RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01450
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Helicopter Mechanic, medically separated for “right wrist and hand pain” and “right shoulder pain,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  The applicant contends he was given a higher rating for his conditions by the VA.  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 - 20081119	VARD - 20090715	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right (Dominant) Wrist and Hand Pain with Osteoarthritis, Status
Post ORIF of Proximal Right Fifth Metacarpal Fracture	5003	10%	Postoperative Fracture of The Right Hand, 5th
Metacarpal Joint	5223	10%	20090408	
Chronic Right (Dominant) Shoulder Pain, Status Post Arthroscopic Labral
Repair and Debridement	5099-5003	10%	Postoperative Biceps Tear and Labral Tear of The Right Shoulder.	5201-5203	10%	20090408	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Chronic Right (Dominant) Wrist and Hand Pain with Osteoarthritis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right wrist and hand pain condition began in August 2007 after punching a wall.  In February 2008 he was referred to a civilian orthopedic surgeon for nonunion of the fifth metacarpal fracture.  The CI underwent open reduction internal fixation of the nonunion in April 2008 and fusion of the right fourth and fifth carpometacarpal joints in August 2008.  The CI continued to report firth hand pain.  The MEB forwarded “chronic right (dominant) wrist and hand pain with osteoarthritis” for PEB adjudication.  

The MEB NARSUM examination on 23 October 2008, (3 months prior to separation), showed tenderness along the proximal fourth and fifth lateral metacarpals in the lateral aspect of the wrist without evidence of swelling. Dorsiflexion was limited to 60 degrees (normal 70), palmar flexion to 55 degrees (normal 80), and ulnar deviation to 15 degrees (normal 45).  

At the VA Compensation and Pension (C&P) examination in April 2009, performed 3 months after separation, the CI reported right hand pain with intermittent use of a wrist brace and an inability to perform repetitive work related activities.  Physical examination showed a tender right hand scar and painful wrist motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5003 code (degenerative arthritis), citing painful motion.  The VA also assigned a 10% rating using code 5223 (two digits of one hand, favorable ankylosis) based on the VA C&P examination 3 months after separation, citing two fingers other than the index finger and thumb as favorably ankylosed.  The Board noted that there was not an avenue to a higher than 10% rating for the right wrist and hand pain condition.  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 chronic right (dominant) wrist and hand pain with osteoarthritis condition.  

Chronic Right (Dominant) Shoulder Pain.  According to STR and the MEB NARSUM, the CI’s right shoulder pain condition began in July 2007 while working on a helicopter gun mount.  He reported persistent right shoulder pain for the next 10 months.  In March 2008, an MRl·revealed a labral tear and tendinosis.  In June 2008, he underwent arthroscopic surgery repair and debridement.  During that surgery, the CI had a bicep tear which was also addressed.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right shoulder pain, with degenerative joint disease” for PEB adjudication.  At the MEB physical therapy consult on 21 August 2008, (5 months prior to separation), the CI reported his right shoulder was stronger and had more range of motion (ROM).  The examiner recorded his right shoulder ROM as follows:  Flexion was 135 degrees (normal 180) limited by painful motion.  According to the MEB NARSUM evaluation on 23 October 2008, (3 months prior to separation), the CI reported continued right shoulder pain after surgery.  The examiner noted his right shoulder joint and bicep tendon showed tenderness with chronic pain and residual arthritis.  At the VA C&P examination on 04 April 2008, performed 3 months after separation, the CI reported right shoulder soreness, stiffness and pain with repeated overhead activities.  The examiner noted the CI could “abduct and flex to 140 degrees” (normal 180) ROM and documented that there was painful motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (degenerative arthritis), citing painful motion.  The VA also assigned a 10% rating using an analogous 5201-5203 code (arm limitation of motion and clavicle or scapula impairment) for pain throughout the ROM.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (approximately 90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was no limitation of motion to support a rating under 5201, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  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 right shoulder condition.  

BOARD FINDINGS:  In the matter of the chronic right (dominant) wrist and hand pain with osteoarthritis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the chronic right (dominant) shoulder pain 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.  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 20140220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR2016001 0059 (PD201401450)

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 and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA