RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX			CASE: PD-2014-00650
BRANCH OF SERVICE:  Army	 SEPARATION DATE:  20060929

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Military Police, medically separated by the Informal Physical Evaluation Board for “chronic right (non-dominate) wrist pain,” with a disability rating of 0%.

CI CONTENTION:  “The ratings for the conditions were too low due to the fact that VA rated them as a combined 30% disability.  In fact, during the separation period I was under treatment for different conditions like Lower Back Chronic Pain, Right Knee Chronic Pain, Small fracture of Left Thumb, just to mention a few.”  His 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 – 20060810	VARD - 20080411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right (Non-dominant) Wrist Pain	5003	0%	Chronic Right Wrist Pain and Cysts	5003	10%	20071207	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Right Wrist Pain.  According to the service treatment records and the narrative summary (NARSUM) the CI injured his right non-dominant wrist in June 2003 when he fell on his outstretched hand during a sports activity.  He was evaluated by an orthopedic surgeon and imaging studies including a wrist arthrogram and magnetic resonance imaging showed possible tears of the scapholunate and lunotriquetral ligaments (ligaments between three hand bones at the wrist from the thumb side).  A CT scan 9 May 2005 noted small cysts of the lunate bone and indicated that the cysts may represent degenerative joint disease (DJD).  The CI underwent right wrist arthroscopic surgery on 11 July 2005 and partial tear of the scapholunate ligament was found and debrided.  Despite occupational and physical therapy after surgery, the CI reported continued right wrist pain with use that limited his ability to perform the Army Physical Fitness Test and an MEB was initiated.

The MEB NARSUM physical exam 4 April 2006, performed 6 months before separation, showed no deformity or swelling of the right wrist.  There was crepitus with circular wrist motion and tenderness to palpation (TTP) of the radius at the wrist.  There was no TTP of any hand bone ligaments, the ulnar side of the wrist, or thumb tendons.  The radius and ulna joint moved properly without tenderness.  Wrist range-of-motion (ROM) was symmetrical with the left, and there was pain with extension.  Strength, sensation, and pulses of the right wrist and hand were normal.

At the VA Compensation and Pension (C&P) exam 5 December 2007, performed 14 months after separation, the CI reported pain and crepitus of the right wrist with “locking,” without flare-ups.  The exam showed wrist ROM of dorsiflexion 50 degrees (normal 70) and palmar flexion 50 degrees (normal 80), with painful motion and there was no additional loss of motion with repetition.  Right wrist X-rays were normal.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the wrist condition 0%, coded 5003 (degenerative arthritis), and cited degenerative joint changes on imaging with full motion and pain with use.  The VA rated the wrist condition 10%, coded 5003, for painful-limited motion of a major joint.  The Board agreed the evidence in record supports a 10% rating of the wrist condition coded as 5003 for limited motion of a major joint with imaging evidence of degenerative changes or coded analogously as 5215 (wrist, limitation of motion) with consideration of functional loss due to painful motion (based on VASRD §4.59, §4.40. and §4.45).  The Board reviewed to see if a higher evaluation was achieved with any applicable code, but there was no evidence of sufficiently limited wrist ROM or ankylosis (5214) to support a higher rating.  Thus, the Board determined that the evidence in record supports a 10% rating for the wrist condition and no higher and chose to code as 5299-5215.  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 wrist condition.

BOARD FINDINGS:  In the matter of the 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 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	
Chronic Right Wrist Pain	5299-5215	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140128, 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, AR20160003382 (PD201400650)

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