RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00091
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Special Purposes Vehicle & Equipment Maintenance Apprentice, medically separated for “extensor tendinosis left wrist” with a disability rating of 10%.  

CI CONTENTION:  The CI requests the Board consider all conditions.  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 based upon a 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 - 20030304	VARD -20040805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Extensor Tendinosis Left Wrist	5308	10%	Extensor Tendinitis, de Quervain Left Wrist, Hand and Fingers	5024	0%	20040601	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Extensor Tendinosis Left Wrist (Non-Dominant).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left extensor tendinosis condition began in August 2002 due to recurrent use at his mechanic job.  Electro-diagnostic studies in September 2002 were normal without evidence of neuropathy.  At an orthopedic consultation in November 2002 (5 months prior to separation), the CI reported dorsal hand pain and a “creaking” sensation when opening the hand.  Physical examination showed full wrist range of motion with crepitus on flexion and extension of the fingers, “mildly positive Finkelstein” testing (pain in tendon of thumb with ulnar deviation of wrist), with no tenderness over the scaphoid bone.  The examiner diagnosed de Quervain tenosynovitis of the left thumb and extensor tendinosis of the fingers.  

At an orthopedic consultation in December 2002 (4 months pre-separation), the CI reported improvement after splinting and occupational therapy.  Physical examination showed a negative Finkelstein test, with no tenderness over the dorsal wrist, and audible snapping with extension and flexion of the digits.  The examiner opined that the tenosynovitis was resolving however the ‘snapping’ was to be rechecked in 1 month following steroid medications.  

At a second opinion orthopedic consultation 10 days later, the CI reported pain localized to the dorsum of the hand, worse with grip.  The physical examination showed no swelling, no tenderness, full wrist range of motion, and pain with resisted extension of the fingers.  Recent radiographic evaluations (X-rays and MRI) were reportedly normal, with no evidence of mass, and normal bony and ligamentous soft tissues.  The diagnosis of extensor tendonitis was reaffirmed and continued splinting with occupational therapy was recommended.  At an orthopedic follow-up visit in January 2003 (3 months pre-separation), the CI reported 35% improvement.  Physical examination showed positive Finkelstein testing, with tenderness and swelling over the 1st dorsal compartment (tendons that control thumb movements).  

Despite treatment, the left extensor tendinosis condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “extensor tendinosis left wrist unresponsive to conservative management” for PEB adjudication.  At the MEB NARSUM examination dated 30 January 2003 (3 months pre-separation), the CI reported “knuckles popping” with pain radiating up the forearm, numbness and decreased grip.  The physical examination showed wear of a splint, full wrist range of motion and normal strength.  There was tenderness of the thumb extensor tendon (first dorsal compartment) extending proximally over the forearm.  

At the VA Compensation and Pension (C&P) examination dated 1 June 2004 (13 months after separation), the CI reported pain that was only associated with flare ups (from frequent use), occurring twice weekly, and lasting 2 hours to half of the day.  He also reported stiffness, occasional swelling, weakness and associated numbness and tingling, crepitus and lack of endurance during the flare-ups.  Physical examination showed no tenderness, swelling or redness of the wrist, with normal strength and no evidence of atrophy. There was normal dorsi- and palmar flexion, and normal ulnar and radial deviation, all without pain.  Testing for tenosynovitis of the thumb and fingers was negative.  Radiologic evaluation of the bilateral hands reportedly showed no significant abnormalities.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the “extensor tendinosis, left wrist” coded 5308 (Group VIII.  Function: extension of the wrist, fingers, and thumb).  The VA rated 0% for the “extensor tendonitis, de Quervain, to include left wrist, hand and fingers” coded 5024 (tenosynovitis), citing no objective findings of painful or limited motion.  

The Board considered the evidence for a higher rating.  There was no evidence of ankylosis (5214) for a higher rating.  There was no evidence of more significant limitations of motion at the wrist (5215) and no higher rating under that code.  There was intermittent evidence of painful motion and tenosynovitis to support a pre separation disability rating of 10% coded 5308.  There was no evidence of a “moderately severe” disability in extension of the wrist and fingers that would support a higher rating under 5308.  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 left wrist extensor tendinosis condition.  

BOARD FINDINGS:  In the matter of the left wrist extensor tendinosis condition and IAW VASRD §4.71a and §4.73, 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 20150130, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00091.

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