RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03966
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030313

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

CI CONTENTION:  The applicant makes no specific contention in their application.  The CI’s complete submission 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 - 20021223	VARD - 20030626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Wrist…[Minor]	5099-5003	10%	Symptomatic Arthrofibrosis …Left Wrist Ganglia	5328-7804	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain Left Wrist.  According to the service treatment record and narrative summary (NARSUM) the right-handed CI experienced ongoing left wrist pain after excisional biopsy of a wrist mass (consisting of a ganglion cyst and some tendon lining) in 2002.  The condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for a Medical Evaluation Board (MEB).  At the time of a post-operative follow-up specialty exam on 1 August 2002 (7 months prior to separation) the CI reported difficulties with the wrist “locking up” and causing pain.  Examination showed 40 degrees of dorsiflexion (normal 70 degrees) and 30 degrees palmar flexion (normal 80 degrees).  Painful motion was present.  The examiner rendered a diagnosis of symptomatic arthrofibrosis (joint scarring) status post excisional biopsy of the wrist ganglion.

Left wrist range of motion (ROM) measurements by occupational therapy on 5 November 2002 (4 months prior to separation) showed dorsiflexion of 40 degrees and palmar flexion 45 degrees.  Left grip strength was 32 pounds and right grip strength was 100 pounds.  The NARSUM exam on 13 November 2002 noted complaints of left wrist pain with “locking up” which prevented push-ups, sit-ups and firing a rifle.  Physical exam showed a surgical scar on the dorsum of the left wrist and forearm with some atrophy of the left forearm measuring about 1.5 centimeters (approximately ½ inch) in circumference smaller than the right forearm.  Left grip strength was diminished.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating coded analogously to 5003 (chronic pain left wrist) citing the USAPDA pain policy.  The VA assigned a 10% rating under a combination 5328-7804 code (muscle, neoplasm of, benign, postoperative symptomatic; scar, unstable or painful), and cited painful superficial scar as the rating rationale.  In this case, limitation of wrist motion (code 5215) was insufficient to warrant the highest 10% rating under that code.  However, there was satisfactory evidence of painful motion to justify a 10% rating IAW VASRD §4.59.  Using the VA’s scar coding pathway, the next higher 20% rating requires “three or four scars that are unstable or painful.”  Since this stipulation was not satisfied, a higher rating was not supported via that option.  Ankylosis coding and muscle injury pathways were inapplicable.  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 wrist condition. 

BOARD FINDINGS:  In the matter of the chronic pain left 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 20140911, 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 XXXXXXXXXXXXXXXXXX, AR20160009432 (PD201403966)

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