RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02773
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020225

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Cavalry Scout) medically separated for right wrist pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The permanent U3 profile allowed for a modified two-event (2-mile run and sit-ups) fitness test to satisfy physical fitness standards.  He was referred for referred for a Medical Evaluation Board (MEB) and “chronic right wrist pain, refractory to aggressive conservative treatment” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated his right wrist as unfitting, rated 0%, for slight and occasional pain, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated. 

CI CONTENTION:  “Please consider all conditions.”  His 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 20020204	VA* -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Wrist	5099-5003	0%	Residuals, Right Wrist Injury	5010	10%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20020223 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  The STR did not contain a VA Compensation & Pension (C&P) examination.   The pertinent historical medical information was obtained from the original VARD summary as well as a paucity of case file clinical encounter documents.

Right Wrist Condition.  The CI injured his right wrist during a fall in October 2001.  Initial and repeat plain X-rays revealed no fracture.  A bone scan obtained in November 2001 revealed findings of degenerative changes in both wrists, worse on the right.  He was permanently profiled in January 2002 with a diagnosis of right wrist pain and referred to an MEB.  At the MEB narrative summary examination on 29 January 2002 (a month before separation), the CI reported the inability to lift with the right hand and pain with any attempted use of his right hand.  His physical examination (PE) revealed tenderness and pain, but full range-of- motion (ROM) of the right wrist.  There was no evidence of effusion or edema.  The examiner rated the CI’s pain as ‘mild’ and ‘occasional’.  As previously noted, there was no VA examination available. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist pain condition at 0% using the analogous arthritis VASRD code 5099-5003 and citing the USAPDA pain policy.  The VA rating of 10% was under 5010 (arthritis due to trauma) citing painful motion.  The normal PE with regards to ROM is not compensable under VASRD criteria for the wrist limitation of motion disability codes, however Board members agreed that painful motion and tenderness was present in support of a 10% rating under VASRD §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right wrist 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the wrist was 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 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board 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	
Chronic Right Wrist Pain 	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160003880 (PD201402773)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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