEval ~ 4 Mo. 

Pre-Sep 

Flexion (145) 

140 

150 

160 

Extension (0) 

5 

10 

10 

Pronation (80) 

45 

10 

70 

Supination (85) 

80 

90 

80 

Comment 

+R 4th digit decreased 
sensation. 

Weaker R grip. 

 

Normal sensation and strength. 

No muscular deficit. 

No skeletal deficits. 

No vascular deficits. 

+Pain on pronation. 

+Pain with prolonged writing. 

Normal sensation. 

+Pain on extreme motion. 

+Tenderness. 

+Crepitus. 

Normal strength. 

Normal vascular exam. 

 




§4.71a Rating 

20% 

30% 

10%* 



 

 

The NARSUM examination 2 years prior to separation revealed sensory loss over the well 
healed skin grafts over the dorsal aspect of the forearm, antecubital fossa, and flexor surface of 
the mid forearm. There were multiple well healed scars from surgery as well traumatic scars 
below the antebrachium. Atrophy of the musculature below the elbow, muscle loss in the 
antecubital fossa and extensor surface was noted. There was decreased sensation of the right 
ring finger globally, with scissoring of the right small finger. Strength testing with dynamometer 
was 22, 22 right hand, and left 55, 50 kilograms. X-rays, on 31 July 2002, revealed evidence of 
right elbow moderate arthrosis with degenerative changes compatible with old trauma; old 
right radius midshaft fracture with plate and screws, some deformity of the ulna from old 
trauma; and right wrist degenerative changes secondary to previous trauma. 

 

At the VA Compensation and Pension (C&P) exam, 15 months prior to separation, the CI 
reported pain on movement of right hand, trouble with pronation of right forearm, pain on 
lifting heavy weights, increased exertion, and repetitive movements of the right upper 
extremity. The CI reported he could write and take care of all his activities of daily living. 
Examination revealed extensive skin grafting of the right upper extremity 10cm (3.9 in) by 10cm 
(3.9 in) on the cubital fossa, and 15cm (5.9 in) by 10cm (3.9 in) on the right forearm. There 
were normal pulses; strength was decreased upon pronation 4+/5 of the right forearm, 
otherwise normal strength, muscle bulk and tone, reflexes, and sensation. ROMs are 
summarized above. It was the C&P examiner’s opinion that the CI was fully employable and did 
not have any functional impairment in carrying out his activities of daily living. The CI was 
employed a Sizemore security guard. 

 

At the TDRL re-evaluation exam, 4 months prior to separation, the CI reported he had been able 
to return to work at a lumberyard to include operation of heavy equipment such as chain saws 
with his right hand effectively. He reported continued painful paresthesias of his right thumb, 
index finger, middle finger, and radial side of his ring finger especially with work and gripping 
things, he did not report dropping objects or notable weakness of his hand or forearm. Physical 
examination revealed formation of a good composite fist with a stiff small finger PIP joint. 
Sensation was intact to two point discrimination; strength was normal 5/5 strength of right 
wrist extensors, wrist flexors and thumb extensors and flexors. The CI had normal vascular 
examination of the hand with 2 second capillary refill and 2+ pulses. No wrist ROMs were 
recorded. 

 

The Board directs attention to its rating recommendation based on the above evidence. In 
consideration of all rating recommendations the Board notes the CI is right hand dominant and 
rating considerations will be for major/dominance. The PEB assigned a 30% rating at the time 
of TDRL entry for the 4 unfitting right upper extremity conditions (elbow, wrist, median nerve 
and fifth finger), forwarded by the MEB, and coded under 8515 (median nerve). However the 
Board acknowledges this code does not capture the unfitting residual pathology of the elbow or 
the fifth finger. Therefore the Board considered the evidence for the elbow and fifth finger for 
rating determinations upon entry onto TDRL. The Board agreed the evidence supports the 20% 
rating criteria coded 5213 (Supination and pronation, impairment of) for the right traumatic 
osteoarthritis of the elbow for motion lost beyond the last quarter of the arc (did not pass 
beyond 60 degrees) yet did pass the middle of the arc (pass 40 degrees). The Board next 
agreed that the evidence supports the only rating criteria of 0% coded 5227 (Ring or little 
finger, ankylosis of) for the right small finger central slip injury. 

 

For its permanent rating recommendation, the Board agreed the TDRL exam is most proximate 
to separation, reflects a continual improvement in the rehabilitation of the right upper 


extremity residuals and assigns this exam most probative value. The PEB assigned a 10% rating 
coded 8515 (paralysis, the median nerve) for mild periodic painful paresthesias in the thumb, 
index, middle and previous measured weakness of right hand. The Board notes the CI is 
capable of working in a lumberyard operating heavy equipment and while there is increased 
pain and weakness with use of the right wrist there are no objective neurologic findings, 
functional or occupational impairments, or incapacitating episodes in the evidence to meet the 
30% higher rating for moderate paralysis. The Board also considered functional loss of the 
muscle groups VII and VIII (VASRD diagnostic codes 5307 and 5308). The Board agreed under 
this code the 30% rating does not support the remarkable recovery and mild functional 
impairments evidenced by the record. 

 

The Board next considered the VA chosen musculoskeletal codes for both the wrist 5215 
(limitation of motion of the wrist) rated 10% for painful limitation of motion and the elbow 
5213 (impairment of supination and pronation) rated 30% for pain limited motion analogous to 
the 5010 code (arthritis due to trauma) which is consistent with the VA exam at that time. For 
the purpose of rating disability from arthritis, elbow, and wrist are considered major joints. 
There is a noncompensable ROM impairment of the right wrist and elbow, and the Board 
agreed that there is satisfactory documentation of painful motion of both joints with 
degenerative X-ray evidence in the pre-separation examinations to merit application of a 
minimal compensable rating (10%) under the 5010 code. With regards to the wrist the Board 
agreed the musculoskeletal or neurological codes, 5215 and 8515 respectively, achieve the 
same 10% rating for the right wrist. However, the Board found both schedules and codes could 
not be applied to the same wrist joint IAW VASRD §4.14 avoidance of pyramiding. The AO 
recommends the 8515 code as it clinically subsumes not only the pain disability but also the 
subjective weakness with use and sensory residuals in the thumb, 2nd and 3rd digits. The Board 
next considered the 5213 code for limited painful pronation of the elbow and agreed the 
evidence does not support the 20% higher rating as “motion lost beyond last quarter of arc, the 
hand does not approach full pronation” requires a measured pronation of less than 60 degrees. 
Finally the Board considered the residuals of the small finger included stiffness of the proximal 
interphalangeal (PIP), painful paresthesias of the radial side of ring finger and a normal grip. 
The Board agreed the evidence supports a 0% rating coded 5227. The Board also considered an 
additional rating for residual scars from seven surgeries and scars from the two skin grafts. By 
precedent, the Board does not recommend separation rating for scars unless their presence 
imposes a direct limitation on fitness. There are trophic changes of the skin due to skin grafting 
and scarring from multiple surgeries and the traumatic injury however the Board agreed the 
evidence does not support functional loss or ratable criteria using VASRD §4.118—Schedule of 
ratings–skin. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
(reasonable doubt), §4.45(f) (the joints) and §4.40 functional loss the Board recommends a 
permanent disability rating for the right upper extremity residuals; 10% for the right wrist 
condition 8515, 10% for the right elbow condition (5010-5003) and 0% for the fifth finger 
condition for a combined 20% rating. 

 

Contended PEB Conditions: The contended conditions adjudicated by the PEB referred from 
the MEB and contended by CI’s were: lower right arm and wrist was broken in half and metal 
plate in the right arm conditions. These conditions were considered above under the right 
upper extremity conditions. There are no other contended conditions for consideration. 

 

 

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 upper extremity condition, the Board unanimously 


recommends a TDRL entry disability rating for the median nerve partial transection and repair 
of 30% coded 8515, for the post traumatic osteoarthritis right elbow 20% coded 5010-5213 and 
for the right small finger central slip injury 0% coded 5227 for a combined 40% rating IAW 
VASRD §4.124a and §4.71a, respectively. For its permanent recommendation of the right 
upper extremity condition, the Board unanimously recommends for the median nerve partial 
transection and repair of 10% coded 8515, for the post traumatic osteoarthritis right elbow 10% 
coded 5010-5003 and for the right small finger central slip injury 0% coded 5227 for a combined 
20% rating IAW VASRD 4.124 and 4.71a, respectively. There were no other conditions within 
the Board’s scope of review for consideration. 

 

 

RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

TDRL 

PERMANENT 

Median Nerve Partial Transection and Repair 

8515 

30% 

10% 

Post Traumatic Osteoarthritis Right Elbow 

5010-5213 

20% 

-- 

5010-5003 

 

10% 

Right small finger central slip injury 

5227 

0% 

0% 

COMBINED 

40% 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120607, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxxx, AR20130005076 (PD201200921) 

 

 

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 constructively place the 
individual on the Temporary Disability Retired List (TDRL) at a combined rating of 40% rather 
than 30% for the period 20 February 2002 to 

2 November 2003 and then following this period no recharacterization of the individual’s 
separation but modification of the permanent disability rating of 10% to 20%. 

 

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 as follows: 

 

 a. Providing a correction to the individual’s separation document showing that the 
individual was separated by reason of temporary disability effective the date of the original 
medical separation for disability with severance pay. 

 

 b. Providing orders showing that the individual was separated with a permanent 
combined rating of 20% effective the day following the TDRL period with no recharacterization 
of the individual’s separation. 

 

 c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will 
provide 40% retired pay for the temporary disability retired period effective the date of the 
individual’s original medical separation and adjusting severance pay as necessary to account for 
the additional TDRL time in service. 

 

 

 

 

 

 

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 xxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)