RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201236 SEPARATION DATE: 20040302 

BOARD DATE: 20130307 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a National Guard SPC/E-4 (62B10/Mechanic), medically separated 
for rheumatoid arthritis (RA). The RA condition could not be adequately treated to allow her to 
meet the physical requirements of her Military Occupational Specialty (MOS), including 
deployment, or satisfy physical fitness standards. She was issued a permanent P3/U3/L3 profile 
and referred for a Medical Evaluation Board (MEB). The MEB also forwarded hypertension, 
identified in the rating chart below, but as a medically acceptable condition. The Physical 
Evaluation Board (PEB) adjudicated the RA condition as unfitting, rated 20%, with application of 
the Veterans Affairs Schedule for Rating Disabilities (VASRD). The hypertension was 
determined to be not unfitting and not ratable. The CI made no appeals and was medically 
separated with a 20% disability rating. 

 

 

CI CONTENTION: The CI elaborated no specific contention in her application. 

 

 

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. 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: 

 

Service PEB – Dated 20031112 

VA ( 2Mos. Post-Separation) – All Effective Date 20040303 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Rheumatoid Arthritis 

5002 

20% 

Rheumatoid Arthritis 

5002 

20%* 

20040511 

Hypertension 

Not Unfitting 

Hypertension 

NSC 

 

Combined: 20% 

Combined: 20% 



*VARD 20040902 40% effective 20040303; 60% effective 20080729 

 

 

ANALYSIS SUMMARY: The CI developed bilateral knee joint pain while awaiting deployment in 
April 2003, but improved with treatment and was cleared to deploy. During deployment she 
developed recurrent symptoms and further joint involvement in her hands, and elbows. She 
was air evacuated to Landstuhl, Germany where she was diagnosed with RA. She was then 
returned to her home station for further treatment and evaluation. Her physical profile 
restricted her from running. The profile also noted the need for regular follow-up 
appointments to monitor medication side-effects and status of disease progression, preventing 
deployment. Her commander’s statement stated that her physical impairments prevented the 
fulfillment of the requirements of her MOS. 

 

Rheumatoid Arthritis Condition. At a rheumatological consultation on 25 August 2003, 
6 months prior to separation, the examiner noted that the CI had widespread inflammatory 


arthritis which had started 5 months earlier. She reported joint swelling, morning stiffness, and 
sleep disruption. She had been primarily treated with Prednisone, non-steroidal anti-
inflammatory drugs and Enbrel, a disease modifying drug, with improvement in her symptoms. 
She denied recent joint swelling, but continued to have occasional interruptions in her sleep 
from pain. Fatigue was moderate and morning stiffness persisted for about an hour. However, 
her appetite remained good and her weight was stable. She denied systemic manifestations 
such as fever, oral ulcers or skin rash. She appeared healthy and alert. On examination, she 
had a slight limp favoring the left knee. Some synovitis was noted in the finger joints bilaterally 
and her grip strength was reduced at 5-/5. There was also reduced and painful range-of-motion 
(ROM) of the right wrist with trace swelling. No rheumatoid nodules or subluxations were 
present. X-rays of the hand were normal. Her examination was otherwise unremarkable. It 
was noted that she was a month into treatment with the Enbrel with a partial response, but 
that it was too early to determine the effectiveness of the drug. Laboratory markers for RA 
were positive. The narrative summary dictated on 5 September 2003, 2 weeks after the above 
appointment. The CI endorsed improvement in symptoms although it is not clear if this is from 
initiation of therapy or since the previous visits. She reported minimal hand and knee pain with 
palpation and swelling and used Naprosyn to control the pain. On examination, there was full 
ROM noted with mild tenderness over the wrist joints, without edema or swelling, and lower 
extremities, again without swelling. No anemia was present on testing. The examiner noted 
that she could not do significant lifting, could not deploy on her medications and that her 
disease was progressive. The VA Compensation and Pension (C&P) exam was accomplished on 
11 May 2004, 2 months after separation. The medication regimen had changed to 
Methotrexate and Imuran starting the previous fall. The CI complained that her shoulders, 
elbows, wrists, hands, knees, ankles, and feet joints were particularly painful on the day of 
exam. She reported that it was difficult for her to take care of the activities of daily living due 
to pain. Her husband assisted her with dressing, bathing, housework, cooking, and driving. 
However, she was gainfully employed, but had an understanding employer. The CI ambulated 
very slowly with obvious pain with a cautious gait. The examiner remarked she was in obvious 
pain in walking and movement of upper extremities; assisting herself with both arms into the 
exam chair as well as rising and sitting although she did not use an assistive device. The 
examiner noted swelling and tenderness of wrists as well as hands, knees, ankles, feet, and 
decreased strength testing, (2/5) due to extremely painful joint movement. The diagnosis was 
RA, active. Per the 2 September 2004, VA rating decision (VARD), the CI was seen on 4 August 
2004 in a VA rheumatology clinic. Enbrel was being discontinued and Humira started. The 
examiner noted that there was no evidence of synovitis in any joint and that there were no 
deformities. The examiner also noted that the records showed that the symptoms were out of 
proportion to objective findings and negative for systemic manifestations of RA such as weight 
loss and anemia. The Board noted that despite this, the VA increased the disability rating from 
20% to 40%. At a later VARD on 1 December 2006, the rater noted she had been examined on 
13 November 2006 and that she continued to have pain, but no anemia or weight loss and was 
working full time as a welder, the civilian job she had prior to activation, although the job “has 
become difficult for her.” The Board directed its attention to the rating recommendation based 
on the above evidence. The PEB and VA both coded the RA as 5002 (arthritis rheumatoid) and 
rated it 20% using the service treatment records (STRs). The CI appealed the VARD; and was 
awarded a 40% disability rating based on the 11 May 2004 C&P. The Board first considered if 
there was evidence of constitutional manifestations associated with active joint involvement 
which would support a rating higher than the 40% adjudicated by the VA. The Board noted the 
CI continued working as a welder after separation and it did not find any evidence of anemia, 
weight loss or severely incapacitating exacerbations to support a higher rating. The Board then 
considered a 40% rating. The Board could not find evidence in the clinical record of symptom 
combinations productive of definite impairment of health objectively supported by examination 
findings or incapacitating exacerbations occurring three or more times a year to support a 40% 
rating. It noted that the VARD, which awarded the 40% rating, documented that the severity of 
the CI’s symptoms was not supported by objective findings. The Board considered the 


 

 

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 RA 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 

Rheumatoid Arthritis 

5002 

20% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120618, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXXXXX, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxx, AR20130009614 (PD201201236) 

 

 

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 xxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)