RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01284
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Food Service Specialist, medically separated for “right (dominate) wrist pain,” with a disability rating of 10%.  

CI CONTENTION:  “Review 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 - 20071113	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominate) Wrist Pain	5099-5003	10%	No VA examination in evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Right (Dominate) Wrist Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right wrist condition began in June 2006 after falling onto his outstretched right wrist while running.  Radiographic imaging (X-rays) revealed no significant degenerative joint disease or significant carpal collapse.  Despite treatment, the right wrist pain 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 “right wrist pain” for PEB adjudication.  In the MEB consultation report performed by orthopedics on 13 June 2007, 8 months prior to separation, the CI reported complaints of pain with activities, such as carrying weights, doing push-ups or lifting objects with his right wrist.  The CI also stated that occupational therapy yielded minimal improvement and no relief of pain with the use of nonsteroidal anti-inflammatories and a brace.  Physical examination showed significant tenderness to palpation and pain on the ulnar side of the wrist (side adjacent to the small finger).  Range of motion (ROM) demonstrated 10 degrees of extension dorsiflexion (normal 70) and 30 degrees of palmar flexion (normal 80).  There was decreased sensation in the region of the incision.  The examiner documented the absence of carpal collapse.  

At the MEB NARSUM on 18 September 2007, 4 months prior to separation, the CI complained of right wrist pain.  Physical examination showed significant tenderness to palpation on the ulnar side of the wrist and increased pain with ulnar deviation, flexion and extension.  The ROM documented by occupational therapy on 18 September 2007 was 55 degrees of dorsiflexion, 45 degrees of palmar flexion, 25 degrees of ulnar deviation, and 10 degrees of radial deviation. Movement in all planes was limited by pain and radial deviation was limited by tissue tightness.  There was no VA Compensation and Pension examination for this Board to review.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist pain condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy rated for slight/frequent pain.  Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of painful motion. There was no ankylosis a higher rating.  There was no evidence of nerve involvement resulting in motor deficits for an addition rating under the neuralgia/neuritis codes.  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 (dominate) wrist condition.  

Contended PEB Conditions:  Cervical Spine Fusion and Left Deltoid Atrophy.  The Board’s main charge is to assess the fairness of the PEB’s determination that cervical spine fusion and left deltoid atrophy contended conditions were not unfitting.  The cervical spine fusion condition was not profiled, implicated in the commander’s statement and was not judged to fail retention standards. The left deltoid atrophy condition was listed in a profile, however no substantiating evidence to corroborate this condition’s disposition as unfitting was found in the CI’s file and it was not judged to fail retention standards. There was no performance-based evidence from the record that cervical spine fusion and or the left deltoid atrophy condition significantly interfered with satisfactory duty performance at separation. Additionally, although both contended conditions existed prior to service (EPTS), these conditions did not meet the 8-Year Rule for EPTS: Title 10, United States Code (Sec. 1207a) which stipulates that a military member must have accrued 8 years of active duty time in order to receive Service disability for a pre-existing condition not aggravated by service.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right (dominate) wrist condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended cervical spine fusion and the left deltoid conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. 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 20150615, w/attachments
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170002463 (PD201501284)

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