RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03873
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Light Wheel Vehicle Mechanic) medically separated for right wrist pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic pain, right wrist” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated her wrist pain as unfitting and rated it at 10% for slight and frequent pain citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant requests consideration of all conditions in her application.  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 20040907	VA* - (~2 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Wrist	5099-5003	10%	Postoperative Residuals, 1st Dorsal Compartment Release, Right Wrist De Quervain’s Tenosynovitis	5215-5024	10%	20041018	
			Scar, Residual, Right Wrist Surgery	5215-7805	0%	20041018	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 4 	
RATING: 10%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20041227 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right Wrist Condition.  The narrative summary (NARSUM) noted the CI developed DeQuervain’s tendonitis (inflammation of tendons of the thumb along the thumb aspect of the wrist) of her non-dominant right wrist.  She was treated with bracing, therapy, and steroid injections, but the tendonitis was recurrent and the CI underwent surgery for release of the tendons on 5 December 2003.  Following the surgery, despite additional treatment with therapy and steroid injection, the wrist pain continued with use and an MEB was initiated.  At the MEB exam, 4 months before separation, the CI reported right wrist pain   The MEB physical exam noted a well-healed scar and tenderness of the tendons on the thumb aspect of the wrist (positive Finklestein’s stress test).  Wrist range-of-motion (ROM) was extension 60 degrees (normal 70) and flexion 75 degrees (80), with painful resisted abduction of the thumb.  Neurological exam was normal.  

At the VA Compensation and Pension (C&P) exam performed 2 months before separation, the CI reported right wrist pain and use of a wrist brace.   Right wrist ROM was normal and there was no additional loss of ROM with repetition.  There was no muscle atrophy noted and no neurological deficit.  Wrist X-rays in 2003 and January 2004 were noted to be normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right wrist condition 10%.  The PEB coded the wrist condition 5099-5003 and cited the USAPDA pain policy and the VA coded it 5215-5024 (tenosynovitis with limited wrist motion).  The Board agreed that the evidence supports a 10% rating of the right wrist coded as 5024 according to VASRD 5003 rating criteria for tenosynovitis of a single major joint or group of minor joints with limited motion.  The Board reviewed to see if the evidence supports a higher rating with any other applicable code, but there was no evidence of wrist ankylosis and a 10% rating is the highest rating available for a single joint coded as 5024.  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:  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 right 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 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.  

RECOMMENDATION:  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 20140815, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 (PD201403873)

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