RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02521
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Integrated Family of Test Equipment Operator/Maintainer, medically separated for “right wrist pain,” with a disability rating of 10%.

CI CONTENTION:  The CI contends endometriosis, in addition to PTSD, which was not identified by the MEB/PEB.  The CI’s 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 - 20040820	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Pain	5099-5003	10%	No VA examination in evidence proximate to separation.	
Endometriosis	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Wrist Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the first record in evidence for the right wrist condition was dated 27 March 2001 when she reported a 1 ½ week history of pain without preceding trauma.  She was treated with medications and duty limitations, but her pain persisted and she began what became an extensive evaluation.  X-rays and electrodiagnostic studies were normal.  She was evaluated by a hand surgeon who did not find a treatable etiology and recommended a rheumatology evaluation.  This was also negative for an etiology as were repeat X-rays of the wrist and an MRI.  She continued duty restrictions and pain medications, but had her pain persisted.  In 2003, the X-rays, MRI, and electrodiagnostic studies were repeated.  All remained normal.  A bone scan was suggestive of disuse, but otherwise normal.  An arthrogram on 10 December 2003 was also normal.  On 14 January 2001, the CI had normal range of motion (ROM) of the wrist.  The CI was then seen in orthopedics on 3 February 2004 and an MEB was recommended for chronic right wrist pain.  The ROM of the wrist was full but painful.  The pain was not well localized.  The remainder of the examination was unremarkable.  

During the 8 June 2004 MEB examination (recorded on DD Forms 2807-1 and 2808, 7 months prior to separation, the CI reported chronic right wrist pain.  Tenderness was noted as was painful and reduced ROM.  The ROM in occupational therapy the next day was reduced as charted below.  Possible secondary gain was documented by the examiner.  The MEB NARSUM examination was dated 21 July 2004, 6 months prior to separation.  The CI reported the onset of pain in basic training while doing pushups and aggravation during advanced infantry training.  It was noted that the evaluations had been normal.  Tenderness and pain were noted with movement.  The ROM was reduced (but not quantified).  After testing, the CI reported paresthesias (tingling) in the 2nd, 3rd, and 4th fingers (median nerve).  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.    An extensive evaluation did not reveal an etiology for the right wrist pain.  The limitation in motion was non-compensable under codes 5214 (wrist ankylosis) and 5215 (wrist limitation in motion).  Painful motion was present, but there was no objective evidence for joint or periarticular pathology on any imaging study.  The panel found no route to a rating higher than the 10% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right wrist condition.  

Contended PEB Conditions:  Endometriosis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement and was judged to be not disqualifying.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right wrist pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended endometriosis condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20151120, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013277, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure