RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00882
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “photophobia, status post corneal laceration repair, right eye” and “chronic wrist pain, status post right De Quervain’s tenosynovitis post release” rated at 0% each, with a combined disability rating of 0%.  

CI CONTENTION:  “I have a P-3 profile.”  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 - 20041221	VARD - 20121205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Photophobia, Status Post Corneal Laceration Repair, Right Eye	6099-6001-6079	0%	Corneal Scar, Residuals of Right Eye Injury	6099-6009	0%	STR	
Chronic Wrist Pain, Status Post Right De Quervain’s Tenosynovitis Post Release	6024	0%	Right Wrist De Quervain's Tenosynovitis S/P Surgery	5215	10%	20121005	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Photophobia, Status Post Corneal Laceration Repair, Right Eye.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right eye condition began in March 1987 after an injury to his eye from a grenade during basic training.  He underwent corneal repair at that time, was reassigned as a military policeman and has experienced light sensitivity interfering with his duties ever since.  The 22 June 2004 ophthalmology examination revealed abnormal pupil shape of the right eye.  Visual fields were normal bilaterally.  Slit lamp examination showed a clear left cornea but the right eye revealed an inferior scar parallel to the limbus at about 3 o’clock inferior to the central axis, but otherwise clear cornea.  The iris of the right eye had a pinpoint defect at about 10 o’clock with some minimal elevation at about 7 o’clock consistent with trauma to the iris.  Best corrected vision was 20/25 OD and OS by Snellen testing with a prescription.  Intraocular pressure was 16 in the right and 17 in the left.  Dilated fundus examination was normal.  

During the 10 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported eye problems.  The examiner noted visual acuity was abnormal and the CI needed corrective lens.  Physical examination showed right eye distant and near vision 20/100 and left eye 20/70 distant and near vision, and need for corrective lens.  The 18 October 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of light sensitivity requiring sunglass use virtually all times.  He was unable to perform his military duty safely, per patient and per his Commander.  His condition was regarded as stable after 17 years.  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 eye condition 0%, coded 6099-6001-6079 (swelling of the cornea of one eye, impaired vision with a rating of 0-10%)  There was no history of incapacitating episodes to qualify for a higher rating under the General Rating Formula for Diagnostic Codes 6000 through 6009.  The VASRD coding prior to 2008 noted that consideration of visual acuity was part of the visual impairment rating system.  The MEB H&P examination noted impaired visual acuity in both eyes, requiring corrective lens.  However, the ophthalmology examination noted the CI had vision of 20/25 in both eyes, when corrected.  The VASRD notes that visual acuity is rated on best corrected vision.  Since the CI’s corrected vision is not greater than 20/40 in either eye, it is not possible to find a pathway to a higher rating under either the 6001 or 6079 codes.  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 eye condition.  

Chronic Wrist Pain, Status Post Right De Quervain’s Tenosynovitis Post Release.  According to the STR and the MEB NARSUM, the CI’s right wrist (dominant) condition began in February 2004 after an injury during a deployment to Iraq.  He was eventually diagnosed with chronic De Quervain’s Tenosynovitis and underwent release of the first dorsal compartment.  During the 10 September 2004 MEB examination the CI reported a hand problem.  Physical examination of the right wrist showed one inch scar of the radial aspect, minimal swelling, moderate tenderness, and decreased range of motion.  There was decreased grip strength of the right hand.  He was taking a synthetic opiate medication for pain.  The 3 November 2004 MEB NARSUM Addendum examination, 3 months prior to separation, noted complaints of problems with picking up more than ten pounds due to pain.  He had night pain if he laid on it and had pain with repetitive motion.  He took over the counter pain medication and stopped narcotic medication for fear of becoming addicted.  There was little impact on activities of daily living (ADL.)  He wore a wrist brace to control some of the symptoms.  He could not fire a weapon or perform activities that aggravated the pain.  His condition was stable and the pain rating was slight and constant.  He had extensive physical therapy in addition to surgical treatment.  

Physical examination showed a well-healed incision over the distal radial aspect of the wrist of about 2.5 centimeters and very mild soft tissue edema.  There was a positive Finkelstein’s test (used to diagnose De Quervain's tenosynovitis in people who have wrist pain) and pain with resisted thumb extension.  There was tenderness along the first dorsal compartment.  Range of motion (ROM) showed (palmar) flexion 90 degrees (normal 80) and (dorsiflexion) extension 75 degrees (normal 70).  X-rays were within normal limits.  The examiner noted he could not fire a weapon since this was his dominant hand and repetitive motions were impaired by his pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 0% using an inappropriate code (6024) but likely intending to use 5024 (tenosynovitis) or 5215 (wrist, limitation of motion), citing no significant limitation of motion.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5215).  However, the NARSUM Addendum reported painful motion supporting a 10% rating (based on §4.59, §4.40 and §4.45).  Panel members agreed that the evidence reasonably justified that the functional limitations of the condition contributed to the CI’s inability to perform his military duties and accordingly a separate disability rating is recommended.  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 5024.

BOARD FINDINGS:  In the matter of the right eye condition and IAW VASRD §4.75, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right wrist condition, the panel unanimously recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Photophobia, S/P Corneal Laceration Repair, Right Eye	6099 6001 6079	0%	
Chronic Wrist Pain, Status Post Right De Quervain’s Tenosynovitis Post Release	5024	10%	
COMBINED	10%	

AR20170017222, 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