RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01622
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Military Policeman, medically separated for “chronic pain, left (non-dominant) wrist” and “asthma,” each rated 10%, with a combined disability rating of 20%.

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 - 20051012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left 
(Non-Dominant) Wrist	5099-5003	10%	Left Hand Fracture(Scaphoid Fracture)	5214	40%	20050305	
Asthma	6602	10%	History of Bronchial Asthma	6602	0%	20050217	
Major Depressive Disorder	Not Unfitting	Depressive Disorder, Not Otherwise Specified	9434	NSC	20050303	
Right Sensory Hearing Loss with Tinnitus	Not Unfitting	Right Ear Sensorineural Hearing Loss	6100	0%	20050314	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Chronic Pain, Left (Non-Dominant) Wrist.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgery for a left scaphoid fracture in October 2002, followed by hardware removal secondary to persistent left wrist pain in September 2003.  During the 9 March 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported chronic left wrist pain.  Physical examination showed completely limited left wrist range of motion (ROM) with tenderness.  

At the 26 April 2004 MEB NARSUM examination, 8 months prior to separation, the CI reported significant left hand pain and decreased use of the left wrist.  He wore a brace.  Physical examination showed obvious pain and left wrist tenderness.  There was marked decrease in grip strength.  The examiner noted the CI “had virtually no flexion or extension in the wrist joint.” There was interphalangeal muscle atrophy.

The 9 July 2004 physical medicine and rehabilitation (PM&R) evaluation documented the left wrist fixed in a neutral position at 0 degrees, 0/5 wrist strength, and 3/5 hand muscle strength.  The 1 November 2004 nerve conduction study was normal.  Repeat 8 February 2005 and 5 April 2005 nerve conduction studies demonstrated bilateral carpal tunnel syndrome and bilateral C5-6 radiculopathy.

At the 5 March 2005 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported left wrist pain and inability to use the left hand with weakness, stiffness, swelling and heat.  He wore a splint.  Physical examination showed hand tenderness, 3/5 grip strength and an inability to move the wrist against resistance.  Left wrist ROM was dorsiflexion to 10 degrees (normal 70), palmar flexion to 5 degrees (normal 80), radial deviation to 0 degrees (normal 45), and ulnar deviation to 0 degrees (normal to 20).  The CI was diagnosis with left hand ankylosis.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 10%, analogously coded 5099-5003 (arthritis, degenerative), with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left wrist condition 40%, coded 5214 (wrist, ankylosis), based on the C&P examination 3 months after separation; citing wrist ankylosis.

Ankylosis is defined as abnormal stiffening and immobility of a joint due to fusion of the bones.  Panel members agreed that the evidence of marked loss of left wrist ROM supports a rating for left hand ankylosis.  Ankylosis is rated as favorable or unfavorable.  The VASRD defines favorable ankylosis as wrist ankylosis in 20-30 degrees of dorsiflexion.  The panel noted the PM&R and VA examinations noted the left wrist was fixed in a neutral position with 0 degrees of radial and ulnar deviation.  Panel member agreed the evidence supports a 30% rating for wrist ankylosis in any other position, except for favorable in the non-dominant hand.  A higher rating of 40% was not supported because unfavorable ankylosis in palmar flexion or ulnar or radial deviation was not present.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the left wrist condition, coded 5214.

Asthma.  According to the STR and the MEB NARSUM, the CI’s asthma condition began in December 2001 with a wheezing episode.  An April 17 2004 Primary Care note documented medications to include Singulair (bronchodilator) at night, Foradil (inhaled bronchodilator) daily, and Proventil (inhaled bronchodilator) as needed.  On 21 April 2004, post-bronchodilator pulmonary function testing (PFT) showed an FEV-1 of 100% of predicted and an FEV-1/FVC of 70%.  The examiner noted mild to moderate obstruction.  On 18 June 2004 (6 months prior to separation), post bronchodilator PFT showed an FEV-1 of 48.6% (pre 59.2) of predicted and an FEV-1/FVC of 82.6%.  The examiner noted moderate obstruction without significant improvement after inhaled bronchodilators.  

The 26 April 2004 MEB NARSUM examination, 8 months prior to separation, noted complaints of recurrent wheezing.  Physical examination showed a normal lung finding.  The medications listed were Proventil as needed, Singulair daily, and Foradil daily.  A 29 July 2004 civilian pulmonologist documented asthma care commencing in June 2004 with treatment with 2 doses of intravenous steroid, a 7-day course of oral steroids and daily theophylline (bronchodilator).  The 2 August 2004 MEB NARSUM addendum, 4 months prior to separation, noted medication of Proventil 3 times daily and Foradil daily.

The 17 February 2005 VA C&P evaluation, 2 months after separation, noted a history of bronchial asthma and bronchospasm the was under treatment.  Physical examination showed normal lung findings.  Asthma medications were not noted.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the asthma condition 10%, coded 6602 (asthma), citing medication profile indicating intermittent use of medicine.  The VA rated the history of bronchial asthma condition 0%, coded 6602 (asthma), based on the C&P examination 2 months after separation, citing a non-compensable evaluation.

Panel members agreed that the VASRD §4.97 threshold for a 30% rating was reasonably satisfied on the basis of prescribed daily utilized inhaled bronchodilator medication documented by STR examinations proximate to separation.  VASRD 4.96 (special provision regarding evaluation of respiratory conditions) stipulates that pre-bronchodilator PFTs are to be used when the post-bronchodilator results are poorer.  Therefore, a 30% rating was also supported by FEV-1 of 59.6-percent predicted noted by the June 2004 examination.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the asthma condition, coded 6602.

Contended PEB Conditions:  Depressive Disorder, Not Otherwise Specified and Right Ear Sensorineural Hearing Loss.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions 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 either of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left wrist condition, the panel unanimously recommends a disability rating of 30%, coded 5214 IAW VASRD §4.71a.  In the matter of the asthma condition, the panel unanimously recommends a disability rating of 30%, coded 6602 IAW VASRD §4.97.  In the matter of the contended depressive disorder, not otherwise specified, and right ear sensorineural hearing loss, the panel unanimously 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain, Left (Non-Dominant) Wrist	5214	30%	
Asthma	6602	30%	
COMBINED	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161021, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180002565, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 50% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs, and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure