RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX                                                                                 CASE:  PD-2014-01163
BRANCH OF SERVICE:  AIR FORCE                                                                    BOARD DATE:  20140924
SEPARATION DATE:  20090203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard SSgt/E-5 (2A6X6/Aircraft Pneudraulics System Technician) medically separated for a chronic left wrist condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a temporary U3 profile and referred for a Medical Evaluation Board (MEB).  The left wrist condition, characterized as “tear of the triangular fibro cartilage complex of the left wrist, with chronic pain”, was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic left wrist pain, status-post repair of triangular fibro cartilage complex” as unfitting, rated at 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Left wrist, left shoulder, left elbow, PTSD secondary to injuries discharged for.  Developed PTSD while still in military from injury on January 19th 2007.  Wasn’t discharged until February 3rd 2009.  Was being treated for PTSD since 2008 and was having anxiety and depression since surgery.”[sic]

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left wrist condition is addressed below; additionally the contended left shoulder, left elbow and post-traumatic stress disorder conditions are not within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Air Force Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20081208	VA - (1 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain	5215	10%	Tenosynovitis, Left Wrist (Non-dominant)	5024	10%*	20090123	
No Additional MEB/PEB Conditions	Other x4	
Combined:  10%	Combined:  50%	
*Derived from VA Rating Decision (VARD) dated 20081208 (most proximate to date of separation)
*VARD 20081208 10% from 20070902, 100% from 20071101 and 10% from 20080601

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews service treatment records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separation; and to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Left Wrist Condition:  The CI reported that he slipped and fell injuring his left, non-dominant arm, wrist on January 19 2007.  He was evaluated in the emergency room where X-ray images were negative for fracture.  He was diagnosed with a wrist sprain and treated with non-steroidal anti-inflammatory drugs.  He continued to experience left wrist pain a diagnostic magnetic resonance imaging (MRI) study was obtained in April 2007.  Although the MRI was essentially normal, his clinical symptoms, mechanism and pain was convincing for the hand surgeon to schedule endoscopic exploration and endoscopic draining of a triangular fibro cartilage complex (TFCC) tear.  The CI underwent repair of the TFCC tear in November 2007.  Extensive post-operative physical therapy resulted in reduced wrist pain, still described as moderate, with some residual decreased range-of-motion (ROM).

The narrative summary (NARSUM) (prepared approximated 5 months prior to separation), documented persistent pain, which required medication daily with narcotics for the past 18 months.  He made some progress with additional sessions of physical therapy, but was finally discontinued on June 3, 2008 because he had reached a plateau of functional recovery of decreased ROM and strength in his left hand.  The pertinent physical exam findings are documented in the chart below.

At the VA Compensation and Pension (C&P) exam performed a month prior to separation, the CI reported he continued to wear a brace about his left wrist and avoided any activity with the left upper extremity.  He reported significant pain and noted that he had to take a considerable amount of medication.  He denied any weakness, but noted stiffness and swelling in the left wrist.  The CI was limited by pain and therefore no fatigability or endurance issues were reported.  The physical exam findings are summarized in the chart below.

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 following chart:

Left Wrist ROM (Degrees)	PT ~ 8 Mo. Pre-Sep	VA C&P ~1 Mo. Pre-Sep	
Dorsiflexion (70 Normal)	40	30	
Palmar Flexion (80)	40	30	
Ulnar Deviation (45)	25	20	
Radial Deviation (20)	10 	10	
Comment: Right Hand Dominant	Decreased strength; No tendonitis	Pos. painful motion; Normal strength	
§4.71a Rating	10%	10%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated this case by applying VASRD code 5215, limitation of wrist motion and rated it 10% citing VASRD standards.  The VA applied code 5024, tenosynovitis and rated it 10% citing “…based on the findings of MRI evidence of tenosynovitis with painful motion of the left wrist”.  As directed by the VASRD, code 5024 is rated under code 5003.  The Board reviewed the left wrist ROM data which did not meet compensable levels for any wrist specific VASRD code.  However, the evidence does support application of VASRD §4.59, painful motion, criteria and the resulting at 10% rating under code 5003 as applied by the PEB.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed was that a disability rating of 10% for the left wrist condition was appropriately recommended in this case.

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 chronic left wrist pain, status-post repair of tear of triangular fibro-cartilage complex condition and IAW VASRD §4.71a, 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 20140305, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-01163

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

							

Attachment:
Record of Proceedings