RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201049 SEPARATION DATE: 20040401 

BOARD DATE: 20130220 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an activated National Guard SSG/E-6 (88M30/Motor Transport 
Supervisor), medically separated for chronic left forearm and knee pain, combined as a single 
unfitting condition. With a prior history of compound fractures of the forearm and patella, the 
CI reinjured his left knee and left forearm after loading trucks in February 2003. The CI stated 
that he was unable to drive trucks or do his job due to unrelieved pain and functional 
limitations. 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). The Physical 
Evaluation Board (PEB) adjudicated chronic left forearm and knee pain, combined as a single 
unfitting condition, rated 0%, with cited application of the US Army Physical Disability Agency 
(USAPDA) pain policy. The CI made no appeals and was released from active duty due to 
medical disability. The CI elected not to receive severance pay but, with greater than 20 years 
of satisfactory Federal service, on 22 December 2003, elected transfer to the Retired Reserve 
List. 

 

 

CI CONTENTION: The CI attached a one page statement to his application suggesting that the 
information provided to the MEB was incorrect. 

 

 

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 ratings for unfitting conditions will be 
reviewed in all cases. 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 the Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20031211 

VA – All Effective Date 20040430 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Lt Forearm & 
Knee Pain 

5099-5003 

0% 

DJD Lt Knee w/ Scar 

5260 

10% 

STR 

Nerve Compression LUE S/P 
Surgery w/ Scar 

8615 

10% 

STR 

.No Additional MEB/PEB Entries. 

HTN w/ Chronic Renal Failure 

7101-7507 

30%* 

STR 

0% X 0 / Not Service-Connected x 0 

STR 

Combined: 0% 

Combined: 40% 



*Original VARD 20050209 rated HTN @ 10%, combined @ 30%. Upon appeal, HTN rating was increased to 30%, combined to 
40%, retroactive to DOS, per VARD 20051007. 

 

 

 

 

 


ANALYSIS SUMMARY: The Board has neither jurisdiction nor authority to scrutinize or render 
opinions in reference to the CI’s statements in the application regarding suspected Disability 
Evaluation System (DES) improprieties in the processing of his case. 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. It must also judge the fairness of PEB fitness adjudications based on the fitness 
consequences of conditions as they existed at the time of separation. 

 

The PEB combined the left forearm condition and the left knee condition as a single unfitting 
condition coded to 5099-5003 and rated 0%, with application of the USAPDA pain policy. This 
approach by the PEB reflected its judgment that the constellation of conditions was unfitting, 
and there was no need for separate fitness adjudications or implied adjudication that each 
condition was separately unfitting. The Board’s initial charge in this case was therefore 
directed at determining if the PEB’s approach of combining conditions under a single rating was 
justified in lieu of separate ratings. When considering a separate rating for each condition, the 
Board considers whether each unbundled condition is reasonably justified as separately 
unfitting or the totality of the evidence indicates the condition would not cause the member to 
be referred into the DES or be found unfit because of that condition. When the Board 
recommends separate fitness recommendations in this circumstance, its recommendations 
may not produce a lower combined rating than that of the PEB. 

 

Left Forearm Condition. The MEB narrative summary (NARSUM) notes that the CI suffered a 
compound radial and ulnar fracture in a motorcycle crash in 1992, while in civilian status, with 
open reduction and internal fixation (ORIF). Soon after, he developed a non-union in the 
forearm with loosening of the hardware, resulting in a second ORIF with bone graft from the 
left hip. Prior to coming on active duty for Operation Enduring Freedom on 13 February 2003, 
the CI’s profile was PULHES 1, noting only a history of controlled hypertension and “Fit for full 
duty.” In a pre-deployment questionnaire on 1 February 2003, the CI stated that he was not in 
a limited duty status and had no medical complaints. A medical note dated 14 March 2003 
notes left forearm pain for one week, stating that the CI had been exempt from push-ups and 
sit-ups, but “does lifting at work.” Examination at this occasion noted mild forearm tenderness, 
no swelling and full range-of-motion (ROM). The CI was returned to CONUS in September 2003 
primarily due to poorly controlled hypertension. Following return to his home base, the CI was 
evaluated in the orthopedic clinic on 20 October 2003 for the MEB. The examiner dictated the 
MEB NARSUM on 31 October 2003 based on this evaluation. At the exam, the CI reported that 
he re-injured his forearm while loading trucks while deployed in February 2003. The CI 
reported stiffness in the forearm and 4/10 pain over the ulnar styloid process (tip of the 
forearm at the wrist) and that the ulnar styloid was “turning upwards.” He reported pain and 
numbness with any use of the arm, and occasionally lost grip when holding items. He stated he 
had numbness in all his fingers, and added that he was unable to do his job “due to his inability 
to feel his left arm while driving.” On examination, the orthopedist noted tenderness at the 
distal forearm and a bony prominence at the ulnar styloid, and a positive Tinel’s sign, indicating 
irritation of the median nerve at the carpal tunnel. No weakness was noted. Wrist extension 
(dorsiflexion) was 47 degrees, wrist flexion 43 degrees, wrist radial deviation 50 degrees, and 
wrist ulnar deviation 45 degrees. Forearm pronation was 90 degrees, and forearm supination 
80 degrees. No VA Compensation and Pension (C&P) exam was performed within 12 months of 
the CI’s separation. 

 

The Board first considered whether the left forearm condition, when considered alone separate 
from the knee condition, was unfitting for continued military service. The Board concluded that 
the evidence in the service treatment record (STR) and the commander’s letter supported a 
conclusion that the left forearm condition standing alone would have caused the CI to be 
referred into the DES and to have been determined to be unfit. The Board then considered its 
rating recommendation for the unfitting left forearm condition at the time of separation. 


Forearm ROM was essentially normal and did not attain a minimum rating under diagnostic 
code 5213. Wrist motion was mildly limited but did not attain a minimum rating under 
diagnostic code 5215. Pain was intermittent, as noted in a 9 January 2004 clinic encounter, 
prior to separation. Motion was adequate, and neurological symptoms were intermittent and 
sensory only. According to the MEB, the patient “has a slight amount of pain occasionally.” 
The Board noted that the VA rated this condition analogously as a pain secondary to a mild 
neuritis of the median nerve (8615). However, neuropathy of the medial nerve would not 
affect all the fingers of the hand, and one would not experience diffuse distal forearm 
tenderness in the setting of median nerve neuropathy. The Board noted the approach by the 
VA for rating was reasonable for the symptoms and disability recorded. Alternatively a 10% 
rating was supportable for painful motion (§4.59) and functional loss (§4.40). However this 
approach would not result in a higher rating and, since it was based on the same impairment, 
two separate ratings are not appropriate (two ratings for the same disability cannot be granted 
in accordance with §4.14 (avoidance of pyramiding). Considering the totality of the evidence 
and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% 
for the left forearm condition, coded 5010-5213 for forearm pain, pain on motion and 
functional loss, is appropriate in this case. 

 

Left Knee Condition. The Board considered whether the left knee pain condition, when 
considered alone separate from the left forearm condition, was unfitting for continued military 
service. The MEB NARSUM notes that, in the same motorcycle accident in 1992, he suffered a 
fracture of the inferior pole of the patella, and required a tendon graft to repair. The CI later 
stated that he had re-injured his knee while pulling chain in January, 2003, prior to deployment, 
and on another occasion, he states it was April, 2003, while deployed. Review of treatment 
records while deployed show no care for or complaint of knee pain. The CI was returned from 
the deployed location due to poorly controlled high blood pressure. The orthopedic MEB 
evaluation on 20 October 2003 recorded a report of left knee pain with use; however, only the 
left forearm was mentioned as duty limiting. The left knee examination noted patellofemoral 
tenderness, and mild limitation of flexion but no swelling or instability. The examiner recorded 
at that time the CI reported slight pain occasionally. The examiner issued an L3 profile based on 
the CI report of pain with use and the condition was included in the MEB referral to the PEB. 
Board members concluded there was no evidence of significant knee impairment prior to 
referral into the DES, and that the knee was not a cause or contributor for the CI’s medical 
evacuation from the deployed location. The Board members concluded that the evidence did 
not show that the left knee condition standing alone would have caused the CI to be referred 
into the DES or be found unfit. 

 

 

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 both the left forearm and the left patellar 
conditions was operant in this case and each condition was adjudicated independently of that 
policy by the Board. In the matter of the left forearm condition, the Board unanimously 
recommends a determination of separately unfit and a separation rating of 10%, coded 5010-
5213, IAW VASRD §4.59. In the matter of left knee pain condition, as combined in the PEB 
adjudication, the Board unanimously agrees that it could not be satisfactorily established as 
independently unfitting and is therefore not ratable for disability. 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 

Chronic Left Forearm Pain 

5010-5213 

10% 

Chronic Left Knee Pain 

Not Unfit 

COMBINED 

10% 



 

 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120614, 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 / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxx, AR20130006028 (PD201201049) 

 

 

1. 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 to modify the individual’s disability rating to 10% 
without recharacterization of the individual’s separation. This decision is final. 

 

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. 

 

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 xxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)