RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00580
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20070426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Health Care Specialist, medically separated for “chronic pain [right] wrist pain,” with a disability rating of 0%.

CI CONTENTION:  “I was rated unfairly by the medical board.”  The CI’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 Physical Evaluation Board (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 - 20070307	VARD - 20071205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain [Right] (Dominant) Wrist	5099-5003	0%	Status Post Excision, Right Ganglion Cyst with Scar and Limitation of Motion	5215	10%	20071022	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Right Wrist.  On 15 May 2006, the CI had surgery to remove a mass on the volar aspect of her right dominant wrist.  She continued to have right wrist pain after surgery.  Due to the chronic persistent nature of her symptoms a Medical Evaluation Board (MEB) was initiated.  During the MEB clinical evaluation dated February 2007, 2 months before separation, she reported hypersensitive skin around the surgical scar.  She was fully functional for activities of daily living but had difficulty firing a weapon or doing any strenuous activity; particularly gripping, pulling, or bearing weight.  On physical examination of the right wrist surgical scar was supple and barely visible.  Range of motion (ROM) flexion and extension were slightly decreased.  She was diagnosed with cutaneous neuroma right volar forearm.

During the VA Compensation and Pension (C&P) exam dated 22 October 2007, 6 months after separation, she reported right wrist numbness, stiffness and weakness.  She was able to brush her teeth, vacuum, cook, dress, take out trash, and garden.  However, she needed assistance with showering, driving, walking, shopping, or pushing a lawn mower.  On physical examination she was in no apparent distress.  The right wrist surgical scar was nontender and normal to palpation.  ROM was normal but painful.  There was no edema, effusion, weakness, tenderness, redness, heat, subluxation or guarding of movement.

The Board directed attention to its rating recommendation based on the evidence.  The PEB rated the right wrist 10% coded 5099-5003 (analogous for degenerative arthritis).  The VA rated the right wrist 10% coded 5215 (wrist, limitation of motion).  The Board noted that the PEB inadvertently listed the left wrist as unfitting.  The Board determined that this error was a typographical discrepancy and not substantive in nature.  Using clinical information from the record, the CI’s wrist condition warranted a 0% rating at the time of separation, based solely on the VASRD §4.71a diagnostic codes for loss of wrist motion (5214 and 5215).  However; IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional impairment and functional loss due to painful motion of a major joint.  There was no path to a higher rating for the right wrist since there was insufficient evidence of a seriously disabling bone or joint abnormality that would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the wrist condition, IAW VASRD §4.40, §4.45 and §4.59.

BOARD FINDINGS:  In the matter of the right 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.  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Pain, Right (Dominant) Wrist	5299-5215	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140122, 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, AR20160006637 (PD201400580)

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