On 31 July 2026, the U.S. Court of Appeals for the Fourth Circuit decided Thompson v. Hegseth, a military disability case involving an Air Force veteran who was medically separated with a 10% disability rating even though the Department of Veterans Affairs later rated the same spinal condition at 40%. A divided Fourth Circuit upheld the military’s decision. Thompson v. Hegseth, No. 24-2050, slip op. at 1, 24 (4th Cir. 31 July 2026) (unpublished).
The case is important because it shows how difficult military disability-rating disputes can become when the medical record contains conflicting examinations. It also illustrates why a Service member challenging a rating should focus not only on favorable evidence, but also on why that evidence is more probative, more consistent with the applicable rating criteria, and more representative of the member’s condition at the time of separation.
A 10% Rating Instead of 30% Can Change the Entire Outcome
Carissa Thompson entered the Air Force in 2002. In July 2003, while on authorized leave, she was thrown from an all-terrain vehicle and then run over by it. She suffered a burst fracture of the L1 vertebra, required hospitalization, wore a large back brace, and was prescribed narcotic pain medication. Thompson, slip op. at 5, 25–26.
Her military duties were significantly restricted. She could not run, jump, climb, crawl, repeatedly bend or twist, participate in sports, lift more than 15 pounds, or stand for more than 15 minutes per hour. Id. at 26.
The Air Force later found her unfit because of the L1 fracture. The Physical Evaluation Board (“PEB”) assigned a 10% disability rating, and she was medically separated on 23 May 2005 with severance pay. Id. at 31.
That percentage had major consequences. A Service member with fewer than 20 years of service who is rated at least 30% may qualify for disability retirement under 10 U.S.C. § 1201. A rating below 30% generally results in disability separation with severance pay under 10 U.S.C. § 1203. Id. at 3–4.
Only a few months after separation, however, the VA rated the same L1 fracture at 40%. Id. at 6.
That discrepancy became the focus of the later litigation.
The Medical Record Told Different Stories at Different Times
Thompson’s medical record did not present a simple, consistent disability picture.
In September 2003, a physical therapist recorded forward flexion of 15 degrees. The following month, an orthopedic physician recorded flexion to 30 degrees before pain began. Id. at 28.
By June and July 2004, however, an orthopedic specialist described her as having “full range of motion,” including the ability to bend forward and touch her toes. At the same time, she continued to report persistent pain, limited walking tolerance, and pain that persisted throughout the day while she remained upright. The examinations did not record her range of motion in degrees. Id. at 29.
The record then shifted again. In December 2004, a pain-clinic physician measured her forward flexion at only 20 degrees and documented that her pain had worsened during the preceding six months. Id. at 29.
In February 2005, a spine specialist documented continued pain that worsened with activity and noted that she was using a fentanyl patch. But that examination contained no spinal range-of-motion measurement. Id. at 30.
Finally, during an August 2005 VA Compensation and Pension examination conducted shortly after her separation, forward flexion was measured at 30 degrees with pain. The examination also documented constant low-back pain, occasional wheelchair use, difficulty walking even short distances, and numbness in both legs. Id. at 30.
The VA ultimately assigned a 40% rating. Id. at 31.
This kind of conflicting record is not unusual in military disability cases. A Service member may have one examination showing relatively normal findings, another showing serious limitation, and a later VA examination that supports a much higher rating. The difficult question is often not whether favorable evidence exists, but which evidence best reflects the disability at the legally relevant time.
The PDBR Kept the Rating at 10%
Years later, Thompson asked the Physical Disability Board of Review (“PDBR”) to reconsider the Air Force’s 10% rating. Congress created the PDBR to review certain disability determinations involving Service members who had been medically separated with ratings of 20% or less during the statutory review period. The PDBR could recommend a new rating, modification of the prior rating, recharacterization to disability retirement, or no change. 10 U.S.C. § 1554a. Thompson, slip op. at 4–5.
The PDBR recommended no change.
It placed substantial weight on the June and July 2004 orthopedic examinations describing “full range of motion.” It also relied on the February 2005 orthopedic examination, even though that examination contained no range-of-motion measurement. By contrast, the PDBR gave less weight to the August 2005 VA examination because Thompson wore a rigid back brace during the testing. The PDBR reasoned that a brace designed to restrict motion made the resulting measurements less useful for VASRD rating purposes. Id. at 15.
The Secretary of the Air Force accepted that recommendation.
Federal Courts Don’t Simply Decide Which Medical Evidence Looks Better
The Fourth Circuit’s decision turned heavily on the standard of review.
The court did not independently decide whether Thompson should have been rated at 10% or 40%. Instead, because the case arose under the Administrative Procedure Act (“APA”), the court asked whether the PDBR acted arbitrarily or capriciously, failed to consider an important aspect of the problem, contradicted the evidence without adequate explanation, or otherwise acted outside the bounds of reasonable decisionmaking.
The majority emphasized that this standard is narrow and highly deferential. Id. at 7–8.
That distinction matters in military-record correction cases. Once a dispute reaches federal court, it is generally not enough to show that another interpretation of the medical evidence would have been more persuasive. A stronger challenge identifies a legal or reasoning defect in the board’s decision. For example, the board may have ignored material evidence, relied on the wrong standard, depended on evidence that could not support the rating assigned, or failed to explain a significant inconsistency.
For that reason, developing the record carefully before the case reaches federal court can be critical.
An Inadequate Examination May Still Affect the Outcome
One of the most important parts of Thompson concerns 38 C.F.R. § 4.2.
Section 4.2 provides that when an examination lacks sufficient detail, the rating authority should return it as inadequate for evaluation purposes. The Fourth Circuit majority agreed that the February 2005 examination was inadequate for rating purposes because it did not provide the range-of-motion information needed to evaluate the condition. Id. at 12.
Nevertheless, the majority held that the PDBR could still consider information contained in that report as part of the broader medical history. Section 4.2 also requires medical reports to be interpreted in light of the “whole recorded history” and reconciled into a consistent disability picture. Id. at 12–14.
That distinction can be important in a disability appeal. Establishing that an examination was defective may not, by itself, remove every observation in that examination from consideration. The stronger argument explains what information was missing, why that missing information mattered under the applicable diagnostic criteria, and why the remaining evidence did not cure the defect.
A Higher VA Rating Is Important, but It Is Not Automatically Controlling
Thompson also argued that the military did not give sufficient weight to the VA’s 40% rating.
The applicable PDBR guidance required comparison of the VA rating for the same unfitting condition and particular consideration of ratings issued within 12 months of separation. The PDBR acknowledged the VA’s 40% rating but explained why it discounted the underlying examination. The Fourth Circuit held that this explanation was sufficient. Id. at 14–15.
A favorable VA rating issued shortly after separation can therefore be powerful evidence, but it should not be presented as though it automatically determines the military rating.
The more persuasive argument is usually that the VA examination accurately reflected the Service member’s condition at the time of separation, satisfied the applicable VASRD criteria, and deserved greater evidentiary weight than the competing military examinations.
The issue is not merely that the VA assigned a different percentage. The issue is why the evidence underlying that percentage more accurately represented the disability when the military disposition became final.
Judge Benjamin’s Dissent Shows Why Chronology Can Matter
Judge Benjamin dissented and would have sent the case back for reevaluation.
Her analysis focused heavily on the sequence of the medical evidence. In June and July 2004, Thompson was described as having full range of motion. But by December 2004, approximately five months before separation, forward flexion was measured at only 20 degrees. In February 2005, her pain remained worse with activity, although no range-of-motion measurement was taken. Then, only a few months after separation, the VA measured forward flexion at 30 degrees. Id. at 40–42.
Judge Benjamin concluded that the evidence nearest separation pointed toward a range of approximately 20 to 30 degrees, which corresponded to a 40% rating. Id. at 42.
More importantly, the dissent criticized the PDBR for failing to meaningfully address the December 2004 20-degree measurement. In Judge Benjamin’s view, the PDBR could not reasonably rely on the more favorable mid-2004 evidence and the February 2005 examination without adequately explaining the intervening evidence showing significant deterioration. Id. at 43–44.
That is an important lesson in military disability appeals. When a board reaches an unfavorable conclusion despite strong contrary evidence, the strongest challenge may not simply be that the board reached the wrong result. Instead, the better argument may be that the board failed to grapple with evidence that directly undermined its reasoning.
Reasonable Doubt and the Higher-Evaluation Rule Still Matter
The case also addressed two VASRD provisions that frequently arise in disability-rating disputes.
Under 38 C.F.R. § 4.3, reasonable doubt concerning the degree of disability must be resolved in favor of the claimant. Under 38 C.F.R. § 4.7, when a disability picture falls between two evaluations, the higher rating applies if the overall disability more nearly approximates the criteria for that rating. Id. at 21–22.
The Fourth Circuit did not hold that either rule was unavailable. Instead, the majority concluded that the PDBR had weighed the evidence and found that 10% was affirmatively supported. Because the PDBR did not find the evidence to be in approximate balance, § 4.3 did not alter the result. Likewise, because the PDBR did not conclude that the overall disability picture more nearly approximated the higher rating, § 4.7 did not require an increase. Id. at 22–24.
The practical point is that merely citing §§ 4.3 and 4.7 is rarely enough. An appeal should explain why the evidence is actually in approximate balance or why the complete disability picture more nearly satisfies the higher rating criteria.
What Service Members Should Take From Thompson
The most important lesson from Thompson is that disability-rating appeals are often evidence-weighting cases as much as they are rating-schedule cases.
A strong challenge should identify the exact VASRD criteria, determine which examinations actually address those criteria, evaluate whether the examinations were adequate, compare the evidence closest to the separation or rating date, explain any worsening or improvement over time, and address unfavorable evidence directly.
It should also identify flaws in the board’s reasoning. Did the board overlook a measurement that contradicted its conclusion? Did it rely on an examination that lacked necessary findings? Did it discount a favorable VA examination without adequately explaining why? Did it give greater weight to older evidence without accounting for later deterioration? Did it meaningfully analyze whether §§ 4.3 or 4.7 applied?
Those questions can determine whether a disagreement over medical evidence becomes a viable administrative or judicial challenge.
How Joel Pettit Law Can Help
Military disability-rating disputes can become highly technical because they involve several systems at once: the medical record, the VASRD, military disability regulations, VA examinations, procedural history, and the administrative-law standards that govern later review.
Joel Pettit Law assists Service members and veterans in identifying where those systems do not fit together correctly. That can include challenging inadequate examinations, identifying overlooked or improperly discounted evidence, comparing military and VA ratings, developing arguments under 38 C.F.R. §§ 4.2, 4.3, and 4.7, and pursuing relief through the PEB process, SAFPC, the AFBCMR or other correction boards, and federal court when appropriate.
The objective is not simply to point to favorable evidence. It is to show, through the governing law and the complete evidentiary record, why the military’s disability determination should be changed.
Thompson is an unpublished decision and therefore is not binding precedent in the Fourth Circuit. Id. at 2. Even so, the majority and dissent provide a useful roadmap for understanding how military disability-rating disputes may be evaluated when the record contains conflicting examinations and a later VA rating that differs substantially from the military’s determination.
