RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00540
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040719

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Indirect Fire Infantryman, medically separated for “right (dominant) wrist pain” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20040318	VARD - 20040722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominant) Wrist Pain	5099-5003	0%	Right Wrist Surgery Residuals and Degenerative Joint Disease	5299-5010	10%	20040506	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right (Dominant) Wrist Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right wrist surgery in December 2002 for scapholunate ligament reconstruction and in May 2003 for pinning of the scapholunate and capitate bones; pin removal was performed in July 2003.  During the 10 December 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported right wrist pain, instability, and weakness of the wrist and hand.  Physical examination showed “painful” right wrist range of motion (ROM); measurements were not cited.  

The 30 January 2004 MEB NARSUM examination, 6 months prior to separation and 5 months after surgical pin removal, noted complaints of right wrist pain.  Physical examination showed “obvious lower arm atrophy” with decreased motion and grip strength.  X-rays showed surgical changes with “tiny hardware” and early degenerative changes.  The 6 February 2004 occupational therapy evaluation documented painful right wrist ROM with dorsiflexion of 50 degrees (normal 70) and palmar flexion of 45 degrees (normal 80).  There was decreased right grip strength of 90 pounds compared to the non-dominant left grip strength of 115 pounds.

At the 6 May 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported right wrist pain.  Physical examination showed “obvious muscle atrophy of his right forearm and diminished ROM of his right wrist.”  Neurovascular status was intact.  ROM testing after repetition showed dorsiflexion of 40 degrees and palmar flexion of 34 degrees with painful motion.  Grip strength was measured as 21.5 Kg. (47 pounds) on the right compared to the non-dominant left grip strength of 53 Kg. (116 pounds).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the right wrist condition 10%, analogously coded to 5299-5010 (degenerative arthritis due to trauma), based on the C&P examination 2 months before separation, citing painful motion.

The VASRD §4.71a threshold for rating for ROM impairment (code 5215, wrist, limitation of motion) is “dorsiflexion less than 15 degrees” or “palmar flexion limited in line with forearm.”  Although there was insufficient limitation of motion to support a rating under the 5215 code, panel members agreed a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no ankylosis of the wrist to justify a rating under the 5214 code (wrist, ankylosis) for alternative rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right wrist condition, coded 5299-5010.

BOARD FINDINGS:  In the matter of the right (dominant) wrist condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5010 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Right (Dominant) Wrist Pain	5299-5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160910, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180000689, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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