RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201262 SEPARATION DATE: 20020718 

BOARD DATE: 20130321 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (77F10/Petroleum Supply Specialist), 
medically separated for right wrist pain, status-post (s/p) fracture; left foot pain with history of 
a bunionectomy; and asthma. Despite occupational therapy and anti-inflammatory 
medications, she continued to have radial sided wrist pain and left foot pain, and could not be 
adequately rehabilitated to meet the physical requirements of her Military Occupational 
Specialty (MOS) or satisfy physical fitness standards. She was issued a permanent U3/L3 profile 
and referred for a Medical Evaluation Board (MEB). Asthma was added as a diagnosis over 5 
months after she entered into the MEB process; she did not receive a new profile. Glaucoma 
and hypercholesterolemia conditions, identified in the rating chart below, were also identified 
and forwarded by the MEB not disqualifying. The Informal Physical Evaluation Board (IPEB) 
adjudicated the right wrist and left foot pain as one unfitting condition, rated 10%, with 
application of the US Army Physical Disability Agency (USAPDA) pain policy. The remaining 
conditions were determined to be not unfitting or medically acceptable. The CI appealed to the 
Formal PEB (FPEB) which added asthma as an additional unfitting condition rated 10% with 
likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) and was then 
medically separated with 20% disability rating. 

 

 

CI CONTENTION: “The rating should be changed because I was awarded 20 percent for asthma 
and left foot due to a operation the military did while serving. My asthma has gotten worse 
and now hard for me to breathe at night bad therefore placed on a breathing machine for sleep 
apnea (airway restriction). I feel that after the board my condition was not evaluated to its 
fullest potential. I was asked during the course of the interview about my asthma medication in 
which my records reflected from the Army why I needed the medication. However, because of 
not being able to produce my medication at the hearing the findings were evaluated at 20 
percent. There were extreme complications with finding the hospital at that time and upon 
arriving at the appointment my medication was mistakenly left inside my car. I feel that the 
board didn’t take the time to evaluate me properly and evaluate my medical records properly. I 
continue to be on medication for asthma and foot pain from surgery.” 

 

 

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 unfitting right wrist and left foot 
conditions and asthma meet the criteria prescribed in DoDI 6040.44 for Board purview and are 
addressed below. The sleep apnea condition was not considered by the PEB and therefore is 
outside the 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 respective Service Board for Correction of Military Records. The Board has 
neither the 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 her case. 


RATING COMPARISON: 

 

Service FPEB – Dated 20020409 

VA (3 Mos. Pre -Separation) – All Effective Date 20020719 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Rt Wrist/ Lt Foot Pain 

5099-5003 

10% 

Residuals Lt Bunionectomy 

5024-5280 

10% 

20020429 

Residuals Rt Wrist Fracture 

5299-5215 

0% 

20020429 

Asthma 

6602 

10% 

Asthma 

6602 

10% 

20020429 

Glaucoma 

Not Unfitting 

No VA Entry 

Hypercholesterolemia 

Not Unfitting 

No VA Entry 

.No Additional MEB/PEB Entries. 

0% X 3 / Not Service-Connected x 2 

20020429 

Combined: 20% 

Combined: 20% 



*A VARD within a year of DOS increases the combined disability to 30% with the addition of migraine headaches at 10% and no 
changes on above conditions. 

 

 

ANALYSIS SUMMARY: The PEB combined the right wrist and left foot pain conditions under a 
single code, analogous to 5003 (degenerative arthritis) and rated 10%, relying on the USAPDA 
pain policy and possibly AR 635-40 for not applying separately rated VASRD codes. IAW VASRD 
§4.71a, the Board must apply separate codes and ratings in its recommendations if 
compensable ratings for each condition are achieved. When the Board judges that two or more 
separate ratings are possibly warranted in such cases, however, it must satisfy the requirement 
that each ‘unbundled’ condition was unfitting and ratable in and of itself. Thus the Board must 
exercise the prerogative of separate fitness recommendations in this circumstance, with the 
caveat that its recommendations may not produce a lower combined rating than that of the 
PEB. The Board’s analysis and recommendations regarding the separate fitness issue and 
potential separate Service rating for each condition entrained in the PEB’s combined rating 
approach is as follows. 

 

Right Wrist Condition. The CI sustained a right wrist scaphoid fracture on 9 September 1996 
when she fell off of a five-ton truck in Germany. She was treated and placed on a permanent 
U2 profile restricting her from pushups in 1997. She continued to have pain though and 
requested a permanent U3 profile which was issued on 20 June 2001. She was also entered 
into the MEB process. The MEB examination was on 20 August 2001. The examiner 
documented scaphoid tenderness and mild crepitus and tenderness with movement. Full 
range-of-motion (ROM) was documented. The narrative summary (NARSUM) examination was 
on 19 October 2001, 9 months prior to separation. The CI reported persistent radial sided wrist 
pain which had not responded to treatment. On physical examination there was tenderness 
over the right wrist at the snuffbox and dorsal radial aspect of the wrist. Right wrist X-rays 
showed irregularity along the scaphoid tubercle, but nonunion was not present. The examiner 
documented normal dorsal and palmar flexion, but ulnar deviation less than the VA normal 
value and radial deviation greater than the VA normal. However, the examiner noted that 
passive and active ROM was equivalent as was the motion of the unaffected left side. The 
action officer noted that this is consistent with normal ROM. At the VA Compensation and 
Pension (C&P) examination on 29 April 2002, 2 months prior to separation, the CI reported that 
she had returned to full duty shortly after the injury and was not aware of any complications 
(from her wrist) once it healed. The physical examination documented normal movement 
without pain or restriction. The examiner did not observe heat, redness, tenderness, or 
effusion. Right wrist radiographs were normal. The examiner documented “no pathology 
identified.” The Board first considered if the right wrist condition, having been de-coupled from 
the combined PEB adjudication, remained independently unfitting. The Board reviewed the 
upper extremity profiles. The final permanent upper extremity (U3) profile described in the 
NARSUM was issued for no push-ups, no pull-ups, no rope climbing, and no lifting more than 25 
pounds with the right upper extremity. The commander stated the CI could perform as a 
supply clerk, but could not perform her designated MOS as it involved moving heavy 
equipment. All members agreed that the profiled functional limitations in evidence would have 


rendered the CI incapable of continued service within her MOS and, accordingly, justified a 
separate rating. 

 

The Board then directed its attention to the rating recommendation based on the above 
evidence. The Board first considered VASRD diagnostic codes 5099-5003 (rated analogous to 
arthritis). The Board found no evidence of arthritis, painful motion, swelling, or muscle spasm 
for a rating above 0%. The Board also considered the VASRD codes 5299-5215 (rated analogous 
to limitation of motion of the wrist) used by the VA for a 0% adjudication and found no 
evidence in the service record to support a higher rating. After due deliberation, considering all 
of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 
disability rating of 0% for the right wrist condition coded 5099-5003. 

 

Left Foot Condition. The CI presented with a 4 year history of bilateral foot pain in July 2000. 
She was found to have a left hallux abductor valgus (HAV) deformity and an equinus (high arch) 
deformity of the foot. That November, she underwent a left bunionectomy and lengthening of 
the Achilles tendon (AT). She continued to have post-operative pain which did not respond 
adequately to conservative management; she was subsequently entered into the MEB process 
for the left foot condition along with the wrist condition discussed above. The NARSUM 
podiatry addendum was on 19 October 2001, 9 months prior to separation. The CI reported 
that she was unable to progress past walking (to running) and continued to have burning along 
her big toe and tenderness of her AT. She was unable to wear military boots, but was 
comfortable in running shoes. Her profile limited her to walking and bicycling at her own pace 
and distance. The examiner noted painless ROM of the left great toe and ankle. There was 
hypersensitivity of the scar and a positive Tinel’s sign along the medial proper digital nerve 
(indicative of nerve irritation). The AT was hypertrophied. X-rays of the left foot revealed a 
healed first metatarsal osteotomy. A bone scan was suggestive of post-operative and post-
traumatic changes with possible left Achilles Tendinitis. At the C&P examination, the CI 
reported she could walk without limping although she preferred to place most of her weight on 
her right foot. She wore sandals and sneakers as much as possible and avoided military 
footwear. She reported continued pain and tenderness of the left foot, but could “sustain 
heavy physical activities without immediate distress.” She was noted to be obese. The physical 
examination revealed tenderness along the scar of the medial aspect of the foot overlying the 
scar from the bunionectomy of the left big toe, and the area over the Achilles tendon was 
distinctly sensitive. Movement was not compromised, no callouses. X-rays were normal other 
than post-surgical changes. Gait and posture were normal as was visual inspection of the foot. 
The Board first considered if the left foot pain condition was separately unfitting. The MEB 
NARSUM podiatry addendum stated that the CI had been unable to progress in activity past 
walking and was unable to wear military footwear. The profile restricted the CI from running or 
marching and she was only permitted to perform sit ups for physical fitness testing. The 
commander stated that the CI could perform as a supply clerk as long as she was not required 
to stand or bear weight on her feet for prolonged periods. She could not perform her 
designated MOS as it involved moving heavy equipment and prolonged standing. The Board 
determined that the functional limitations from her left foot would have rendered the CI 
incapable of continued service within her MOS and that the left foot condition is separately 
unfitting. 

 

The Board then directed its attention to the rating recommendation based on the above 
evidence. It noted that the majority of clinical visits regarding the left foot were for follow-up 
on the HAV condition in isolation from the AT lengthening. The primary in Garrison duty 
limitation was from prolonged standing and weight bearing, both more consistent with the HAV 
condition than the AT. Neither the MEB nor VA examiners apportioned relative disability 
between the two conditions. IAW VASRD §4.14 (avoidance of pyramiding), evaluation of the 
same disability under multiple diagnoses is to be avoided. The Board considered VASRD 
diagnostic code 5099-5003 (rated analogous to arthritis) used by the PEB. The Board did not 


find any evidence of painful motion, weakness, fatigue, swelling or spasm for a higher than 0% 
adjudication using this diagnostic code. The Board also considered the codes 5024-5280 
(tenosynovitis and unilateral hallux valgus) used by the VA for 10% adjudication and found that 
the CI clearly met the criteria for a 10% rating under code 5280. The Board considered the use 
of codes 7804 for painful, superficial scars and 8799-8724 (neuralgia of the posterior tibial 
nerve), but it is not clear that the scars and neuralgia were separately unfitting. Regardless, 
these also are limited by VASRD §4.14. After due deliberation, considering all of the evidence 
and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 
10% for the left foot condition coded 5280, unilateral hallux valgus. 

 

Asthma Condition. The CI was diagnosed with post-exertional bronchospasm in 1999. 
Although her pulmonary function tests (PFTs) were normal, she was prescribed a 
bronchodilator, Albuterol, to use as needed prior to exercise. At a follow up appointment, it 
was noted that her symptoms persisted even with pre-medication prior to exercise. She was 
evaluated by pulmonology on 26 September 2001 and thought to have a restrictive pattern on 
her PFTs with a normal examination. A Methacholine challenge test, to help diagnose her 
condition, was performed on 4 October 2001, during the MEB process, and showed a marked 
response. On 19 October 2001, the pulmonologist recommended that asthma be added to her 
MEB diagnosis. A pulmonology addendum for the MEB was dictated that day and the CI also 
was prescribed Advair (combination bronchodilator and steroid anti-inflammatory drug). The CI 
reported using Advair on subsequent medical appointments, and at the VA Compensation and 
Pension (C&P) examination. At the C&P examination, the CI reported that in general, she could 
sustain heavy physical activities without immediate distress, with no history of cough, shortness 
of breath, or chest pain. There was a normal lung and respiratory exam. The PFT results are 
noted below. The examiner remarked successful control of acute asthma attacks, and a mild 
reduction in vital lung capacity and rates of airflow under the preventive therapy of Advair. 
There were two PFT exams in evidence, with documentation of additional ratable criteria, 
which the Board weighed in arriving at its rating recommendation; as summarized in the chart 
below. 

 

 

Pulmonary Exam 

MEB ~10 Mo. Pre-Sep 

VA ~2 Mo. Pre-Sep 

FVC (% Predicted) 

67.4% 

78% 

FEV1 (% Predicted) 

69% 

78% 

FEV1/FVC 

89.9% 

86% 

Meds 

No bronchodilator response 

Not significantly changed with 
bronchodilator; On Advair and 
Albuterol 

§4.97 Rating 

30% 

30% 



 

The Board directed its attention to the rating recommendation based on the above evidence. 
Both the PEB and the VA used VASRD code 6602 (bronchial asthma) and rated the condition at 
10%. The Board noted that the FEVs/FVC ratio was normal and that there was no change with 
the use of bronchodilators. Neither is consistent with the diagnosis of asthma. However, the 
MEB forwarded the diagnosis and the PEB rendered the condition unfit rendering this moot. 
There were no documented exacerbations to justify a rating higher than 30%. Using the VASRD 
6602 code, either PFT results of FEV-1 69% of predicted at the MEB or the daily use of steroid 
medications met the 30% rating criteria. After due deliberation, considering all of the evidence 
and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 
30% for the asthma 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 wrist/right foot pain condition was 
operant in this case. These conditions were determined to be separately unfitting and 
adjudicated independently of that policy by the Board. IAW VASRD §4.71a, the Board 
recommends that the right wrist condition be coded 5099-5003 and rated 0%. The left foot 
condition is recommended to be rated at 10% and coded 5280. In the matter of the asthma 
condition, the Board recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97 by a 
vote of 2:1. The single voter for dissent submitted the appended minority opinion. 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 and that the discharge with severance pay be recharacterized to reflect permanent 
disability retirement, effective as of the date of her prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Rt Wrist Condition 

5099-5003 

0% 

Lt Foot Pain 

5280 

10% 

Asthma 

6602 

30% 

COMBINED 

40% 



 

 

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 

 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxx, AR20130011065 (PD201201262) 

 

 

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 reject the Board’s recommendation and accept the Board’s minority opinion as accurate that 
the applicant’s final Physical Evaluation Board disability rating remains unchanged. There is 
insufficient justification to support the Board’s recommendation in accordance with Army and 
Department of Defense regulations. 

 

2. 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 xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards) 

 

 

 


MINORITY OPINION: 

 

The key question to the Board was whether there was reasonable doubt as to the CI’s severity 
based on medication use. The PEB rated the Asthma condition 10% based upon what they 
considered insufficient evidence demonstrating that the CI was actually taking “the daily 
inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication” as 
required by the VASRD code 6602. 

 

A review of the pharmacy records in evidence validates the PEB’s observations. A 30 day supply 
of Advair was dispensed on 19 October 2001. The next time the CI was dispensed Advair was 
over three months later on 25 January 2002. 

 

Based on testimony, objective evidence and the fact the CI did not offer any additional 
evidence to refute the PEB findings, the minority voter believed there is insufficient objective 
evidence even with liberal concession of reasonable doubt to support the majority opinion. It 
was noted that the CI personally appeared at the FPEB with legal counsel and that the CI, in 
fact, actually concurred with the PEB’s findings. 

 

The minority opinion observed that the VA rating official also conferred 10% rating utilizing the 
same evidence before the Board. The VA has maintained this rating through the most current 
VARD dated 7 August 2012. The minority voter believes that there is insufficient objective 
evidence to rate the Asthma condition at 30% based on daily use of medication. In addition, 
the PFTs completed two months prior to separation also support a 10% rating. 

 

The Secretary is respectfully urged to consider the minority recommendation that there be no 
recharacterization of the CI’s disability and separation determination.