RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01810
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20020415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Supply Management Journeyman, medically separated for “chronic right wrist pain,” with a disability rating of 10%.

CI CONTENTION:  The CI requests that all conditions be considered.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20020228	VARD - 20021118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Wrist Pain	8715	10%	R Wrist, Ganglion Cyst…Tenosynovitis	5015-5024	0%	20021007	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Wrist Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s “chronic right wrist pain” condition began in December 2000 with gradual onset of pain.  In February 2001 a small, mobile, cyst-like structure (a ganglion cyst) was noted at a medical appointment, which the CI declined to have surgically removed.  

The 17 December 2001 MEB NARSUM, 4 months prior to separation, noted complaints of an inability to lift objects without pain.  Physical examination showed a 1.5 cm ganglion on the right wrist, which was tender, with an otherwise normal wrist.  Range of motion (ROM) was limited very slightly in flexion and extension, but not abduction (radial deviation) or adduction (ulnar deviation).  At the 7 October 2002 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported  intermittent symptoms of right wrist discomfort from overuse or carrying things.  She indicated at times there was some redness and tenderness on the back of the hand, which extended up to the forearm, which the examiner felt was consistent with tenosynovitis.  Physical examination recorded ROM with dorsiflexion to 70 degrees (normal 70), palmar flexion to 90 degrees (normal 80), radial deviation to 20 degrees (normal 20), and ulnar deviation to 55 degrees (normal 45).  There was no loss of motion with repetition or against strong resistance.  There was no redness, warmth, or tenderness and no bony abnormality or ganglion cyst was noted.  The fingers had full function of extension and a good grip.  Touching the thumb to all four fingers with good strength was present.  The remainder of the hand joints were unremarkable.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist 10%, coded 8715 (median nerve-neuralgia).  The VA rated wrist 0%, coded 5015-5024  (benign new growth of bones - tenosynovitis), based on the VA C&P examination 6 months after separation, citing lack of objective evidence of painful or limited motion.  Members discussed whether the neuralgia was moderate rather than mild at the time of separation.  Medication use was limited, as was pain in the absence of heavy lifting.  Therefore, members felt the neuralgia was closer to mild, especially since 6 months post-separation pain was minimal and ROM was full, the grip was good, and no ganglion was noted.  The panel considered rating under both the PEB code (8715) and an analogous code 5215, but determined that would be pyramiding, which is to be avoided per VASRD §4.14 (avoidance of pyramiding).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the “chronic right wrist pain” condition.  

BOARD FINDINGS:  In the matter of the “chronic right wrist pain” condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150706, 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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01810.

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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings