RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX						            CASE:  PD-2014-04339
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20081112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Aerospace Propulsion Craftsman) medically separated for a right wrist condition.  The right wrist condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was placed on light duty and referred for a Medical Evaluation Board (MEB).  “Chronic right wrist pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic right wrist pain status post arthroscopy with posterior interosseous nerve neurectomy” and “decreased extension right wrist” as unfitting, rated 10% and 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  

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 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 20080908	VA* - (~1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Pain s/p Arthroscopy with Posterior Interosseous Nerve Neurectomy	8716	10%	Right Wrist Tendonitis	5215-5024	10%	20081216	
Decreased Extension Right Wrist	5099-5003	10%					
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7 	
RATING:  20%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20090428 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Right Wrist Pain s/p Arthroscopy with Posterior Interosseous Nerve Neurectomy and Decreased Extension.  The CI was right hand dominant.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s right wrist pain began in August 2007 after an injury.  Radiographic studies were negative.  Pain persisted despite conservative therapy and the CI underwent right wrist surgery in February 2008 for nerve removal (posterior interosseous nerve neurectomy).  Despite treatment, the CI’s right wrist condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).  

At the time of the occupational therapy clinic appointment on 15 May 2008, the CI reported continued wrist pain with extension, constant pain and the need for a splint to sleep.  On examination grip strength was normal and there was painful, limited motion as summarized below.  

At the MEB NARSUM examination on 16 June 2008, performed 5 months before separation, the CI reported continued wrist pain 7-10/10 exacerbated by activity with interference with duty.  The MEB physical exam noted well healed scars, painful wrist motion and a small (2-3 mm) mobile nodule on the back of the hand.  

At the VA Compensation and Pension (C&P) examination on 16 December 2008, performed 1 month after separation, the CI reported a similar injury and surgical history and complaints.  Physical exam showed a non-tender wrist scar, with a tender wrist and painful motion (to normal limits) following repetition.  Neurologic exam was normal for motor, sensory and reflex testing with “peripheral nerve involvement was not evident during examination.”  The diagnosis was right wrist tendonitis.  

The goniometric range-of-motion (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)	OT ~6 Mo. Pre-Sep	MEB ~5 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
Dorsiflexion (70 Normal)	54	70	70	
Palmar Flexion (80)	62	80	80	
Comment	Painful motion; “lacking 12 degrees of extension”	Painful Motion	Painful after repetition	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10% (coded 8716, ulnar nerve neuralgia), citing mild pain and inability to lift over 20 pounds; plus 10% (coded 5099-5003), citing limited ROM.  The VA rated the right wrist condition 10% (coded 5215-5024, wrist, limitation of motion-tenosynovitis), citing painful motion on repetition.  All exams documented painful motion and the wrist was not ankylosed (frozen).  There was no avenue to a higher rating for the wrist condition.  There was no fixed neurologic deficit of the right upper extremity and insufficient evidence of a moderate impairment of the ulnar nerve for any higher peripheral nerve neurologic rating.  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 conditions.  

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 wrist conditions and IAW VASRD §4.124a. and §4.71a, the Board unanimously recommends no change in the PEB adjudications.  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 20141221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear 

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-04339.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings