RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAM:  XXXXXXXXXXXXXXXXXXXX                                                         BRANCH OF SERVICE:  ARMY  
CASE NUMBER:  PD1200870                                                             SEPARATION DATE:  20080129 
BOARD DATE:  20130103   
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  PV2/E-2  (25Q/Multichannel  Transmission  Systems 
Operator-Maintainer), medically separated for chronic pain, right hand and right supraspinatus 
tendinitis (shoulder) with chronic pain.  The CI fractured his right hand in April 2007 during his 
Advanced  Individual  Training  (AIT)  at  Fort  Gordon,  GA  after  falling  on an  outstretched  hand.  
The  CI  underwent  surgery  and  began  a  regimen  of  physical  therapy  (PT).    He  also  reported 
injuring  his  right  shoulder  during  physical  training  in  December  2006.    He  was  unable  to 
improve  adequately  with  treatment  or  meet  the  physical  requirements  of  his  AIT  and  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).  The MEB forwarded 
no other conditions for Physical Evaluation Board (PEB) adjudication.  The MEB submitted the 
conditions  to  the  PEB  as  right  shoulder  pain  (slight/intermittent)  secondary  to  supraspinatus 
tendonitis and chronic right hand pain secondary to closed fracture of the second, third and 
fourth  metacarpal  bone,  healed  with  residual  pain  (slight/intermittent).    The  PEB  initially 
adjudicated the conditions as chronic pain, right hand and right supraspinatus tendinitis with 
chronic  pain,  unfitting,  rated  10%  and  0%  with  cited  application  of  the  US  Army  Physical 
Disability Agency (USAPDA) pain policy which was continued on the first USAPDA revised PEB 
prior to the CI’s separation date.  The CI made no appeals, and was medically separated with a 
10% disability rating.  The USAPDA issued a revised administratively corrected PEB in February 
2009 with the final rating of the conditions at 10% and 10%, respectively, with application of 
the Veterans Affairs Schedule for Rating Disabilities (VASRD).   
 
 
CI CONTENTION:  The CI elaborated no specific contention in his application.   
 
 
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 the unfitting chronic pain, right hand and right supraspinatus tendinitis with chronic pain 
conditions meet the criteria prescribed in DoDI 6040.44 for Board purview; and, are addressed 
below.  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 Admin PEB – Dated 20090203 
Condition 

Code 

Rating 

Chronic Pain, Right Hand 

5099-5003 

10% 

Exam 

20090411 

Code 

Rating 

VA (15 Mos. Post-Separation) – All Effective Date 20080130 
Condition 
Degenerative 
Joint  Disease, 
Right  Second,  Third  and  Forth 
Fingers, Residuals of Fractures 
Status Post Acromioplasty, Right 
Shoulder 
0% X 1 
Combined:  20% 

5010-5229 

10%* 

5201 

10% 

10% 

5024 

20090411 

20090411 

Right 
Supraspinatus 
Tendinitis  with  Chronic 
Pain 
↓No Additional MEB/PEB Entries↓ 
Combined:  20% 
* VA Rating reduced to 0% effective 20090411; combined rating reduced to 10% effective 20090411. 
 
 
ANALYSIS SUMMARY: 
 
Chronic Right Hand Pain Condition.  The CI fell on his right (dominant) outstretched hand while 
attending AIT in April 2007, fracturing the mid shaft of the second, third and fourth metacarpal 
bones.    He  underwent  open  reduction,  internal  fixation  (ORIF),  had  pins  removed  and 
underwent  PT.    Five  months  later,  despite  improvement  of  the  CI’s  fingers’  range-of-motion 
(ROM) and a “reasonably good grip of the right hand,” because of residual chronic hand pain 
that worsened with exertional activity and fine motor movements, he was referred to the MEB.  
At orthopedic physical exam of the MEB in September 2007, the CI reported hand pain with 
loading activities.  Physical exam revealed well healed incisions, no tenderness, hands with full 
ROM and right hand with all fingers with full extension and composite flexion (ability to make a 
full fist and grasp objects) over 200 degrees (200 is no disability IAW AMA Guide to Disabilities, 
6th  edition).    The  orthopedist  opined  that  the  CI’s  right  hand  metacarpals  had  well  healed 
fractures and that he showed no functional deficit.  On MEB physical exam, a week after the 
above exam, the CI was noted to have well healed superficial surgical scars.  The right hand had 
minimal  tenderness  and  showed  full  ROM.    Fingers  had  full  extension  and  he  had  a  full 
composite fist.  There was no rotational deformity.  X-rays revealed well-healed fractures of the 
metacarpals.  The CI’s injured right (dominant) finger ROMs were measured by goniometry 6 
months postoperatively and were compared to those of his left (non-dominant) hand and were 
within 5 degrees of those of the left hand.  Grip strengths on the injured dominant right hand 
averaged  83  (121  normal  for  age)  and  did  not  decrease  over  three  assessments.    This  is  in 
comparison to the uninjured non-dominant left hand with an average of 95 (104.5 normal for 
age).   
 
At the VA Compensation and Pension (C&P) exam 15 months after separation, in April 2009, the 
CI  reported that  he  had  been  seen  at the  Wilmington  VA Medical  Center  in December  2009 
with complaints of a few months of numbness and tingling in the 4th and 5th digits of his hand.  
On  physical  exam  he  was  found  to  have  mildly  impaired  sensation  in  the  ulnar  distribution.  
Electrodiagnostic  evaluation  revealed  a  mild  right  ulnar  entrapment  at  the  elbow,  no  ulnar 
compression and no peripheral neuropathy.  Physical examination at the C&P of all hand joints 
bilaterally  were  0  to 90  degrees  flexion  and to 0  degrees extension.    There  was  no  atrophy, 
weakness nor additional restriction of range-of-motion (ROM) due to pain, fatigue, weakness or 
lack  of  endurance  following  three  repetitive  ROM  assessments.    X-ray  exam  showed  mild 
degenerative changes at the first metacarpal phalangeal joint (thumb).   
 
The  Board  first  considered  the  chronic  right  hand  pain  condition.    The  PEB  and  VA  chose 
different  coding  options  for  the  right  hand  condition  and  arrived  at  the  same  rating 
recommendation.    The  VA  rated  this  condition  5010-5229  for  arthritis  on  X-ray  with  likely 

noncompensable limitation of motion of the index or long finger.  The PEB, based upon VASRD 
§4.71a, rated the CI’s right hand condition code 5099-5003 at 10% for pain on movement, in 
accordance with §4.45.  The PEB was unable to establish degenerative arthritis by X-ray with 
the  limitation  of  motion  of  the  specific  minor  joints/grip  noncompensable.    The  only  higher 
rating for the fingers requires ankylosis (5222).  There was no evidence of ratable peripheral 
nerve impairment and thus codes 8715 and 8716 would not be applicable in this case.  After 
due  deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (Resolution  of 
reasonable  doubt),  the  Board  concluded  that  there  was  insufficient  cause  to  recommend  a 
change in the PEB adjudication for the chronic right hand pain condition.  The Board concluded 
therefore that this condition could not be recommended for additional disability rating.   
 
Right Supraspinatus Tendonitis with Chronic Pain Condition.  The CI’s initial injury was during 
basic training in September 2006 when he fell on his left elbow.  After that he began to have 
“toothache-like” right (dominant) shoulder pain.  Five months later, in March 2007 he was seen 
in  clinic  complaining  of  aching  right  shoulder  pain  and  an  occasional  feeling  of  its  being 
unstable, with a vague history of dislocation  years before without medical attention for this.  
After completing physical therapy, he was able to attend AIT physical training for the next 5 
months, until he injured his hand at which time he was referred to the MEB.  At the time of his 
MEB exam, the CI reported aching in his right shoulder and on the magnetic resonance imaging 
(MRI) exam he reported “popping and pain with overhead activities” as well as pushups.  He 
was diagnosed at the time of MEB with supraspinatus tendonitis, which was confirmed by MRI.  
The CI did not have arthritis on MRI.  The goniometric ROM evaluations in evidence which the 
Board  weighed  in  arriving  at  its  rating  recommendation,  with  documentation  of  additional 
ratable criteria, are summarized in the chart below. 
 

OT for MEB ~3 Mo. Pre-Sep 
Right (Dominant) 
(160) 165/160/160 
(180) 180/180/180 
‘Pain limits ROM’ and ‘FROM’; no 
atrophy; nontender at joints; neg 
apprehension tests;   
10% 

VA C&P ~14 Mo. Post-Sep 
Right (Dominant) 
180 
180 
Pain  decreased  from  10/10 
to 4/10 4 Mo. post-op 
0% 

Shoulder ROM 
(Degrees) 
Flexion (0-180⁰) 
Abduction (0-180⁰) 
Comments:  Surgery  10 
Mo. after sep 
§4.71a Rating 

       *Initially rated 0%; administrative correction to 10% application Army USAPDA    

 
 
At  time  of  MEB  the  occupational  therapist  opined  “pain  limits  range  of  motion,”  with 
documented normal extension with a decrease in flexion 160 degrees (normal 180 degrees) and 
decreased internal and external rotations.  The orthopedist at MEB did not mention weakness, 
fatigue,  nor  instability  but  did  note  that  “pain  limits  range  of  motion”  and  internal  rotation 
decreased  to  45  degrees  (normal  90  degrees)  after  repetition.    The  CI  had  negative 
apprehension  tests  and  had  no  atrophy  of  his  shoulder.    Seven  months  after  separation,  in 
October  2008,  the  CI  was  seen  in  consultation  at  the  Wilmington  VA  Medical  Center  and 
reported right shoulder pain and weakness, with particular symptoms on overhead reaching.  
Physical examination at that time revealed tenderness in the anterior subacromial space and a 
positive impingement sign.  It was noted that the CI had “FROM.”  Eleven months after his date 
of separation, in December 2008, the CI underwent shoulder surgery (acromioplasty and labral 
debridement) for impingement syndrome with two labral tears.   
 
At the (C&P) exam 4 months after surgery (14 months after separation), in April 2009, the CI 
reported a reduction of pain from 10/10 to 5/10 after surgery.  Physical examination revealed 
no keloid, tenderness nor deep adherence of scar to underlying tissues.  The examiner opined, 
“DeLuca  Criteria:    No  additional  restriction  of  the  range  of  motion  due  to  pain,  fatigue, 

weakness or lack of endurance during flare-ups or following three repetitive range of motion 
assessments.”  The final diagnosis was “right shoulder acromioplasty and labral debridement, 
restricted.  No residuals.”   
 
The  Board  directs  attention  to  its  rating  recommendation  for  the  right  (dominant)  shoulder 
condition based on the above evidence.  The final (corrected) rating was for 10% coded 5024 
(Tenosynovitis).  The VA coded the shoulder as 5201 (Arm, limitation of motion) at 10% from 
the  day  after  separation  with  a  decrease  to  0%  effective  April  2009  based  on  VA  exam 
demonstrating post-surgical improvement.  The PEB administratively corrected the code 5024 
(tenosynovitis) rating from 0% to 10%.  All evidence and exams proximate to separation were 
ratable at the 10% level for painful or pain-limited motion.  After due deliberation, considering 
all  of  the  evidence  and  mindful  of  VASRD  §4.3  (Resolution  of  reasonable  doubt),  the  Board 
concluded that there was insufficient cause to recommend a change in the PEB adjudication for 
the right supraspinatus tendonitis with chronic pain condition.  The Board concluded therefore 
that this condition could not be recommended for additional disability rating.   
 
 
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  final  rating  ruling  in  this  case  that  any  prerogatives  outside  the 
VASRD were exercised.  In the matter of the chronic right hand pain condition and IAW VASRD 
§4.71a, coded 5099-5003 at 10%, the Board unanimously recommends no change in the PEB 
adjudication.  In the matter of the right supraspinatus tendonitis with chronic pain condition 
and IAW VASRD §4.71a, coded 5024 at 10%, 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 
5099-5003 
5024 
COMBINED 

10% 
10% 
20% 

UNFITTING CONDITION 
chronic right hand pain condition 
right supraspinatus tendonitis with chronic pain condition 

 
 
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 

SFMR-RB 
 

 

 
 

 

 

 
 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency  

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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 

XXXXXXXXXXXXXXXXXX, AR20130003024 (PD201200870) 

 
 

 

 
 

 

 
 
 
 

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 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     XXXXXXXXXXXXXXXXX 

     Deputy Assistant Secretary 
         (Army Review Boards)