RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03317
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Satellite Communications System Operator/Maintainer, medically separated for “tenosynovitis, right (dominant) wrist” with a disability rating of 10%.   

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 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 - 20090219	VARD - 20091120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tenosynovitis, Right Wrist	5024	10%	Right Wrist Strain	5024	10%	20090910	
Chronic Right Ankle Pain	Not Unfitting	Right Ankle Strain	5271	10%		
Hypertension		Hypertension	7101	10%		
Osteitis Pubis		Osteitis Pubis	5099-5016	NSC		
Hemorrhoids		External Hemorrhoids	7336	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Tenosynovitis, Right (Dominant) Wrist.  According to service treatment record and MEB narrative summary (NARSUM), the CI underwent compartment release surgery in March 2008.  The post-surgical MRI showed mild changes of the abductor pollicis longus and tendinosis.  During the January 2009 MEB examination (recorded on DD Forms 2807 and 2808) 3 months prior to separation, the CI reported right wrist pain, but denied numbness or tingling.  He noted that he had been treated for right wrist and thumb tenosynovitis and carpal tunnel syndrome.  Physical examination showed decreased range of motion (ROM) of the right wrist.  

The 29 January 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of right wrist pain, worse after surgery, with decreased ROM and strength.  The CI had normal electromyography (EMG) and nerve conduction studies and denied numbness, tingling, paresthesias in his fingers or arms, sensory problems and discoloration of skin.  He continued to have difficulty using screwdrivers and other activities requiring dexterity.  His pain increased with lifting heavy objects.  Physical examination of the right wrist showed no evidence of inflammation and sensory function was intact.  There was decreased grip strength on the right compared to the left but muscle atrophy was not present.  The examiner concluded the condition was chronic and stable. The ROM evaluation was performed 3 weeks prior to the NARSUM and recorded dorsiflexion at 50 degrees (normal 70) palmar flexion at 78 degrees (normal 80) ulnar deviation at 3 degrees (normal 45), and radial deviation at 23 degrees (normal 20).  Pain on motion was noted.  

At the 10 September 2009 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported pain, decreased ROM and loss of strength to the right wrist.  Physical examination showed dorsiflexion at 70 degrees, palmar flexion at 80 degrees, ulnar deviation at 45 degrees and radial deviation at 20 degrees, with pain noted in all planes of motion.  There was no additional limitation of motion due to fatigue, weakness, lack of endurance or incoordination.  There was no evidence of inflammation, instability, weakness or tenderness.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10%, coded 5024 (tenosynovitis), rated for limitation of motion of one major joint.  The VA also rated the right wrist condition 10% under the same code, citing painful motion causing functional loss based on the C&P examination.  There was no compensable limitation of wrist motion that supported a rating under the VASRD diagnostic codes for limitation of motion (5215).  However, there was evidence of painful motion and functional loss supporting a 10% rating based on §4.59, 4.45, and 4.40.  There were no additional applicable codes to consider.  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.  

Contended PEB Conditions:  Right Ankle Pain, Hypertension, Osteitis Pubis and Hemorrhoids.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Only the chronic right ankle pain was profiled; however, the CI could still complete the Army Physical Fitness Test with an alternate aerobic event.  None were implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right wrist condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right ankle pain, hypertension, osteitis pubis and hemorrhoid 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.  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 20170325, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008823, 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