RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00839
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Land Combat Electronic Missile System Repairer, medically separated for “reflex sympathetic dystrophy involving distal left upper extremity” with a disability rating of 20%.  

CI CONTENTION:  “Still suffering from pain, limiting actions, work load.  Left hand/wrist continues to lose feeling.” 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 - 20070306	VARD - 20070921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
RSD involving Distal LUE	8799-8713	20%	Residuals, Excision of Ganglion Cyst on Left Wrist	7805	0%	20070626	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Reflex Sympathetic Dystrophy (RSD) involving Distal Left Extremity (LUE).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI was identified as having a ganglion cyst of the left wrist in May 2005.  This was confirmed on an MRI.  Due to pain and swelling, surgical removal was accomplished on 26 January 2006.  The CI underwent rehabilitation in occupational therapy and initially did well.  However, he was deployed due to ops tempo requirements on 8 March 2006, 6 weeks after surgery.  He had progressive pain and loss of sensation which did not improve with time and ultimately led to medical evacuation from theater on 23 October 2006.  He was referred back to occupational therapy and also underwent a neurological evaluation on 7 November 2006.  It showed a subjective loss of sensation over the wrist near the excision site.  Electrodiagnostic testing (EDX) the same day was normal.  At an orthopedic evaluation on 12 January 2007, it was noted that the CI had persistent pain despite rest, physical therapy, and medications.  An examination of the left hand and wrist was unremarkable.  As the CI was unable to meet duty requirements, an MEB was initiated.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 13 February 2007, 2 months prior to separation, the CI reported chronic pain and loss of movement and strength since his surgery.  On examination, he reported pain with strength testing and was noted to have a (surgical) scar on the wrist.  The MEB NARSUM was the same day.  It noted that he had ongoing pain and took two Percocet (a narcotic) a day to control it.  On examination, he had slight sensitivity to touch on the right, but did not have skin changes such as a change in color, temperature, or hair pattern and did not have swelling or atrophy.  On testing, the range of motion (ROM) and strength were reduced.  At the VA Compensation and Pension (C&P) examination on performed 26 June 2007, 3 months after separation, the CI reported occasional numbness across the left hand, aggravated by lifting.  He did not use an assistive device and had no restrictions in activities from his left wrist.  He worked detailing windows (for his father’s construction company).  On examination, the scar was well healed.  Sensation and strength were intact.  Motion of all joints was recorded as full and pain free.  An X-ray was unremarkable.  The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Wrist ROM
(Degrees)	PT/MEB ~2 Mos. Pre-Sep
(20070130) p.45	
	Right	Left	
Dorsiflexion (70 Normal)	76	74	
Palmar Flexion (80)	60	56	
Ulnar Deviation (45)	30	31	
Radial Deviation (20)	20	10	
Comment		Motor reduced	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the analogous 8799-8713 code (analogous to a neuralgia of all cervical radicular groups), citing intermittent pain with activity.  The VA also assigned a 0% rating using 7805 code (scars) based on the VA C&P examination 3 months after separation, noting a well healed scar with normal strength, sensation, and motion of the wrist as well as a normal X-ray.  The Board considered the findings and found no route to a rating higher than the 20% adjudicated by the PEB.  It noted that the impairment from the RSD condition and the (excised) ganglion cyst were not severable and separate ratings were not supported.  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 RSD of the LUE condition.  

BOARD FINDINGS:  In the matter of the reflex sympathetic dystrophy condition and IAW VASRD §4.71a and 4.124a, 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 20150605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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, AR20170000802 (PD201500839)

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