RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02362
BRANCH OF SERVICE:  Army	BOARD DATE:  20150203
SEPARATION DATE:  20050531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-4 (Unit Supply) medically separated for a wrist injury.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “right wrist injury with continued pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (see rating chart below) for PEB adjudication.  The Informal PEB adjudicated “crush injury, right wrist” unfitting, rated 0%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining conditions were determined to be not unfitting.  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 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:

Army IPEB – dated 20050427	VA* – based on Service Treatment Record (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crush Injury, Right Wrist	5099-5003	0%	Right Wrist Crush Injury	5215	10%	STR	
Obstructive Sleep Apnea	Not Unfitting	Sleep Apnea	6847	NSC	STR	
Meniscal Tear	
Not Unfitting 
	Right Meniscal Tear Condition	5299-5257	NSC	STR	
		Right Knee Pain Condition	5257	NSC	STR	
		Left Knee Pain Condition	5252	NSC	STR	
Other x 0 (Not In Scope)	Other x 0 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20051118 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Wrist Injury.  In August 2004, while deployed overseas, this CI suffered a wrist injury when a heavy box fell on his right wrist.  Radiologic imaging was negative for any fracture.  He was treated with splinting, but continued to have wrist pain.  The CI was evacuated from theater and returned to home station where he received treatment for his wrist injury.  However, in spite of treatment, the CI continued to have wrist pain.  Due to the chronic, persistent nature of his wrist symptoms, an MEB was initiated.  The MEB narrative summary was dictated on 8 February 2005.  The CI reported that he was unable to grasp with the right hand, without having significant pain.  On 2 March 2005, the CI had an MEB physical examination.  The right hand and wrist were noted to have decreased range-of-motion (ROM), and decreased grip.  Actual measurements of right wrist ROM were not recorded at that visit. 

After separation, the CI was scheduled for a VA Compensation and Pension exam on 2 September 2005.  However, he failed to appear for that exam.  The ROM evaluations in evidence, which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.

Right Wrist ROM
(Degrees)	Ortho PA ~ 7½ mos. Pre-Sep
(20041012)	OT ~ 7½ mos. Pre-Sep
(20041012)	OT ~ 6½ mos. Pre-Sep
(20041115)	
Dorsiflexion (70 Normal)	25	55	65	
Palmar Flexion (80)	25	30	55	
Ulnar Deviation (45)	25	normal	32	
Radial Deviation (20)	5	normal	22	

The Board carefully reviewed all available evidence, and directed attention to the following rating recommendation.  The Army PEB and the VA chose different coding and rating options for the right wrist condition.  The PEB coded it 5099-5003 (analogous to degenerative arthritis), and assigned a disability rating of 0%.  The VA used diagnostic code 5215 (wrist, limitation of motion) and rated it 10%.  The Board determined that the November 2004 occupational therapy (OT) exam was closer to the CI’s date of separation, so those ROM measurements had greater probative value than the other ROM measurements noted above.  At the November 2004 OT exam, there was 55 degrees of palmar flexion, and 65 degrees of dorsiflexion (extension).  Therefore, the painful right wrist condition was essentially non-compensable based on the 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 significantly 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 right wrist pain, due to crush injury.  It is appropriately coded 5299-5215, and IAW VASRD §4.40 and §4.45, meets criteria for a 10% rating.

Other MEB/PEB conditions.  In January 2005, the CI was diagnosed with OSA.  He was treated with continuous positive airway pressure (CPAP), which greatly improved his symptoms.  The MEB judged that the OSA condition failed to meet Army retention standards, IAW AR 40-501.  The MEB also forwarded a third condition, meniscal tear (medically acceptable).  In April 2005, the Army Informal PEB determined that both the OSA condition and the meniscal tear were not unfitting and therefore not ratable.

The Board’s main charge with regard to these two conditions is to assess the fairness of the PEB’s determination that these conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  These two conditions (OSA and meniscal tear) were reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  Specifically, with regard to OSA, the STR indicates that the CPAP treatment greatly improved his symptoms.  After due deliberation, in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the OSA and the meniscal tear.  Therefore, no additional disability ratings are recommended.

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.  As noted above, PEB reliance on the USAPDA pain policy for rating the right wrist pain may have been operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right wrist condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5215, IAW VASRD §4.40 and §4.45.  In the matter of the OSA and the meniscal tear, the Board unanimously recommends no change from the PEB determination as not unfitting.  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	
Crush injury, right wrist	5299-5215	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140522, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150010595 (PD201402362)

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:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA