RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

SEPARATION DATE:  20050511 

 
NAME:  XXXXXXXXXXXXX                                                                         BRANCH OF SERVICE: ARMY  
CASE NUMBER:  PD1200232 
BOARD DATE:  20121022 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SGT/E-5 (88M/Truck Driver), medically separated for 
chronic left upper extremity pain and weakness secondary to shrapnel injury.  The CI sustained 
shrapnel injury to left upper arm from an IED attack in Iraq in September 2003.  A chronic left 
upper  extremity  pain  and  weakness  condition  developed  and  could  not  be  adequately 
rehabilitated  with  treatment  to  meet  the  physical  requirements  of  his  Military  Occupational 
Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 profile and 
referred for a Medical Evaluation Board (MEB).  The MEB forwarded no other conditions for 
Physical  Evaluation  Board  (PEB)  adjudication.    The  PEB  adjudicated  the  chronic  left  upper 
extremity pain and weakness condition as unfitting, rated 0%, with application of the Veteran’s 
Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically 
separated with a 0% disability rating. 
 
 
CI CONTENTION:  “Service member received a rating of 0% for injuries he suffered from an IED 
explosion on active duty during OIF1 Sep 2003.  Service member was not evaluated for PTSD 
and TBI during his separation from the military.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department  of  Defense  Instruction  (DoDI)  6040.44  (4.a)  is  limited  to  those  conditions  which 
were  determined  by  the  PEB  to  be  specifically  unfitting  for  continued  military  service;  and, 
when requested by the CI, those condition(s) “identified but not determined to be unfitting by 
the PEB.”  The unfitting chronic left upper extremity pain and weakness condition meets the 
criteria  prescribed  in  DoDI  6040.44  for  Board  purview;  and,  is  addressed  below.    Other 
requested conditions, posttraumatic stress disorder and traumatic brain injury 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 Correction of Military Records. 
 
 
RATING COMPARISON:   
 

Service IPEB – Dated 20050216 
Condition 

Code 

Rating 

VA (4 Mos. Post-Separation) – All Effective Date 20050512 

Code 

Rating 

Exam 

Chronic Left Upper 
Extremity Pain and 
Weakness Secondary to 
Shrapnel Injury 

5303 

0% 

↓No Additional MEB/PEB Entries↓ 

Condition 

Residuals of Shrapnel Wound to 
the Left Arm and Hand to 
Include Scarring with 
Complaints of Loss of Sensation 
and Weakness 
Left Shoulder Condition with 
Weakness and Loss of Strength 
Tinnitus 

7804-8516 

10% 

20050915  

0% X 2 / Not Service-Connected x 4 

5201 
6260 

0% 
10% 

20050915 
20051027 
20050915 

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  Left  Upper  Extremity  Pain  and  Weakness.  The  CI  sustained  shrapnel  wounds  and 
abrasions to the left upper arm and forearm from an IED attack in Iraq in 2003.  Wounds were 
superficial  and  debrided  without  closure  in  the  emergency  department.    X-rays  identified  a 
small foreign body near the biceps muscle and some small bits of fragment in the mid forearm 
but no bone injury.  The foreign body was subsequently removed through a small incision and 
the  wounds, primarily  closed  with  six  sutures.  Postoperatively  the  wounds  healed  but the  CI 
developed symptoms of pain and weakness in the wrist, elbow and, left shoulder.  On a clinic 
visit performed on 4 April 2004, the CI first reported pain in the shoulder when lifting the arm 
over his head.  Routine X-rays of the shoulder and wrists were normal.  Magnetic resonance 
imaging  (MRI)  of  the  shoulder  performed  in  May  2006,  revealed  only  some  degenerative 
disease in the left AC joint area.  A neurology exam performed on 20 July 2004, 3 months prior 
to the MEB, motor strength of all muscles of the left and  right shoulders, elbows and wrists 
were  5/5.    Sensory  and  reflex  examinations  were  normal.    Electromyelogram  (EMG)  studies, 
performed on 24 June 2004, were reported to identify no nerve injury.  There were multiple 
goniometric range-of-motion (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.   
 

Left Elbow  
(Degrees) 

Flexion (Normal 145) 

Extension( 145) 

Comment 

§4.71a Rating 

Left Wrist  
(Degrees) 

Dorsiflexion (Normal 70) 

Palmar Flexion (80) 

Comment 

§4.71a Rating 

Left Shoulder  

(Degrees) 

 

 

MEB 7 Mo. Pre-Sep 

(20041022) 
130 (RT 137) 
130 (RT 137) 

 C&P 4 Mo. Post-Sep 

(20050915)  

Full 
Full 

Complete AROM attained;  No painful ROM  

No painful motion 

0% 

0% 

MEB ~7 Mo. Pre-Sep 

(20041022) 

60 
65 

No painful ROM 

0% 

MEB 5 Mo. Pre-Sep 

(20050111) 

VA C&P ~4 Mo. Post-Sep 

(20050915)  

Full 
Full 

No painful motion 

0% 

 C&P 4 Mo. Post-Sep 

(20050915)   

Flexion (180) 

Abduction (180) 

175  
180  

180 
180 

No painful motion; No change with repetition 

No painful motion repetition; 

Comments 
§4.71a Rating 

0 % 

0% 

At  the  MEB/narrative  summary  (NARSUM)  evaluation  performed  on  10  October  2004, 
5 months before separation, the CI reported numbness and tingling in the left arm and hand 
and  chronic  pain  in  the  left  arm  and  shoulder  and  he  was  unable  to  do  pushups.    The  MEB 
physical exam noted focal tenderness over the left shoulder joint.  ROM examinations for all 
joints  of  the  left  arm  were  slightly  reduced  as  noted  above.    Sensory  exam  was  normal  and 
motor  strength  4-5/5.    At  the  VA  Compensation  and  Pension  (C&P)  exam  performed  on 
15 September 2005, 4 months after separation, the CI reported no arm pain and pain in the 
shoulder on only when raising arm above shoulder level.  He noted that the he was a full time 
student  and  the  arm  condition  did  not  affect  his  daily  activities.  Results  of  the  physical 
examination are noted above.  There was no painful ROM or limitation of ROM for any joint.  A 
small area of numbness, 4 by 2 cm, was noted on the left forearm adjacent to a small scar.  The 
neurologic exam, including sensation in this area, was normal.  The Board directs attention to 
its rating recommendation based on the above evidence.  The Board notes the CI to be right 
hand dominant.  The PEB rated the left upper extremity condition 0% code 5303, muscle group 
III  (shoulder  girdle)  slight,  citing  slightly  weakened  upper  extremity  motor  strength.    The  VA 
separated the arm into two components rating: the forearm rated 10% using code 7804-8516, 
citing scars and slight cutaneous numbness and the shoulder, rated 0% using code 5201 citing 
history  of  subjective  pain  with  movement  of  the  arm  to  shoulder  level  not  shown  on 
examination.  The Board reviewed the rating by the PEB.  The Board noted the CI to reference 
difficulties with the shoulder, elbow and forearm and the PEB to combine these and rate as a 
single unfitting condition.  Not uncommonly 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 
may unbundle for individual rating but, in that circumstance, must maintain the prerogative of 
separate fitness recommendations, with the caveat that its recommendations may not produce 
a lower combined rating than that of the PEB.  The Board first addressed the fitness of each 
individual left upper extremity region affected by the shrapnel wounds.  The Board noted the 
unfitting inability of the CI to carry or fire a weapon, carry a fighting load at least two miles, 
construct individual fighting, don or wear chemical defense equipment or perform other duties 
required of a soldier in his grade and MOS.  The Board noted that the functions of the arm are 
complexly integrated in the performance of these duties and was unable to ascertain from the 
service record any specific anatomic arm location or function that was individually unfitting.   
 
The Board unanimously agreed that individually, the shoulder, forearm and wrist impairments 
were non-compensable under §4.71a, and §4.59 given slight reductions in ROM without pain 
and  normal  strength  on  proximate  examinations.    The  Board  considered  rating  each  under 
§4.56,  (evaluation  of  muscle  disability),  but no rating higher  than  0%,  slight,  was  achievable.  
The Board noted that the residual scars were small, stable not tender and therefore were not 
unfitting for military duty and therefore not subject to rating.  There was no evidence of ratable 
peripheral  nerve 
in  this  case,  since  no  motor  weakness  was  present, 
electrodiagnostic studies were negative for a nerve impairment and sensory symptoms had no 
functional implication.  After due deliberation, considering all of the evidence and mindful of 
VASRD  §4.3  (reasonable  doubt),  the  Board  concluded  that  there  was  insufficient  cause  to 
recommend a change in the PEB adjudication for the left arm condition.  
 
 

impairment 

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.  In the matter of the left 
arm condition and IAW VASRD §4.73, 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:   
 

VASRD CODE  RATING 

5303 

0% 

UNFITTING CONDITION 

Chronic Left Upper Extremity Pain and Weakness…. 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120305, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXX, AR20120020579 (PD201200232) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 

     XXXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)