RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02328
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20020524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Network Systems Operator, medically separated for left wrist pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).   The “chronic left wrist pain and chondromalacia” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “left wrist pain” as unfitting, rated 0%. The CI made no appeals and was medically separated.   

CI CONTENTION:  “Please consider all conditions.”  

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 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 20020212	VA* - (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (ND) Wrist Pain	5215	0%	Residuals of Left Wrist Injury & Surgery 	5014-5024	10%	20020328	
Other x 0 (Not In Scope)	Other x 4	
RATING:  0%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20020709 (most proximate to date of separation (DOS))  

ANALYSIS SUMMARY:    

Left wrist pain.  In April 1998, this CI fell and injured his left wrist.  He was diagnosed with a tear of the scapho-lunate ligament.  Arthroscopy was done on the left wrist, and chondromalacia was noted.  It was determined that the CI was not a candidate for surgical repair of the torn ligament.  He was treated with physical therapy (PT) and occupational therapy (OT).  However, in spite of all treatment efforts, the wrist pain persisted.  Due to the chronic, persistent nature of the wrist pain, an MEB was initiated.  The MEB physical examination (PE) was on 9 January 2002.  On PE of the left wrist, there was tenderness directly over the scapho-lunate ligament.  Range of motion (ROM) was measured, and is summarized in the chart below.  The CI was medically separated from service on 24 May 2002.  Two months before separation, on 28 March 2002, he had a VA Compensation and Pension (C&P) exam.  There was mild to moderate limitation of motion, with pain on motion, along with tenderness to palpation (TTP).

The Board directed its attention to its rating recommendation based on the above evidence.  The Board determined that the January 2002 MEB exam was about four and a half months before the CI’s date of separation (DOS), so those ROM measurements had greater probative value than the other ROM measurements noted above.  At that January 2002 MEB exam, there was approximately 40 degrees of palmar flexion, and about 40 degrees of dorsiflexion (extension).  Therefore, the painful left wrist condition was essentially non-compensable based solely on the VA Schedule for Rating Disabilities (VASRD) §4.71a diagnostic codes for loss of wrist motion (5214 and 5215).  However; IAW VASRD §4.40 (functional loss) and §4.45 (the joints), 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 loss and disability due to painful motion of a major joint.  There was no path to a higher rating since there was insufficient evidence of a seriously disabling wrist abnormality that would justify a higher rating.  After due deliberation, the Board determined that a rating of 10% was appropriate.  Considering all of the evidence, and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a rating of 10% for chronic left wrist pain.  It is appropriately coded 5299-5215, and IAW VASRD §4.40, §4.45, and §4.71a, meets criteria for a 10% rating.

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 condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5215, IAW VASRD §4.40, §4.45, and §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board, therefore, 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	
Left (non-dominant) Wrist Pain 	5299-5215	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140507, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR20150018405 (PD201402328)

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, I accept the Board's recommendation to modify the individual's disability rating to 10% without recharacterization 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