RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	   CASE:  PD-2014-00958
BRANCH OF SERVICE:  NAVY	Date of separation: 20081108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Galley Cashier, medically separated for left wrist pain and left thumb weakness.  The condition could not be adequately rehabilitated to meet the physical requirements of her Rating.  She was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The “pain in joint involving forearm” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “left wrist pain and loss of motion status post left de Quervains release” and “left thumb weakness status post left de Quervains release “as unfitting, rated 10% and 10%.  The CI made no appeals and was medically separated.  

CI CONTENTION:  Her condition has gotten worse since separation.  Her complete submission is at Exhibit A.

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:  

IPEB - Dated 20080723	VA* - (~2 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain and Loss of Motion Status Post Left de Quervains Release	5099-5024	10%	Left Wrist Strain	5215	10%	200080923	
			Status Post Left Wrist Surgery with Residual Scar	7804	10%	20080923	
Left Thumb Weakness Status Post Left de Quervains Release	5307	10%	Not Addressed	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 12 (equals SC, NSC & deferred)	
RATING:  20%	RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20090120 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Left Wrist Pain and Loss of Motion Status Post Left de Quervains Release Condition.  The record shows that the CI developed left wrist and thumb pain in February 2007 and was diagnosed with de Quervains (tenosynovitis).  She was treated with immobilization and splinting without resolution.  She then had a surgical release in October 2007.  The narrative summary (NARSUM) was dated 15 May 2008, 7 months after surgery and 6 months prior to separation.  She continued to have pain with activity.  She was diffusely tender over the base of the left thumb and the top of the wrist next to the thumb.  She showed 4/5 strength with motion of her thumb.  “Multiple studies” were normal; the action officer opined that “multiple studies” would include X-ray studies which would be expected to be normal in this condition.  At the VA Compensation and Pension (C&P) examination performed on 23 September 2008, 11 months after surgery and 2 months before separation, the CI reported that her pain had begun 2 years earlier after maternity leave.  (The cause of de Quervains is unknown; however, the onset is associated with pregnancy among other factors).  The condition was aggravated by activity and mitigated with medications.  She was able to brush her teeth, take a shower, vacuum, drive a car, and dress herself.  She could not cook, take out the trash, garden, or push a lawnmower.  The cause of the limitations was not specified.  The CI also reported pain in the right wrist, back, and both feet.  On examination, she was noted to be right dominant as she wrote with her right hand.  The examination of the right wrist was normal.  The left showed tenderness and guarding of movement, but was otherwise unremarkable.  The range-of-motion (ROM) of the right wrist was normal (addendum to the C&P).  The left was reduced as charted below.  Repetition increased her pain, but did not further limit the motion.  The neurological examination was normal.  Following separation, the CI had a second procedure (fusion of two wrist bones) on the left wrist on 13 January 2009 (as documented in a 28 October 2013 C&P examination).  It is not clear from the record if this was related to the pre-separation wrist pain.  The action officer noted that this particular procedure is done for arthritis, typically after trauma, of the wrist bones (carpals) and that this diagnosis was not in evidence prior to separation.  The CI also reported that she was left dominant at this evaluation.  The CI had rehabilitation in occupational therapy and achieved 30 degrees of dorsiflexion palmar flexion in the final note in evidence dated 23 June 2009, 5 months after the second surgery.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist pain and loss of motion at 10%, coded 5099-5024 (analogous to tenosynovitis [inflammation of the lining of a tendon]).  The VA rated the CI at 10% as well for left wrist strain, coded 5215 (limitation of motion of the wrist).  The Board noted that this is the highest rating available for either code and found no better coding option available.  The Board also noted that the rating is the same for the dominant and non-dominant hand rendering this issue moot.  The Board observed that the objective findings in evidence following the second operation on the left wrist area, 2 months after separation, support a 10% rating as well.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left wrist pain condition.  

Left Thumb Weakness Status Post Left de Quervains Release Condition).  The CI also reported tenderness and pain at the base of the left thumb.  The ROM was reduced as noted below to 60 degrees from the thumb to the fingertips and painful.  The VA C&P did not address the thumb separately, but did note a normal neurological examination for the left upper extremity.  The final OT note in evidence, dated 23 June 2009, after the second surgery, noted improved function and a grip strength of 40 pounds vice the right side 65 pounds.  The Board directed its attention to its rating recommendation based on the above evidence.  The Board considered the use of code 5228 (limitation of motion of the thumb), but the gap, if present, between the thumb pad and fingers is not documented.  The PEB used the code 5307 (Group VII muscles of the wrist and finger flexors) and rated it at 10% for a moderate disability.  The Board noted that the rating is the same for a moderate disability for the dominant and non-dominant side.  The evidence available for review provided no route to a rating higher than the 10% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left thumb condition.  

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the de Quervains release with left wrist pain and loss of motion and left thumb weakness conditions and IAW VASRD §4.71a and §4.73, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 4 Jan 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXX former USMC  
- XXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USMC 
- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXX former USN

						  XXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)