RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01346
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Unit Supply Specialist, medically separated for chronic right wrist pain, with a disability rating of 10%.  

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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040514	VARD - 20050404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Wrist Pain with Atypical Carpal Tunnel Syndrome and Ganglion Cyst	5099- 5003	10%	Ganglion Cyst, Right Wrist	5299-5215	10%	20050303	
	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Wrist Pain.  According to service treatment record and MEB narrative summary (NARSUM), the CI’s wrist condition began in early 2002 during basic training.  A hand surgeon in March 2004 diagnosed right wrist/forearm pain, atypical carpal tunnel syndrome, and lateral epicondylitis.  The hand surgeon did not recommend surgery.  An electrodiagnostic study done in February 2004 was normal, with no evidence to suggest a right median neuropathy, a right ulnar neuropathy, nor a right superficial radial sensory neuropathy.  Magnetic Resonance imaging of the right wrist in December 2003 findings suggested two adjacent ganglion cysts.  

The 26 April 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant pain and stiffness in his right wrist and sharp pain shooting from his wrist to his elbow.  He reported pain was worse with movement at the right wrist.  He reported occasional tingling in his fingers, but denied any numbness.  Physical examination showed subcutaneous atrophy at the right radial wrist, tenderness to palpation, positive Tinel's sign (test for carpal tunnel), and equivocal Phalen's (carpal tunnel) test.  The range of motion (ROM) of the right wrist measured in degrees with a goniometer was: ulnar deviation 10 (normal 45), radial deviation 11 (normal 20), dorsiflexion 20 (normal 70), and palmar flexion 25 (normal 80).  All of the ROM’s on the right were decreased and produced significant pain.  

At the 3 March 2005 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported constant right wrist pain.  Physical examination showed normal appearance and there was normal ROM of the right wrist.  There was no additional limited motion due to pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10%, coded analogously to 5003 (arthritis, degenerative), citing slight pain not requiring daily narcotic therapy/constant, with application of the US Army Physical Disability Agency pain policy.  The VA also rated the right wrist condition 10%, coded analogously to 5215 (wrist, limitation of motion of), based on the C&P examination 6 months after separation, citing reasonable doubt in favor of functional impairment.  There was no evidence of wrist ankylosis to support a rating under 5214 (wrist ankylosis). There was no evidence of moderate median or ulnar nerve dysfunction for a rating higher than 10% analogous rating under the respective codes (8515, 8516).  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 wrist 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 were no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161006, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180003421, 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