RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20011230 

 
NAME:  XXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200773 
BOARD DATE:  20130205 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SPC/E-4  (14R1O/LOS-F-H  Crewmember),  medically 
separated for  chronic  post-surgical  facial pain.   The  CI  has  a history  of  chronic  right  jaw  and 
right ear pain since 1998 due to a large mass.  The CI had a series of jaw procedures over the 
course of the next 2 years, but the chronic right jaw pain condition could not be adequately 
rehabilitated.    The  CI  did  not  improve  adequately  with  treatment  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).  The MEB 
forwarded  no  other  conditions  for  Physical  Evaluation  Board  (PEB)  adjudication.    The  PEB 
adjudicated  the  chronic  post  surgical  facial  pain  condition  as  unfitting,  rated  10%,  with 
application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no 
appeals, and was medically separated with a 10% disability rating.   
 
 
CI CONTENTION:  “I was rated for pain only to keep it at 10%.  When I contested it I was told I 
would be put out with 0% or I could settle for the 10%.  No other injuries or illness’s (sic) were 
even considered.  I suffered loss of teeth, loss of jaw bone, ongoing dental problems along with 
debilitating headaches.  Other items that should have been considered was an ongoing back 
injury from  an  accident in  1993  at  Ft.  Stewart  GA,  an  ongoing  stomach and breathing  issues 
from  the  combat  in  Desert  Storm.    The  inability  to  work  due  to  the  high  dose  of  narcotic 
medication for facial pain.  Since I was not retired or given a higher rating I was not able to have 
the facial surgery followed for at least 10 years which is what I was instructed to do.  VA will not 
look at dental due to my 80% disability.” 
 
 
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 other requested conditions by the CI 
and  rated  by  the  VA  at  separation  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. 
 
 
 
 
 
 
 
 
 
 
 

Code 

Rating 

VA (7 Mos. Post-Separation) – All Effective Date 20012131 
Condition 
S/P  Surgical  Enucleation  of 
Odontogenic Keratocyst from Rt 
Posterior Mandible 
Mild Lumbar Spondylosis 
Tinnitus 
GERD 
0% X 8 / Not Service-Connected x 2 
Combined:  50%* 

5010-5243 
6260 
7346 

10% 
10% 
10% 

8299-8205 

30% 

Exam 

20020717 

20020804 
20020726 
20020728 
20020816 

RATING COMPARISON:   
 

Service IPEB – Dated 20010928 
Condition 
Chronic 
Facial Pain 

Surgical 

Post 

Code 

5099-5003 

Rating 

10% 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 
*Additional conditions added and rated  effective 20040407 and  20110210.  Overall combined  rating increased to 80% from 
20120221 VARD. 
 
 
ANALYSIS SUMMARY:  The Board acknowledges the CI’s assertions that he was told he “would 
be put out with 0%” or he “could settle for the 10%” rating.  It is noted for the record that the 
Board does not have the jurisdiction to scrutinize or render opinions in reference to asserted 
service  improprieties  in the  disposition  of  a  case.    The  Board’s  authority,  as  defined  in  DoDI 
6044.40,  resides  in  evaluating  the  fairness  of  Disability  Evaluation  System  (DES)  fitness 
determinations and rating decisions for disability at the time of separation.  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.  This role and authority is granted 
by Congress to the Department of Veteran Affairs (DVA).  The DVA, operating under a different 
set  of  laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  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 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.    Post-
separation  evidence  therefore  is  probative  only  to  the  extent  that  it  reasonably  reflects  the 
severity of disability at the time of separation. 
 
Chronic Post Surgical Facial Pain.  An oral surgery evaluation in June 2000, 19 months before 
separation, noted “numbness as well as pain” in the area of the surgical site.  Physical exam, 
magnetic resonance imaging and CT scan of the area did not identify a cause of the pain, but 
neurologic  evaluation  determined  that  injury  to  branches  of  cranial  nerves  V  and  VII  as  a 
consequence of multiple surgeries was a likely contributing cause.  There was no evidence of 
recurrence of the cyst.   An illegibly dated neurology note in 2001 stated that pain developed 
spontaneously, was sometimes triggered by cold, occurred 3-4 times per week and lasted for 
hours.  He took 4-5 doses of a narcotic pain medication per week, which provided partial relief.  
Examination showed mild weakness of jaw muscles.  At the narrative summary (NARSUM) exam 
performed on 16 August 2001, 4 months prior to separation, the CI reported constant right jaw 
and  right  ear  pain,  which  worsened  in  cold  weather  and  when  bending  forward,  and  could 
precipitate a severe headache.  Physical activity and wearing protective masks or chin straps 
aggravated his symptoms.  His pain was treated with a twice daily narcotic pain medication, and 
a second narcotic to be taken as needed.  The physical exam described mild weakness of the 
masseter  muscles  and  mild  decreased  sensation  to  pin  prick  along  the  right  jaw.    The  ear 
examination  noted  no  abnormalities.    A  VA  Compensation  and  Pension  neurological  exam 
performed on 3 August 2002 (7 months after separation) reported daily pain in the jaw that 
would  sometimes  radiate  behind  the  right  eye  and  would  last  several  hours  to  a  day.  
Headaches were reported to occur 3-5 times per week.  He was taking an “around the clock” 
narcotic  medication for his  jaw  pain,  and  reported  missing  3-4  days  of work  per  month  as a 
plumber due to pain.  Examination revealed diminished sensation in the mandibular branch of 
the  right  trigeminal  nerve.    The  tongue  protruded  normally  and  the  palate  elevated 
symmetrically. 

2                                                           PD1200773 
 

The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB and VA chose different coding options for the condition.  The PEB’s 10% adjudication under 
an analogous 5003 code (degenerative arthritis) cited the USAPDA pain policy.  The VA assigned 
a 30% rating under an analogous 8205 code (fifth cranial nerve).  In deliberating a pathway to a 
rating  higher  than  10%,  the  Board  considered  that  cranial  nerve  injury,  particularly  of  the 
trigeminal  nerve,  contributed  to  the  etiology  of  the  pain.    Rating  under  cranial  nerve  codes 
entails a judgment call regarding the severity of incomplete paralysis, especially the moderate 
vs. severe distinction.  The NARSUM examiner and a neurologist documented mild jaw muscle 
weakness, a reflection of trigeminal nerve injury.  While the NARSUM examiner described the 
pain as constant with intermittent exacerbations, a neurologist previously reported that pain 
was intermittent and lasted for hours.  Pain-related functional impairment while in the Army 
was reflected in a profile that prohibited wear of a mask or chin strap.  The VA examiner also 
described the pain as constant and severe enough to require frequent narcotics, and which led 
to regular work absences.  The highest 50% rating is permitted under 8205 for tic douloureaux 
(trigeminal neuralgia, a sensory-only condition), a specific diagnosis that was not rendered by 
specialists in this case; however, even if the diagnosis was conceded, Board members agreed 
that  the  50%  criterion  was  not  supported  by  the  severity  of  pain  reflected  in  the  evidence 
above.    While  it  was  readily  agreed  that  the  degree  of  muscle  weakness  does  not  reflect  a 
functional level of impairment supporting a 30% rating in this case, the severity of the sensory 
component was debated.  In deliberating a rating, the Board considered that the CI required 
daily narcotic pain medication because the condition did not respond well to medication given 
for  neuropathic  pain;  and  the  pain  condition  caused  him  to  miss  work  3-4  days  per  month.  
Ultimately, Board members agreed that the pain component would be fairly subsumed under 
the “severe” rating.  The Board further considered that headaches, which began soon after the 
first surgery and were rated separately by the VA, were in a location consistent with trigeminal 
nerve  distribution.    Under  VASRD  §4.14  (Avoidance  of  pyramiding)  assigning  two  separate 
ratings  for  the  same  disability  is  prohibited.    However,  even  if  a  headache  condition  distinct 
from the unfitting facial pain condition is conceded, this condition must itself be independently 
unfitting to merit additional rating.  The Board concluded that the evidence of record did not 
support  inclusion  of  headaches  as  a  separately  unfitting  condition.    After  due  deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the 
Board recommends a disability rating of 30% for the chronic facial pain condition, coded 8205.  
 
 
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  chronic post  surgical  facial  pain  condition  was 
operant  in  this  case  and  the  condition  was  adjudicated  independently  of  that  policy  by  the 
Board.  In the matter of the chronic post-surgical facial pain condition, the Board unanimously 
recommends a disability rating of 30%, coded 8205 IAW VASRD §4.124a.  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:   
 

VASRD CODE  RATING 
8205 
COMBINED 

30% 
30% 

UNFITTING CONDITION 
Chronic Post Surgical Facial Pain 

 
 

3                                                           PD1200773 
 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120607, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXX, DAF 
           Acting Director 
           Physical Disability Board of Review 

4                                                           PD1200773 
 

 
 

 
 
 

 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXX, AR20130003053 (PD201200773) 
 
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 30% effective the date of the individual’s original medical 
separation for disability with severance pay.   
 
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: 
 
 
a.  Providing a correction to the individual’s separation document showing that 
the individual was separated by reason of permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 
 
 
disability effective the date of the original medical separation for disability with 
severance pay. 
 
 
account for recoupment of severance pay, and payment of permanent retired pay at 
30% effective the date of the original medical separation for disability with severance 
pay. 
 
 
and medical TRICARE retiree options. 
 
 
 
 
 
 
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 

c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 

b.  Providing orders showing that the individual was retired with permanent 

5                                                           PD1200773 
 

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 
 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

6                                                           PD1200773