RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2016-00340
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090318

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic left, non-dominant, wrist pain” with a disability rating of 10%.

CI CONTENTION:  The condition continues to worsen.  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 - 20090228	VARD - 20100216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left, Non-Dominant, Wrist Pain 	5299-5212	10%	Chronic Left Wrist Pain	5020-5215	10%	20090917	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Left, Non-Dominant, Wrist Pain.  According to service the treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left wrist condition began in August 2008 after falling while running in basic training.  X-rays dated 28 August 2008 raised a question of mild scapholunate interval (space between the scaphoid and lunate bones of the hand) widening, which may have reflected injury.  Magnetic resonance imaging (MRI) dated 24 October 2008 correlated with a prior MRI dated 4 September 2008.  Findings were consistent with a distal radial fracture that appeared to extend into the distal radioulnar joint, a suggestion of a triangular fibrocartilage (TFC) tear at the ulnar insertion, and a synovial cyst 7 x 3 x 3 mm.  An MRI dated 24 November 2008 demonstrated healing of the distal radius fracture with a TFC tear at the ulnar insertion and a dorsal ganglion cyst 5 x 4 x 6 mm.  

During the 14 January 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported she fractured her left wrist in basic training.  Physical examination noted the left wrist stress fracture.  The 5 February 2009 MEB NARSUM examination, 1 month prior to separation, noted complaints of chronic pain in the left arm and wrist.  Physical examination showed a small ganglion cyst over the ulnocarpal joint of the left wrist, which was mildly tender.  There was no other edema, bony or soft tissue tenderness or obvious ligamentous laxity.  Phalen’s test (to determine carpal tunnel syndrome) was negative bilaterally.  Left wrist range of motion (ROM) measurements were palmar flexion 81 degrees (normal 80), dorsiflexion 83 degrees(normal 70), ulnar deviation 44 degrees (normal 45), and radial deviation 22 degrees (normal 20).  There was some discomfort on ulnar deviation, otherwise no weakness, incoordination, or lack of endurance noted.  Examination of the hand was normal and there was 5/5 strength in the wrist dorsiflexors and palmar flexors.  Grip strength and pincher grasp were full and equal in both hands.  

At the 17 September 2009 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported she fractured her distal radius and was treated with a cast for 1 month and underwent therapy thereafter.  She could not perform pushups and she used a wrist brace whenever she did heavy exertion.  Physical examination of the left wrist showed radial tenderness and the Finkelstein test (to determine De Quervain’s tenosynovitis) was normal.  ROM measurements were flexion 0-60 degrees with pain at 60 degrees and extension 0-70 degrees, ulnar deviation 0-40 degrees, and radial deviation 0-20 degrees, all without pain.  The ROMs were not limited by repetitive use.  On the dorsum of the left wrist was a 0.75 x 1.0 cm mass consistent with a ganglion cyst, which was slightly tender on palpation.  X-rays of the left wrist dated 17 September 2009 were normal.  The examiner noted there were no objective findings for the fracture of the left distal radius condition, but there was a ganglion cyst of the left wrist.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left, non-dominant, wrist pain due to dorsal ganglion cyst, triangular fibrocartilage tear and healing distal radial fracture condition 10%, coded 5299-5212 (radius, impairment of), citing VASRD §4.20 (analogous ratings) and functional loss IAW VASRD §4.10 (functional impairment), §4.40 (functional loss), §4.45 (the joints), and §4.59 (painful motion).  The VA also rated the chronic left wrist pain due to dorsal ganglion cyst, triangular fibrocartilage tear and residual distal radial fracture condition 10%, coded 5020-5215 (synovitis-wrist, limitation of motion of), based on the C&P examination 6 months after separation, citing it was the maximum evaluation provided in the Rating Schedule for that disability.  There was no nonunion in the upper half of the radius, loss of bone substance or deformity, or loss of bone substance (1 inch or more) and marked deformity to provide a route to a higher rating using code 5212 (radius, impairment of) nor was there any wrist ankylosis (code 5214) or wrist limitation of motion (code 5215) to warrant a higher rating.  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 chronic left, non-dominant, wrist pain condition.  

BOARD FINDINGS:  In the matter of the chronic left, non-dominant, wrist pain 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 20150701, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015409 , XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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