RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201760 SEPARATION DATE: 20020918 

BOARD DATE: 20130123 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (11B/Infantry), medically separated for 
chronic painful right thumb joint. The CI injured his right thumb in hand-to-hand combat 
training in September 2001. After 4 months of occupational therapy, the CI did not improve 
and the right thumb joint condition could not be adequately rehabilitated for him to meet the 
physical requirements of his Military Occupational Specialty or satisfy physical fitness 
standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board 
(MEB). Healing (left) ankle fracture and benign electrocardiogram (EKG) findings of (right) 
ventricular conduction delay, identified in the rating chart below, were also identified and 
forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated the chronic painful 
right thumb joint condition as unfitting, rated 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: “Continued chronic discomfort in right knee after performed surgery. Also 
continued chronic discomfort in right thumb. Surgery was performed on my right knee for a 
torn meniscus that had been previously misdiagnosed, after surgery I had chronic discomfort 
and @ 14cc of fluid was drained from the back of my knee, I still experience chronic discomfort 
when running or walking long distances and swelling still occurs in the back of my knee. It is 
very painful to touch the swollen area or even put ice on it. My right thumb gets stiff and hard 
to hold items in my right hand. Always aches, sometimes painful to move.” 

 

 

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 chronic painful right thumb condition 
as requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board 
purview; and, is addressed below. The not unfitting healing left ankle fracture and EKG findings 
are not requested and will thus not be discussed. The right knee condition requested for 
consideration and the remaining conditions rated by the VA at separation and listed on the DD 
Form 294 are 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 Army Board for the Correction of Military Records. 

 

 

 

 

 

 

 

 


RATING COMPARISON: 

 

Service IPEB – Dated 20020805 

VA (At Separation) – All Effective Date 20020919 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Painful Right 
Thumb Joint 

5099-5003 

0% 

Right Thumb, Posttraumatic 
Ulnar Collateral Ligament 
Surgical Repair 

5228 

0% 

20020910 

Healing (Left) Ankle 
Fracture 

Not Unfitting 

Left Ankle Distal Tibia Linear 
Fracture… 

5271 

10% 

20020910 

Benign Electrocardiogram 
Findings of (Right) 
Ventricular Conduction 
Delay 

Not Unfitting 

Asymptomatic Right Bundle 
Branch Block, Right Ventricular 
Conduction Delay… 

7005 

NSC 

20020910 

.No Additional MEB/PEB Entries. 

Right Knee Retropatellar Pain 
Syndrome 

5099-5024 

10% 

20020910 

Not Service-Connected x 1 

20020910 

Combined: 0% 

Combined: 20% 



 

 

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. While the 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 DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or potential complications of conditions resulting in medical separation nor for conditions 
determined to be service-connected by the Department of Veterans Affairs (DVA) but not 
determined to be unfitting by the PEB. However, the DVA, operating under a different set of 
laws (Title 38, United States Code), 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. 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. 

 

Chronic Painful Right Thumb Joint Condition. The CI suffered a dislocation of his right 
(dominant) thumb with rupture of the ulnar-collateral ligament in 2001 (the so called 
gamekeeper’s thumb). This was successfully repaired in October 2001 with a resultant stable 
hand and thumb condition. Despite rehabilitation, intermittent, persistent pain developed at 
the surgical site. At the MEB narrative summary (NARSUM) exam, 18 July 2002, 2 months 
before separation, the CI reported reduced grip strength secondary to pain without instability, 
numbness, tingling or radicular pain in the hand. On physical exam, minimal tenderness was 
present at the base on the right thumb. The thumb joint was stable and the surgical repair 
intact. Range-of-motion (ROM) at the thumb joint was normal with full opposition of the 
thumb to the base of the fifth digit. Pinch and grip strength were decreased in the right hand 
compared to the left secondary to pain. At the VA Compensation and Pension (C&P) exam, 
19 September 2002, a month before separation, CI noted pain with gripping. On examination, 
ROM at the thumb was normal, the surgical repair intact, and the thumb joint stable. Motor 
strength at the thumb was slightly reduced to 4/5. The Board directs attention to its rating 
recommendation based on the above evidence. The Board noted the CI to be right hand 
dominant. The PEB and VA both rated the condition 0% using different codes. The PEB rated 
using the Army pain policy noting the pain to be moderate and occasional. The VA rated under 
code 5228, thumb, limitation of motion, citing normal ROM. A rating of 10% would require a 
gap of one to two inches on opposition, not supported by the record in evidence. The Board 
unanimously agreed that the thumb after repair was stable with no motor, sensory or joint 
dysfunction. The Board agreed that the thumb was non compensable under motion codes 
5224 and 5228. The Board noted the decreased grip and pinch secondary to pain and agreed 
that §4.59 was applicable and supported a disability rating of 10%. The Board found no 


pathway to higher rating under any applicable VASRD code. 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 thumb 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 thumb was operant in this case and the condition 
was adjudicated independently of that policy by the Board. In the matter of the thumb 
condition, the Board unanimously recommends a disability rating of 10%, coded 5010-5003 
IAW VASRD §4.59. 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 

Painful Right Thumb Joint 

5010-5003 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120929, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for XXXXXXXXXXXXXXXX, AR20130006091 (PD201201760) 

 

 

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 XXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)