RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01314
BRANCH OF SERVICE:  army	SEPARATION DATE:  20041228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistics Specialist, medically separated for “left wrist pain” with a disability rating of 0%.   

CI CONTENTION:  “Review all conditions.”  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 - 20040908	VARD - 20050307	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain	5024	0%	Left Wrist De Quervain’s Tenosynovitis (Non-Dominant)	5024	10%	20041021	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY: 

Left Wrist Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left wrist pain condition began in approximately September 2003 with an insidious onset.  The 3 August 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of a 2-year history of non-traumatic left wrist pain which worsened with military duties.  The CI had discomfort with activities involving her left wrist.  The CI reported limited benefit from conservative treatment which included splinting, steroids, and nonsteroidal anti-inflammatory medications.  Physical examination showed no deformity, effusion or warmth.  There was wrist tenderness over the first extensor compartment and a positive Finkelstein test (pain with active and passive thumb movement).  Wrist motor function and sensitivity were intact.  
During the 27 August 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported “De Quervain’s” (thumb tendon swelling caused by repetitive motion) and pain with lifting.  The CI did not take any medications.  The examiner noted left thumb extensor tendon range of motion (ROM) with pain.  

At the 21 October 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported left wrist tenosynovitis.  Physical examination showed left wrist tenderness on the radial side, the distal 5 centimeters of the left radius, and the thumb metacarpal.  The CI was right-hand dominant.  There was normal left wrist ROM except for decreased extension to 50 degrees (normal 70).  The examiner noted limited left wrist flexion and extension with painful motion in comparison to the right.  There was also pain with pronation.  Left thumb ROM was normal for body type and muscle mass except for carpal metacarpal flexion, which was limited in comparison to the right.  The CI exhibited significant left thumb palmar abduction and carpal metacarpal flexion pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist pain condition 0%, coded 5024 (tenosynovitis), citing left wrist tenderness over the first extensor compartment and positive Finkelstein sign.  The VA rated the left wrist condition 10%, also coded 5024, based on the C&P examination 2 months before separation, citing decreased ROM with pain on motion.  The panel agreed there was no wrist or thumb limitation of motion or ankylosis which supported a rating under diagnostic codes for 5214, 5215, and 5228.  However, there was evidence of painful motion with functional loss which supports a 10% rating (based on §4.59, §4.40 and §4.45).  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 left wrist pain condition, coded 5024.  

BOARD FINDINGS:  In the matter of the left wrist pain 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 the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Wrist Pain	5024	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161001, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001385, 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