RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00353
BRANCH OF SERVICE:  Army	BOARD DATE:  20141204
SEPARATION DATE:  20060605

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Food Service Operations) medically separated for a left wrist condition.  The left wrist condition could not be adequately rehabilitated 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).  The MEB forward the “Chronic left wrist pain” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “left wrist pain with excision of ganglion cyst two times,” as unfitting, rated at 0%, referencing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I feel the rating on my left wrist was not accurate due to the fact that I had under gone 2 surgeries.  One took place in 2001 and the other in 2003.  And I still have slight chronic pain from normal daily tasks using my wrist.  And I was also left with a big scar from the sergeries [sic].  And the rating for my back I feel is also in accurate [sic] due to the fact that im always in pain and have been seen at the hospital several times for back pain.” 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  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/Naval 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 IPEB – Dated 20060327	VA - (7.5 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain	5099-5003	0%	Left Wrist Pain and Removal of Ganglion Cyst	5215	10%	20070123	
Other x 0 (Not in Scope)	Other x 2		
Rating:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20070319 (most proximate to date of separation)

ANALYSIS SUMMARY: 

Left Wrist Condition.  The CI was left hand dominant.  Absent a history of direct trauma, the CI initially developed left wrist pain in 2001 with later manifestation of a mass, diagnosed as a ganglion cyst (a benign jellylike fluid filled sac that originates from a tendon or a joint capsule).  Under orthopedic care, he underwent a surgical excision of the cyst in 2001 and a repeat excision in 2003.  X-rays and nerve conduction tests about the left wrist were normal.  Despite aggressive physical and occupational therapy, his painful wrist remained.  At the 9 January 2006 narrative summary examination (5 months prior to separation), the CI reported left wrist pain with occasional abnormal sensation about his left hand.  The physical examination (PE) revealed tenderness (primarily over the previous surgical scar) and tingling sensation with forced flexion.  His diagnosis was chronic left wrist pain, status post ganglion excision.  The commander’s statement indicated that the CI’s limitations and wearing of a wrist brace prevented him from performing the duties of his MOS.

At the 23 January 2007 VA Compensation and Pension examination (7 months after separation), the CI reported “occasional aching in the wrist during cold weather or with strenuous use but no other related symptoms.”  He was employed as a stocker at a department store and voiced no impairment in activities of daily living.  The PE revealed minimally decreased and painful motion at terminal range.  Repeat X-rays remained normal.  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.

Left Wrist ROM
(Degrees)	PT/MEB ~ 4.5 Mo. Pre-Sep
	VA C&P ~ 7.5 Mo. Post-Sep
	
Dorsiflexion (70 Normal)	65,67,68	60	
Palmar Flexion (80)	55,55,52	75	
Comment	tenderness	painful motion… at terminal range	
§4.71a Rating	0-10%	0-10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left wrist pain condition at 0% using the analogous arthritis VASRD code 5099-5003, citing the USAPDA pain policy.  The VA rating of 10% was under code 5215 (wrist; limited motion) citing painful motion.  Clearly there was decreased left wrist ROM on the MEB examination, but not compensable under VASRD criteria for the wrist limitation of motion disability codes.  Board members acknowledged and discussed the inconsistency of the IPEB’s (DA Form 199) statement of “soldier has pain with range of motion” when the MEB PT examination specifically listed “no” as to the same.  Additionally, consideration was given towards the application of §4.40 (functional loss) due to tenderness on examination in support of a 10% rating under VASRD §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that the inconsistency of painful motion be applied for the benefit of the CI, and therefore, recommends a rating of 10% for painful motion.  Absent radiologic evidence of arthritis, members agreed that an analogous code under limitation of motion was appropriate.

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 DoDI 1332.39 for rating the left wrist was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the left wrist condition the Board unanimously recommends a disability rating of 10%, coded 5299-5215 IAW VASRD §4.71a.  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	VASRD CODE	RATING	
Left Wrist Condition	5299-5215	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140107, 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 XXXXXXXXXXXXXXX, AR20150007655 (PD201400353)

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 10% 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:

CF: 
(  ) DoD PDBR
(  ) DVA