RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2014-02806 
BRANCH OF SERVICE:  Army  	SEPARATION DATE: 20080509 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Human Resources Specialist) medically separated for “right hand pain, post first dorsal compartment release,” rated at 10%.  

CI CONTENTION:  The CI requested that the Board review all of her conditions.  Her 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 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 20080416	VA* - 5 months Post Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hand Pain, Post First Dorsal Compartment Release	5024	10%	De Quervain Syndrome, Right Wrist	5214	20%	20081010	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1	
RATING:  10%	COMBINED RATING: 30%	
*Derived from VA Rating Decision (VARD) dated 20081031 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Right Hand Pain Condition.  The right handed CI underwent right thumb tendon release surgery on 16 October 2007 (7 months prior to separation) for treatment of De Quervain’s tendinitis (inflammation of a thumb tendon).

The narrative summary (NARSUM) on 23 January 2008 (4 months prior to separation) reported continued pain, numbness and tingling over the surgical incision site which prevented typing.  Physical exam showed a tender but well-healed surgical site.  Painful motion was present.  Wrist palmar flexion was 90 degrees (normal 80 degrees) and dorsiflexion 90 degrees (normal 70 degrees).  Examination by occupational therapy (OT) on 4 March 2008 (2 months prior to separation) found palmar flexion of 70 degrees after repetitive motion, and dorsiflexion of 60 degrees.  Range-of-motion (ROM) was limited by pain.  Right hand grip strength was slightly reduced, but the CI was able to form a full composite fist and to fully oppose the thumb to all digits.  At the VA Compensation and Pension (C&P) exam performed 5 months after separation, the CI reported right wrist pain that occurred weekly, lasted for hours and was alleviated by rest and use of a brace.  However, another part of the report stated that pain occurred daily.  Examination showed right wrist dorsiflexion of 40 degrees and palmar flexion of 40 degrees.  Painful motion was present.  “Impaired strength or dexterity of this (right) hand” was reported, but it was also stated that motor strength was normal.  A one centimeter gap was present between the right thumb and fingers during forced opposition of these digits.

The Board directed attention to its rating recommendation based on the above evidence.  Under the 5024 coding pathway (tenosynovitis), the PEB cited VASRD §4.40 (functional loss) and §4.59 (painful motion) as rationale for a 10% rating.  Using the 5214 code (wrist, ankylosis of) the VA assigned a 20% rating.  The Board noted that wrist or thumb ankylosis was not present, thus a rating under the 5214 code or via a thumb amputation pathway was not supported.  Board members agreed that application of §4.40 or §4.59 for a 10% rating was appropriate in this case, but considered alternate pathways to a higher rating.  However, a compensable rating was not justified for limitation of motion under the 5215 code (wrist, limitation of motion of) or the 5258 code (thumb, limitation of motion).  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 bilateral 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.  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 right hand 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 20140603, 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 XXXXXXXXXXAR20160004022 (PD201402806)

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