RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00701
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080504 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistics Supply Specialist, medically separated for “ligamentous tears of right (dominant) wrist” 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 - 20080319	VARD - 20080825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ligamentous Tears of Right Wrist	5099-5003	10%	Right Wrist Sprain 	5024	10%	20080321	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Ligamentous Tears of Right (Dominant) Wrist.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI surgical repair on 27 April 2007.  The CI was referred to occupational therapy.  Unfortunately, he did not regain either the strength or mobility to return to full duty.  He was noted to have a “piano key” sign, indicative of TFCC (triangular fibro-cartilaginous complex) instability.  A second procedure was discussed, but the likelihood of return to duty was low and the CI declined.   

During the 5 October 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported continued severe pain.  The range of motion (ROM) and grip strength were reduced.  Tenderness was present.  X-rays showed stable post-surgical changes.  The ROM measurements after repetition were obtained in occupational therapy on 24 October 2007.  Dorsi-flexion was 60 degrees (normal 70), palmar flexion was 63 degrees (normal 80), radial deviation 15 degrees (normal 20), ulnar deviation was 25 degrees (normal 45).  Grip strength was reduced to less than half of the non-dominant left grip.  

The 14 November 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of longstanding right wrist pain which precluded full duty including firing a weapon.  The physical examination showed decreased active ROM of the right wrist with tenderness to palpation over the distal ulnar head, both the dorsal and ventral aspects, with no erythema, edema or ecchymosis noted.  Sensation was intact, but he had decreased right grip strength at 3/5 to 4/5.  The CI was also noted to have chronic instability.  

At the 21 March 2008 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported constant pain, weakness and stiffness.  A splint was used at night but not during the day.  There was no additional loss of ROM with flare-ups.  The physical examination showed dorsi-flexion of 55 degrees, palmar flexion of 50 degrees, radial deviation was 10 degrees and ulnar deviation was 35 degrees.  Grip strength was reduced by approximately 50%.  

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 additional loss due to painful motion associated with joint and periarticular pathology in accordance with VASRD §4.59.  The VA also rated the right wrist condition 10%, coded 5024, (tenosynovitis), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  The panel considered the evidence.  The ROM of the right wrist was limited, but the limitation did not warrant a rating higher than 0% under any applicable code for the wrist.  Instability and weakness were also noted, but did not provide a higher rating than the 10% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded 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 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 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 20170219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004748, 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