RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02088
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Reservist O2, Transportation Officer, medically separated for “chronic left wrist pain” with a disability rating of 0%.

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 - 20050215	VARD - 20051104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Wrist Pain	5099-5003	0%	Status Post Left Wrist Injury	5215	0%	20050718	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic Left Wrist Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left wrist surgery in October 2003 for left triangular fibrocartilage complex (TFFCC) tear.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left wrist pain” for PEB adjudication.  At a physical therapy examination 15 months prior to separation, the CI stated that she could not lift heavy objects with her left hand or roll down the window.  The CI was observed to have decreased active range of motion (ROM) of the wrist with pain limitation, specifically with ulnar deviation reduced by 10 degrees from normal (45 degrees, normal).  The MEB NARSUM examination on 6 January 2005, 4 months prior to separation, noted complaints of episodic and severe pain of the left wrist that limits her from performing lifting activities.  Physical examination showed tenderness with palpation to the ulnar and radial aspect of the left wrist. Crepitus was palpated only on the ulnar side of the CI’s left wrist with pain reproduction.  ROM to both wrists were equal and normal.

At the 18 July 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported pain at the medial aspect of her wrist.  She stated that she could not perform activates requiring repetitive motion due to severe wrist pain.  The CI admitted to not using medications, brace or immobilizations to control or abort the pain.  She stated that she was mindful to not use the wrist so that she does not cause pain.  Physical examination showed the ROM at the left wrist was 80 degrees of dorsiflexion (70 degrees, normal), 15 degrees of radial deviation (20 degrees, normal) and 25 degrees of ulnar deviation (45 degrees, normal).  The examiner noted that the wrist moved in a “pain-free manner.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 0%, analogously coded 5003 (arthritis, degenerative), citing normal radiographs and motion.  The VA rated the left wrist condition 0% coded 5215 (wrist, limitation of motion), based on the VA C&P examination 2 months separation, citing no evidence of limitation of motion or pain.  The Board noted reports of pain with objective findings of crepitus, tenderness to palpation, and pain reproduction with wrist movement at the MEB NARSUM examination.  Board member agreed that the evidence support a 10% rating IAW VASRD 4.59, 4.40 (painful motion and functional loss).  There was no limitation of motion for a rating under 5215.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic left wrist pain condition, coded 5099-5003.

BOARD FINDINGS:  In the matter of the chronic left wrist pain condition, the Board unanimously or majority recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.59a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Wrist Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150727, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004078, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure