RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-00249
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Health Care Specialist, medically separated by the Informal Physical Evaluation Board (PEB) for right wrist pain, with a disability rating of 0%.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070116	VARD - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DeQuervain’s Tenosynovitis of the Right (Non-Dominant) Wrist…	5024	0%	DeQuervain’s Tenosynovitis, Status Post Distal Ulnar Fracture, Right Upper Extremity	5214-5024	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Wrist Condition.  The CI is left hand dominant.  In April 2005, the CI injured his right wrist during a fight.  Initial X-rays did not reveal any bony abnormality.  Orthopedic evaluation diagnosed tenosynovitis and recommended bracing, medication, and local injections.  His painful symptoms temporarily resolved with each of four injections.  Secondary to the persistence of pain, he was permanently profiled in November 2006 and referred to a Medical Evaluation Board (MEB).  At the narrative summary (NARSUM) examination (06 December 2006; 2 months pre-separation), the CI’s chief complaint was chronic right wrist pain.  His physical examination (PE) revealed tenderness and painful motion about the right wrist.  Specialized clinical testing clearly indicated an inflammatory tendon condition.  He was neurologically intact.  Although no range was documented, the examiner stated wrist motion was normal.  His diagnosis remained as tenosynovitis of the right wrist.  The commander’s statement indicated that the CI’s limitations prevented him from performing the duties of his MOS.  A VA Compensation and Pension (C&P) examination was not available for review, but a VARD (proximate to separation) indicated that the CI failed to report for a scheduled appointment on 25 May 2007.  The VA adjudicated the CI’s condition at 0% citing the absence of painful or limited motion of a major joint or group of minor joints.  

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the wrist condition at 0% under the primary VASRD code of 5024 (tenosynovitis) with the PEB citing no loss of motion.  Clearly the NARSUM examination revealed the presence of painful motion as well as tenderness and therefore, in support of a 10% rating under VASRD §4.59 and or §4.40 (functional loss).  Absent evidence of ankylosis, there was no additional or alternative route to a higher impairment rating than that obtained under §4.59 or §4.40.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right wrist condition.

BOARD FINDINGS:  In the matter of the right wrist condition, the Board unanimously recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Tenosynovitis; Right Wrist 	5024	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131231, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160005435 (PD201400249)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA