RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00174
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Patriot Launching Station Operator/Maintainer, medically separated for “chronic right (dominant) wrist pain” rated 10%.  

CI CONTENTION:  “I continue to have pressure and pain in my legs.  This pain and pressure has led to long term sleep problems.  Since I have left the Army I have had additional surgeries on my left and right legs.”  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 - 20060407	VARD - 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right (Dominant) Wrist Pain…	5099-5003	10%	…Arthritis of the Right Wrist…	5215-5003	10%	20060511	
			Right Wrist Scar … 	7804	10%	20060511	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Right Wrist Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-handed CI’s right wrist condition began in 2004 with a ganglion cyst and a fall onto his outstretched hand.  In October 2005 the CI underwent surgery of the right wrist with debridement of a torn fibrocartilage (TFCC) and resection of the distal ulna (and bone chip removal).  

The 14 March 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic wrist pain with inability to perform heavy lifting and repetitive motion with his right hand.  At the 28 March 2006 occupational therapy (OT) physical examination the CI complained of 10/10 pain with motion and 4/10 pain at rest.  The examiner stated “functional limitations (were) performing most tasks with the left upper extremity due to pain in the right upper extremity.”  The right wrist range of motion (ROM) evaluation is charted below.  

At the 11 May 2006 VA Compensation and Pension (C&P) evaluation, performed 2 week before separation, the CI reported right wrist pain and stiffness with numbness, tingling and weakness, as well as tender scars.  Physical examination showed painful and limited right wrist ROM as charted below.  Testing for nerve entrapment (Tinel’s and Phalen’s) were negative, however, there was noticeable weakness of grip compared to the non-dominant side, with motor graded as 3/5 (5/5 normal).  There was a 4 cm tender scar on the dorsum of the wrist.  

The ROM examinations in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Right Wrist ROM
(Degrees)	OT ~2 Mo. Pre-Sep	VA C&P ~2 Wks. Pre-Sep	
Dorsiflexion (70 Normal)	50	50	
Palmar Flexion (80)	25	60	
Ulnar Deviation (45)	25	35	
Radial Deviation (20)	20	15	
Comment		Painful motion; weakness	
§4.71a Rating	0%-10% (PEB 10%)	10%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10%, coded 5099-5003 (degenerative arthritis), citing ROM and lifting limitations and the US Army Physical Disability Agency pain policy.  The VA rated the right wrist condition 10%, coded 5215-5003 (wrist, limitation of motion - degenerative arthritis), based on the VA C&P examination 2 weeks before separation, citing painful motion.  The VA also rated the right wrist surgical scars 10%, coded 7804, citing a superficial scar that was painful on examination.  The panel concurred that a 10% rating for functional loss due to pain was appropriate, as adjudicated by both the PEB and VA.  The 10% awarded is the highest rating available under code 5215 for wrist limitation of motion, and there was no ankylosis of the wrist (immobile/frozen wrist) for any higher rating under code 5214 (wrist ankylosis).  Alternative analogous rating of the right ulnar surgical shortening would not warrant any higher rating.  There was no evidence of any peripheral nerve disability for alternative rating under VASRD §4.124a.  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 left wrist pain condition.  

BOARD FINDINGS:  In the matter of the right wrist condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20160330, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014098, 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