RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01836
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Light Wheel Vehicle Mechanic, medically separated for “chronic left (non-dominant) wrist pain and limitation of motion” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20040908	VARD - 20050125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain	5099-5003	10%	Left Wrist Injury with Arthritic Changes	5215-5010	10%	20040928	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI underwent left wrist surgery to repair a dislocated lunate (wrist bone) in July 2003.  In January 2004 he underwent a proximal row carpectomy surgery (removes a row of small wrist bones) due to a scapholunate dissociation (wrist ligament injury) with arthritic changes.  Post-operative left wrist function improved but grip remained weak and pain did not resolve.

At the 17 August 2004 MEB NARSUM examination, one month prior to separation, the CI reported left wrist pain that was constant on bad days.  His grip was weak rendering him unable to perform his military duties.  Physical examination showed left grip strength to 45 pounds while the right dominant side was 109 pounds.  There was no neurovascular compromise of either hand.  Goniometric range of motion (ROM) measured in degrees showed dorsiflexion to 50 (normal 70), palmar flexion 25 (normal 80), ulnar deviation 35 (normal 45), and radial deviation 0 (normal 20); painful motion was not addressed.  During the 20 August 2004 MEB examination (recorded on DD Forms 2807-1 and 2808) physical examination revealed left wrist weakness which limited all ROM.

At the 28 September 2004 VA Compensation and Pension (C&P) examination, 2 days prior to separation, the CI reported constant left hand pain aggravated by gripping anything.  Physical examination showed dorsiflexion to 5 degrees, palmar flexion to 20 degrees, and both ulnar and radial deviation were 10 degrees with painful motion.  The examiner noted left wrist swelling and left hand grip motor strength at 4/5 compared to 5/5 on the right.  There was full bilateral hand ROM.

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), citing that the condition was rated under a group of “minor” joints otherwise not ratable under limitation of motion or radiologic criteria.  The VA rated the left wrist condition 10%, coded 5215-5010 (wrist, limitation of motion, traumatic arthritis), citing painful or limited motion based on the C&P examination.

The panel agreed there were no limitations in supination or pronation (5213), or limitation of dorsiflexion, palmer flexion, flexion or ankylosis (5214, 5215) to support a 10% rating.  However, there was evidence of painful motion to support a 10% rating IAW VASRD §4.59, as recorded on the VA ROM examination proximate to separation.  After due deliberation, considering all 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 left wrist condition.  

BOARD FINDINGS:  In the matter of the left 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.

AR20180015083, 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.