RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03801
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041007

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Generator Mechanic, medically separated for “chronic pain, right wrist,” with a disability rating of 10%.

CI CONTENTION:  Hand and wrist conditions limit mobility. The CI’s complete submission, with attachments, is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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:

 SERVICE PEB - Dated 20040820	VARD - 20050106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Wrist	5099-5003	10%	History of Perilunate Dislocation, Right Wrist	5215-5010	10%	20050106	
			Postsurgical Scarring of Right Wrist	7804	10%	20050106	
RATING:  10%	RATING:  50%	

ANALYSIS SUMMARY:

Chronic Pain, Right Wrist.  The CI is right hand dominant.  The CI injured his right wrist while playing basketball in August 2000 and underwent surgical fixation of a dislocated lunate bone.  After extensive occupational therapy, the CI remained with chronic pain and weakness; eventually was referred to a Medical Evaluation Board (MEB).  His permanent profile of May 2005 listed the diagnosis as perilunate dislocation of the right wrist.  At the MEB narrative summary (NARSUM) examination (3 August 2004; 2 months prior to separation), the CI reported constant dull right wrist pain aggravated with use.  Additionally, he reported decreased grip strength which limits his ability to lift objects greater than 10-20 pounds or perform pushups or pull ups.  The right upper extremity focused physical examination was normal excepting decreased range of motion (ROM) of the right wrist.  The examiner assessed the CI’s pain as “moderate” and “constant.”  His diagnosis remained as chronic right wrist pain status post surgical fixation.

At the VA Compensation and Pension (C&P) examination (15 January 2005; 3 months after separation), the CI endorsed right wrist pain and stiffness associated with paresthesia (altered sensation) on the outside of his hand.  Additionally, he reported weakness in gripping and grabbing with the right hand.  His physical exam revealed tenderness and global decrease in wrist ROM.  There was no comment in regards to the presence of painful motion.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.
Right Wrist ROM
(Degrees)	MEB ~2 Mo. Pre-Sep
(20040803)	VA C&P ~3 Mo. Post-Sep
(20050106) 	
Dorsiflexion (70 Normal)	30	30	
Palmar Flexion (80)	40	30	
Ulnar Deviation (45)	30	20	
Radial Deviation (20)	15	5	
Comment	Painful motion with ulnar grind	Tenderness; Painful motion not cited	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition at 10% using VASRD code 5099-5003 (Analogous for arthritis, degenerative) indicating involvement of at least two major joints.  The VA’s 10% rating was dual coded under 5215-5010 (Wrist, limitation of motion and traumatic arthritis) in the dominate upper extremity and cited limited motion for its rating.  Board members agreed there was decreased right wrist ROM on both pre and post-separation examinations.  All Board members agreed that absent evidence of wrist ankylosis code 5214 or periods of incapacitation under code 5003.  A 10% rating is the maximum impairment level supported in this case.  There were no other coding options available that would render a higher rating than 10% as adjudicated by the PEB.  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 right wrist condition.

BOARD FINDINGS:  In the matter of the right wrist 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 20140819, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 JUL 2016

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 AR20160009353 (PD201403801)

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