RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:   ARMY  
SEPARATION DATE:  20070506 

 
NAME:  XXXXXXXXXXXXXX  
CASE NUMBER:  PD1200335 
BOARD DATE:  20121115 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty,  SGT/E-5,  (52D/Power  Generation  Equipment 
Repairer), medically separated for right wrist (dominant).  The CI fell on his outstretched right 
hand  while  playing  football.    He  was  found  to  have  a  navicular  fracture  and  treated 
conservatively, initially, and then surgically over a 2 year period.  He did not have improvement 
adequate  to  meet  the  physical  requirements  of  his  Military  Occupational  Specialty  (MOS)  or 
satisfy  physical  fitness  standards.    He  was  issued  a  permanent  U3  profile  and  referred  for  a 
Medical  Evaluation  Board  (MEB).    Posttraumatic  stress  disorder  (PTSD),  alcohol  abuse, 
dyslipidemia, headaches, low back pain (LBP), mild high frequency hearing loss (HFHL) of the 
left ear and cervicalgia (neck pain), as identified in the rating chart below, were also identified 
and  forwarded  by  the  MEB  as  medically  acceptable.    The  Physical  Evaluation  Board  (PEB) 
adjudicated the right wrist condition as unfitting, rated 10%, with application of the Veteran’s 
Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition(s) were determined to 
be not unfitting.  The CI made no appeals, and was medically separated with a 10% disability 
rating.   
 
 
CI CONTENTION:  “I was rated 10% by DOD-However the VA rating was 100%.  I wish to have 
my DOD decision reviewed.”   
 
 
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  CI  contended  for  all  conditions 
adjudicated  by  the  PEB.    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:   
 

VA (1 Mos.Post-Separation) – All Effective Date 20070507 

Service IPEB – Dated 20070322 
Condition 

↓No Additional MEB/PEB Entries↓ 

Right wrist(dominant)  
Headaches 
Cervicalgia 
PTSD 
Low back Pain 
Mild HFHL left ear 
Alcohol abuse, episodic 
Dyslipidemia 

Rating 
10% 

Code 
5215 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

Condition 

Right wrist fusion 
Chronic Tension Headaches 
PTSD 
L Spine, DDD 
Left Hearing Loss 
NO VA ENTRY 
NO VA ENTRY 
Tinnitus 

Code 
5214 

8199-8100 

9411 
5243 
6100 

 
 

6260 

Rating 
30% 
10% 
30%* 
0%* 
NSC 

 
 

Exam 

20070606 
20070606 
20070606 
20070606 
20070606 

 
 

10% 

20070606 

Combined:  10% 

0% X 3 / Not Service-Connected x 5 

Combined:  60% 

20070606 

*PTSD increased to 70%; L spine increased to 10%; Total 90% - All effective 20090313 
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.    The  Board  notes  that  the  mere  presence  of  a  diagnosis  at  separation  is  not 
sufficient to render the condition unfitting for duty.  The Board utilizes DVA evidence proximal 
to  separation  in  arriving  at  its  recommendations;  and,  DoDI  6040.44  defines  a  12-month 
interval for special consideration to post-separation evidence.  The Board’s authority as defined 
in DoDI 6044.40, however, resides in evaluating the fairness of DES fitness determinations and 
rating decisions for disability at the time of separation.  Post-separation evidence, therefore, is 
probative only to the extent that it reasonably reflects the disability and fitness implications at 
the time of separation. 
 
Right  Wrist  (dominant)  Condition.    There  were  two  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 chart below.   
 

Right Wrist ROM 

Degrees 

MEB ~4 Mo. Pre-Sep 

VA C&P ~1 Mo. Post-Sep 

 

 

Dorsiflexion (0-70) 
Palmar Flexion (0-80) 
Ulnar Deviation (0-45) 
Radial Deviation (0-20) 

0-10 
0-17 

0 
0 

Comment 

Limited ROM due to fusion 

0 (No extension) 

0-50 (30 after repetition) 

0 (No ulnar deviation) 

0-10 

Add’l loss in motion with 5 
pound weight repetition 

§4.71a Rating 

10% 

10% 

 
The CI fell on his outstretched right (dominant) hand while playing football in 2004.  He was first 
seen for this complaint a month later on 19 April 2004 reporting continued pain.  He was found 
to have a navicular fracture on X-ray and treated with a cast.  The fracture failed to heal and he 
had  an  excision  of  the  fragment  in  October  2004.    His  pain  persisted  and  he  subsequently 
underwent two additional operations in January and July 2006 to fuse some of the wrist bones.  
He was noted to have bony fusion on post-operative CT scan, but with some bony fragments 
present  also.    No  post-operative  complications  were  noted.    His  pain  still  persisted  despite 
aggressive pain management.  The pain and the reduced ROM impaired duty.  At the MEB exam 
performed on 18 January 2007, 4 months prior to separation, the CI reported that he had lost 
motion,  used  a  brace  and  had  a  TENS  (transcutaneous  electrical  nerve  stimulation)  unit  for 
pain.    The  MEB  physical  exam  noted  decreased  ROM  of  the  right  wrist,  reduced  rapid 
movement  and  decreased  strength  at  4/5.    The  narrative  summary  (NARSUM)  was  dictated  

9 March 2007, 2 months prior to separation.  The CI reported constant wrist pain at a level of 
4/10.  He denied any other sensory symptoms.  The pain was aggravated by sit-ups, push-ups, 
lifting more than two pound or any “jarring” activities including fast walking.  He was unable to 
work as a mechanic.  His symptoms were improved with rest and the TENS unit.  He had been 
started on a Lidoderm patch as well.  It was noted that he had had a prior right hand fracture in 
1995, prior to service.  On examination, he was found to have well-healed, non-tender scars 
from the surgical procedures.  Sensation was normal, but he was tender to palpation over the 
radial aspect of the right wrist.  There was no effusion.  A test for median nerve compression 
was negative.  Strength was reduced in both flexion and extension at 4+/5.  Although the CI 
wanted  to  remain  on  active  duty,  his  commander  noted  that  the  CI  could  not  meet  the 
requirements of either his MOS or physical fitness standards secondary to his wrist.  Otherwise, 
he noted that his duty performance had been superb.  At the VA Compensation and Pension 
(C&P) examination, the CI reported that he treated the pain with a brace, Lidoderm patch and 
TENS  unit.    He  was  unable  to  use  his  wrist  for  any  type  of  work  or  activity  because  of  the 
discomfort that it caused.  On examination, there was no heat, swelling or redness suggestive of 
inflammation.  The ROM is above.  There was no loss of motion with repetitive motion while 
holding a one pound weight, but flexion was reduced to 30 degrees after three repetitions with 
a five pound weight.  Sensation and strength were noted to be normal.  The scars were well 
healed.    The  Board  directs  attention  to  its  rating  recommendation  based  on  the  above 
evidence.  The PEB coded the right wrist as 5215, limited motion, and rated it at 10%.  The VA 
coded the wrist 5214, ankylosis of the wrist, and rated it at 30%.  The Board considered both 
coding options.  It noted that while the CI did have limitations in ROM and pain, the wrist was 
not ankylosed.  Several bones in the wrist were fused together, but motion remained.  In the 
absence  of  complete  fusion  of  the  wrist,  the  use  of  this  code  for  either  a  favorable  or 
unfavorable limitation cannot be supported.  The Board also considered the use of 5125, loss of 
use of the hand, but the level of disability did not support this.  The Board then considered the 
use  of  code  5010  for  traumatic  arthritis.    The  Board  determined  that  the  limitations  in  use 
secondary to pain and limitations in motion supported the criteria of “occasional incapacitating 
exacerbations.”    The  Board  considered  if  the  level  of  disability  was  sufficient  for  an  extra-
scheduler evaluation of 30% under a 5010-5214 coding option, but the majority of the Board 
found that it did not.  After due deliberation, considering all of the evidence and mindful of 
VASRD  §4.3  (reasonable  doubt),  4.40  (loss  of  function)  and  4.45  (the  joints),  the  Board 
recommends a disability rating of 20% for the right wrist condition, coded 5010.   
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were PTSD, alcohol abuse, dyslipidemia, headaches, LBP, mild HFHL and cervicalgia (neck pain).  
The  Board’s  first  charge  with  respect  to  these  conditions 
is  an  assessment  of  the 
appropriateness of the PEB’s fitness adjudications.  The Board’s threshold for countering fitness 
determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating 
recommendations,  but  remains  adherent to  the  DoDI  6040.44  “fair  and  equitable”  standard.  
There  were  no  records  in  evidence  detailing  treatment  for  PTSD.    The  MEB  psychiatric 
evaluation performed on 14 February 2007, 3 months prior to separation, noted that the CI had 
been seen in mental health one time in 2005 and had two follow-up telephone consultations in 
Oct 2005 and April 2006.  The CI reported that he could deploy again were it not for his wrist.  
He was determined to have minimal impairment for military duty.  The commander noted on 
19 January 2007, 4 months prior to separation, that the duty performance of the CI was superb 
and only noted the wrist as duty limiting.  No profile was noted for the PTSD condition and the 
MEB found it to be medically acceptable.  Uncomplicated alcohol abuse is not ratable IAW DoDI 
1332.28 E5.  In addition, there is evidence in the record that the CI has problems with alcohol 
prior to enlistment.  Dyslipidemia is a laboratory finding and not a diagnosis.  It is not ratable.  
There were several notes in the record regarding the headaches which apparently developed 

during withdrawal from narcotic analgesics.  The NARSUM noted that these had not interfered 
with  functioning  and  that  he  had  not  been  given  a  permanent  profile  for  them.    The 
commander’s  letter  was  silent  for  headaches.    The  MEB  determined  the  headaches  to  be 
medically acceptable.  There are no records in evidence indicating that the CI was treated for 
LBP.  He was seen in 2003 for lower extremity numbness and weakness diagnosed as a peroneal 
neuropathy.  The CI did annotate on the separation history that he had had a MRI for LBP and 
the C&P examiner noted that there was mild bulging of the discs at L4-5 without nerve root 
impingement.  The commander did not comment on the back, there was no profile for the back 
and the MEB found the back condition to meet retention standards.  The VA determined the 
LBP to be non-compensable.  Service records do document a HFHL in the left ear.  The hearing 
loss was not profiled by the Army and was determined by the VA to be within VA normal limits.  
There is no indication of duty impairment and it was determined to meet retention status.  The 
CI had a MRI of the cervical spine performed on 13 October 2006 to evaluate leg weakness.  It 
showed potential disk desiccation at C3-4, but was otherwise unremarkable.  There are no visits 
for neck pain in the records in evidence.  The NARSUM documented that the CI was seen for 
localized  left  sided  neck  pain  and  treated  by  a  chiropractor.    The  neck  pain  was  noted  as 
meeting  retention  standards  and  was  not  profiled.    The  VA  determined  the  neck  pain  to  be 
related to the headaches and not a separate condition.  None of these conditions were profiled; 
none were implicated in the commander’s statement; and, none were judged to fail retention 
standards.  All were reviewed and considered by the Board.  There was no indication from the 
record that any of these conditions significantly interfered with satisfactory duty performance.  
After  due  deliberation  in  consideration  of  the  preponderance  of  the  evidence,  the  Board 
concluded  that  there  was  insufficient  cause  to  recommend  a  change  in  the  PEB  fitness 
determination for the any of the contended conditions and, therefore, no additional disability 
ratings can be recommended. 
 
 
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 right wrist condition, the Board recommends, by a 2:1 
vote, a disability rating of 20%, coded 5010 IAW VASRD §4.71a.  The single voter for dissent 
(who  recommended  using  the  codes  5010-5214  at  a  30%  disability  rating)  submitted  the 
appended  minority  opinion.    In  the  matter  of  the  contended  alcohol  abuse,  dyslipidemia, 
headaches, LBP, mild HFHL and cervicalgia conditions, the Board unanimously recommends no 
change from the PEB determinations as not unfitting.  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 
Limited Motion of the Right (Dominant) Wrist 

 
 
The following documentary evidence was considered: 
 

VASRD CODE  RATING 

20% 
20% 

5010 

COMBINED 

           MICHAEL F. LoGRANDE, DAF 
           President 
           Physical Disability Board of Review 

Exhibit A.  DD Form 294, dated 20120327, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
MINORITY  OPINION:    The  CI’s  right  wrist  (dominant)  condition  exceeded  the  disability  level 
adjudicated  by  the  PEB.    In  assessing  the  CI’s  level  of  permanent  disability  at  separation,  I 
believe  it  more  closely  approximates  a  30%  rating  (vs.  the  20%  rating  recommended  by  the 
majority).  The challenge in this case is to marry the clinical and functional picture of this CI at 
time  of  separation  with  an  appropriate  and  fully  descriptive  disability  rating  level  per  the 
VASRD.   
 
The VA used the rating code 5214, while deviating from a strict definition of ankylosis (frozen 
joint).  Evidence in the record shows the CI’s right wrist was ankylosed in dorsiflexion (that is, 
restricted  motion  for  dorsiflexion  was  functionally  equivalent  to  favorable  ankylosis)  with 
palmar flexion significantly degraded as well as limited range of radial deviation (and in fact, 
multiple  bones  in  his  wrist  were  surgically  fused).    In  fact,  one  could  argue  that  the  CI’s 
remaining ROM was in the unfavorable direction.  The Board surmised the PEB justifiably used 
the VA rating criteria under code 5215 to describe limited motion in this case.  However, the 
Board also surmised that the CI’s complete disability picture (mindful of criteria under 4.40 and 
4.45 of 38CFR part IV) was not fully described by the PEB (perhaps as a function of the PEB’s self 
imposed  limitation  of  strict  adherence  to  rating  criteria  under  5215).    In  reaching  a  20% 
disability “picture” of this CI, the Board determined that evidence clearly showed the CI to have 
“occasional  incapacitating  exacerbations”  of  his  minor  joint  (wrist).  Therefore  using  these 
criteria under VA rating code 5003 is supported by the evidence. 

However,  unlike  the  MEB  examiner  (approximately  4  months  pre-separation),  the  C&P 
examiner  (1  month  post-separation)  included  a  functional  assessment  of  the  CI’s  right 
dominant  wrist  with  light  weights  (accounting  for  DeLuca  criteria).    This  exam  clearly 
demonstrated  significant  functional  loss  of  the  CI’s  dominant  right  wrist.    Further,  the  CI’s 
commanding officer described a soldier who experienced a severe functional disability due to 
his wrist.  In his performance statement, CPT ----- stated: “the Soldier cannot lift more than 2 
pounds  with  his  right  hand…he  can't  run,  can't  jump,  no  push-ups,  no  sit-ups,  can't  carry  a 
weapon, and can't ruck march…he cannot grip or twist tools to fix generators… he cannot do 
anything that requires repetitive motion with his right hand (with emphasis)…he has lost the 
fine motor skills in his right hand..he cannot crawl because it puts too much pressure on his 
right hand…he is unable to lift anything with his right hand…his pain level at rest is 4 out of 
10...when he lifts, grasps, twists, or uses his fine motor skills his  pain level is 8 out of 10.”  The 
CI was issued a U4 profile and was severely restricted in his activities (limited to walking at his 
own  pace).    Clearly,  the  degree  of  functional  loss  in  the  CI’s  right  (dominant  wrist)  had  a 
significant impact on his overall level of functioning. 

Using  the  VA  rating  code  5003  as  the  Board  did  in  this  case,  does  not  fully  account  for  the 
severity of the CI’s functional loss.  In addition, as used in this case, the 5003 code requires a 

“minor joint” be affected.  The CI’s condition affected his right wrist (a minor joint) but it bears 
noting the CI was right hand dominant and this degree of additional impairment isn’t captured 
under the 5003 code in this case.  I believe it is fully supportable by the evidence and justice 
requires the Board to use an extra-schedular rating (per 38CFR 3.321 (b) which more closely 
approximates the CI’s actual level of disability and industrial impairment at time of separation.  
Under the proposed extra-schedular coding below, VA code 5010 accounts for the precipitating 
trauma and follow on disease process after multiple surgeries to the CI’s permanently disabled 
right (dominant) wrist, while VA code 5214 allows the Board to accurately account for the CI’s 
overall level of functional impairment.   

In considering this alternate recommendation, I call attention to several governing regulations 
under 38CFR.  Section 4.7 of the VASRD states:  “Where there is a question as to which of two 
evaluations shall be applied, the higher evaluation will be assigned if the disability picture more 
nearly approximates the criteria required for that rating.  Otherwise, the lower rating will be 
assigned.”    Also,  section  4.21  states:  “In  view  of  the  number  of  atypical  instances  it  is  not 
expected, especially with the more fully described grades of disabilities, that all cases will show 
all  the  findings  specified.    Findings  sufficiently  characteristic  to  identify  the  disease  and  the 
disability there from, and above all, coordination of rating with impairment of function (with 
emphasis)  will,  however,  be  expected  in  all  instances.”    In  addition,  under  section  4.69,  the 
VASRD  explicitly  accounts  for  the  “dominant  hand”  in  assessing  a  given  level  of  disability.  
Finally as stated above, 38 CFR 3.321 (b) makes allowance for exceptional cases:   “where the 
schedular  evaluations  are  found  to be  inadequate…The  governing  norm  in  these  exceptional 
cases is: A finding that the case presents such an exceptional or unusual disability picture with 
such  related  factors  as  marked  interference  with  employment…to  render  impractical  the 
application of the regular schedular standards.” 

RECOMMENDATION: 
 
As  the  minority  voter,  I  recommend  recharacterization  of  the  CI’s  disability  and  separation 
determination, as follows: 
 

 

 

 

 

UNFITTING CONDITION 

Arthritis, Traumatic Rated Extra-Schedular as Wrist, Ankylosis 
of: Favorable (Major Hand) 

VASRD CODE 
5010-5214 
COMBINED 

RATING 

30% 
30% 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

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 XXXXXXXXXXXXXXXXXXX, AR20120021208 (PD201200335) 
 
 
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 20% 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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)