RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01348
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Tracked Vehicle Mechanic, medically separated for “chronic (non-dominant) left wrist pain” with a disability rating of 0%.  

CI CONTENTION:  The condition has continued to worsen since leaving the service.  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 - 20061103	VARD - 20080214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic (Non-Dominant) Left Wrist Pain	5099-5003	0%	Tenosynovitis, Left Wrist	5024	10%	20070921	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30#	

ANALYSIS SUMMARY:  

Chronic (Non-Dominant) Left Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left wrist condition began in 2002 with no specific injury.  He noted a swelling that was diagnosed as a ganglion cyst.  Splinting, activity modification, and corticosteroid injections did not resolve his symptoms of aching, tingling, and generalized discomfort.  An EMG/NCS on 14 February 2006 revealed slightly prolonged left median sensory distal latencies consistent with a borderline focal demyelinating process of the left median nerve at the level of the carpal tunnel.  

The 10 May 2006 physical therapy (PT) examination, 7 months prior to separation, noted complaints of left wrist pain with tingling and numbness throughout the day.  The CI wore a wrist brace during the day and had a ganglion injected 3 weeks prior.  Physical examination demonstrated right wrist motor testing as 4/5 with pain on wrist and elbow extension.  There was tenderness to palpation and grip strength was 40 pounds (compared to 100 pounds on the right side).  There was a positive Finkelstein test (for de Quervain's tenosynovitis).  Left wrist range of motion (ROM) was active extension to 52 degrees (normal 70), and complaint of pain with passive (actively assisted) extension to 70 degrees.  Active flexion was 75 degrees (normal 80), and passive to 80 degrees.  Ulnar deviation was 30 degrees (normal 45) and radial deviation was 40 degrees (normal 20).  There was full supination and pronation with painful motion.  The diagnosis was left wrist pain with ganglion.  

During the 20 September 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported chronic left wrist pain with numbness and tingling.  Physical examination revealed left wrist tenderness with “full” ROM.  The 12 October 2006 MEB NARSUM examination, noted complaints of chronic left wrist pain, pain with manual activities, and pain with wrist extension in the prone firing position.  Physical examination showed a significant palpable dorsal cyst with no neurological or vascular deficits.  Tinel's (for nerve irritation) was negative.  Wrist ROM recorded the exact same values as the 10 May 2006 PT evaluation.  

At the 21 September 2007 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported left wrist pain and stiffness.  Left wrist X-rays showed no evidence of acute fracture or dislocation, with a normal variant (osseous fusion of the luno-triquetral joint space).  The examiner found left wrist tenderness and ROM with dorsiflexion to 71 degrees, palmar flexion to 73 degrees, ulnar deviation to 33 degrees, and radial deviation to 19 degrees.  There was painful motion on ulnar deviation and no ROM changes following repetition.  The diagnosis was mild de Quervain's tenosynovitis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing “rated for pain, minimal/occasional,” with likely application of the US Army Physical Disability Agency pain policy.  The VA rated the left 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.  Members noted that while there was no ankylosis or limitation of motion to warrant ratings under codes 5214 or 5215, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  Alternative analogous rating under peripheral nerve codes (VASRD §4.124a) for neuropathic pain would be no higher than 10%, and dual rating was not supported IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left wrist condition, coded 5099-5024.  

BOARD FINDINGS:  In the matter of the chronic left wrist pain, the panel recommends a disability rating of 10%, coded 5099-5024 IAW VASRD §4.71a.  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 (Non-Dominant) Left Wrist Pain	5099-5024	10%	
AR20190004054, XXXXXXXXXX

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Dear XXXXXXXXXX:

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