RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01372
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041025

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Tactical Aircraft Maintenance Journeyman, medically separated for “bilateral wrist pain” rated at 10% each hand for a combined disability rating of 20%.  

CI CONTENTION:  He was discharged for bilateral wrist pain and weakness in his hands, but after separation the VA diagnosed him with service connected fibromyalgia.  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 - 20040722	VARD - 20050329	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Wrist Pain 	8515 	10%	Fibromyalgia	5025	40%	20050112	
		10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bilateral Wrist Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first seen on 25 June 2003 for a 3-month history of bilateral wrist pain without specific trauma or injury.  At an orthopedic examination on 15 October 2003, the CI was initially noted to have a normal grip, then reduced, and then normal again.  No muscle wasting was present and X-rays were normal.  The CI was referred to neurology and seen the next day on 19 November 2003.  He reported progressive weakness of the hands. On examination, there was diffuse atrophy of the hands and forearms, but no focal atrophy.  Grip strength was reduced, but electrodiagnostic testing was normal bilaterally.  

The 15 May 2004 MEB NARSUM examination, 5 months prior to separation, noted longstanding complaints of bilateral wrist pain, diffuse joint pain and depression.  An extensive evaluation had been non-diagnostic.  The physical examination showed normal strength.  The CI was seen in follow up in neurology on 19 May 2004.  Symptoms were persistent despite medications and duty limitations.  On examination, 12 of 18 trigger points were positive for fibromyalgia (non-diagnostic).  The wrist range of motion (ROM) was full and pain free.  Strength and sensation were normal.  While fibromyalgia was not excluded, the diagnosis of chronic fatigue syndrome was thought more likely.  Neither was actually diagnosed.  In a follow-up primary care examination on 9 July 2004, 4 months prior to separation, the CI was noted to have full ROM, but reduced grip strength at 4/5.  

At the 12 January 2005 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported a 2-year history of progressive fatigue and weakness.  On examination, he had normal movement and sensation of the hands, but grip strength was 20% of normal.  However, atrophy was not recorded.  The ROM was normal or near normal bilaterally.  Painful motion was not recorded, but tenderness was present.  Bilateral wrist X-rays were negative.  Fibromyalgia trigger points were positive (14/18) and met the diagnostic threshold.  A C&P examination dated 4 April 2008 did note that the fibromyalgia condition had apparently progressed since the previous C&P evaluation, but on examination there was no atrophy and the strength was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral wrist conditions 10% each, coded 8515 (incomplete paralysis of the median nerve).  The VA did not specifically rate the wrist conditions, but rated the CI for fibromyalgia at 40%, coded 5025, based on the C&P examination 3 months after separation.  While some examinations, including the C&P proximate to separation, showed reduced grip strength, others showed normal motor function.  These included a neurology evaluation 5 months prior to separation and a C&P remote from separation.  Electrodiagnostic testing of the upper extremities was normal as well.  The preponderance of evidence supported the PEB adjudication of mild rather than moderate impairment at separation.  The limitation in motion was not compensable under any code for the wrist and neither painful motion nor X-ray findings were present to support the use of the 5003 code for degenerative arthritis.  Fibromyalgia was not considered by either the MEB or PEB and is outside the panel’s scope of review.  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 bilateral wrist conditions.  

BOARD FINDINGS:  In the matter of the bilateral wrist conditions and IAW VASRD §4.71a and §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161006, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01372.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

	

Attachment:
Record of Proceedings