RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01488
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041014

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

CI CONTENTION:  He was rated 0% by the Army but 40% by the VA and now has a 90% rating.  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 - 20040712	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Wrist Pain	5099-5003	0%	                       No VA Examination Proximate to Separation	
Right Knee Pain	Not Unfitting		
Bilateral Plantar Fasciitis	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI’s left wrist condition began in 1998 with bilateral hyper-dorsiflexed injuries to his wrists.  Since that time he complained of pain with twisting motion of the wrist.  Examination showed marked mid-carpal instability for which he had numerous treatments with casting and immobilization.  A left wrist four corner fusion was performed on 27 January 2003 for metacarpal instability.  Postoperatively, the CI received a wrist splint and underwent occupational therapy.  In September 2003 the CI complained of pain at the surgical plate especially with a grip, which prevented him from completing duties as a heavy mechanic.  On 9 January 2004 the CI underwent hardware removal and a posterior interosseous nerve neurectomy (surgical removal of all or part of a nerve).  At the time of surgery a fibrous union was noted.  Postoperatively, the CI noted “popping.”  At an occupational therapy visit on 28 January 2004 the range of motion (ROM) for the left wrist was dorsiflexion of 40 degrees (normal 70), palmar flexion of 65 degrees (normal 80), radial deviation of 5 degrees (normal 20), and ulnar deviation of 20 degrees (normal 45).  

During the 6 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported mid-carpal instability and inability to perform certain motions of the wrists.  Physical examination showed post-surgical scars on the dorsum of the left hand and decreased ROM of the wrists.  The 7 May 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of intermittent sharp pain 5/10 in the left wrist with resisted pronation and supination.  The CI was unable to lift a gallon of milk, do pushups, remove or tighten bolts, lift oil drums, or generate torque necessary for use of pneumatic tools.  He denied any problems with the right wrist.  Physical examination showed well-healed incisions with minimal edema and tenderness over the incision sites and no evidence of significant deformity.  ROM measurements of the left wrist revealed pronation 90 degrees (normal 80), supination 90 degrees (normal 85), dorsiflexion 60 degrees, volar (palmar) flexion 80 degrees limited by pain, radial deviation 15 degrees limited by pain, and ulnar deviation 30 degrees.  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 left wrist pain condition 0%, coded 5099-5003 (arthritis, degenerative), citing slight and intermittent pain, presumably under the U.S. Army Physical Disability Agency pain policy.  Members noted that while the CI underwent a left wrist four corner fusion, there was no unfavorable or favorable wrist ankylosis (5214) nor was there limitation of wrist motion (5215) sufficient to warrant a rating using those codes.  There was no impairment of supination and/or pronation (5213) to warrant a 10% rating.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) based on volar flexion and radial deviation limited by pain at the NARSUM examination.  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 5099-5003.  

Contended PEB Conditions:  Right Knee Pain and Bilateral Plantar Fasciitis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The contended conditions were not profiled, implicated in the commander’s statement nor judged to be unfitting, although the right knee pain with mild degenerative arthritis did not meet retention standards.  Members noted that the CI reported at his NARSUM examination that he was able to run two miles at his own pace and distance and was able to ruck at his own pace and distance up to 10 miles.  There was no performance-based evidence from the record that either condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended conditions, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left wrist pain condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended right knee pain and bilateral plantar fasciitis conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Wrist Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161010, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005203, 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