RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03158
BRANCH OF SERVICE:  Army	BOARD DATE:  20150423
SEPARATION DATE:  20050108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Infantry Mortarman, medically separated for chronic 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).  “Traumatic degenerative changes at the left wrist, and snapping tendon” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic left wrist pain, with history of a fall during basic, and ultimate surgery to remove a ganglion” as unfitting, rated 0%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI requested that the Board review all of his 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: 

Army IPEB – Dated 20041105	VA* – (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Wrist Pain	5099-5003	0%	Residuals of Left Wrist Injury	5010-5215	10%	20041108	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050128 (most proximate to date of separation (DOS))  

ANALYSIS SUMMARY:  

Left Wrist Pain.  During basic training, this CI fell and injured his left (non-dominant) wrist.  He was treated with profile and Ibuprofen (Motrin).  Over time, his wrist pain got worse.  He was seen by Orthopedics and by Hand surgery.  It was decided that he was not a surgical candidate at that time.  In March 2003, he deployed with his unit.  During his deployment, he noted increased pain and increased “snapping” of the left wrist.  The CI was medically evacuated from theater.  Arthroscopic surgery was performed for removal of a ganglion and debridement at the scapholunate ligament.  After surgery, he was better.  However, following his return to duty, the wrist symptoms returned and MEB was initiated.  The MEB physical examination (PE) was in August 2004, and it was normal.  Left wrist range-of-motion (ROM) testing revealed a palmar flexion of 73 degrees and dorsiflexion (extension) of 70 degrees.  There was some pain with motion.  Repetition did not cause additional loss of ROM.  In the MEB narrative summary, the diagnosis was: “Traumatic degenerative changes at the left wrist, and snapping tendon.” 

The CI was medically separated from service on 8 January 2005.  Two months before separation, on 8 November 2004, he had a VA Compensation and Pension (C&P) exam.  He reported that his overall health was good, but he couldn’t work out as well as he used to.  He could sustain heavy physical activities without immediate distress, but could not do pushups, due to the left wrist pain.  On PE, he appeared fit and healthy, and in no distress.  PE of the left wrist revealed visible snapping of the extensor carpi ulnaris tendon.  Wrist ROM was “full.”  Grip strength was normal, and neurovascular status was intact.  The ROM evaluations which the Board weighed in arriving at its recommendation, are summarized below.

Left Wrist ROM
(Degrees)	MEB ~5 mos. Pre-Sep
(20040810 )	VA C&P ~2 mos. Pre-Sep
(20041108)	
Dorsiflexion (70 Normal)	73	“full”	
Palmar Flexion (80)	70	“full”	
Ulnar Deviation (45)	46	“full”	
Radial Deviation (20)	10	“full”	

The Board directed its attention to its rating recommendation based on the above evidence. The November 2004 C&P exam was just 2 months before separation, so that exam had significant probative value.  At that exam, there was full ROM of the left wrist.  Therefore, the painful left wrist condition was essentially non-compensable based solely on the VASRD §4.71a 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, IAW VASRD §4.40 and §4.45.

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 was operant in this case and the unfitting wrist condition was adjudicated independently of that policy by this Board.  In the matter of the chronic left wrist pain, the Board unanimously recommends a disability rating of 10%, coded 5299-5215, IAW VASRD §4.40 and §4.45.  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	
Chronic left wrist pain, with history of a fall 	5299-5215	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140616, 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 XXXXXXXXXXXXXXXXXX, AR20150018722 (PD201403158)

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