RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03340
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Petroleum Supply Specialist, medically separated for “chronic right wrist pain” 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 - 20060627	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Wrist Pain…	5099-5003	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Right Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right hand dominant CI’s right wrist condition began in November 2004 after being hit by a motor vehicle while crossing the highway on foot.  Right hand X-rays showed a non-displaced fracture of the ulnar styloid and a non-displaced fracture of the base of the first metacarpal joint (MCJ).  Serial X-rays showed healing of the first MCJ fracture and interval healing of the ulnar styloid fracture.  However, the CI continued to report wrist pain and there was tenderness of the lateral aspect of the wrist; the first MCJ fracture site was non-tender.  An MRI performed on 20 April 2005 showed the ulna fracture, triangular fibrocartilage injury, and tendonitis of the extensor carpi ulnaris tendon (wrist dorsiflexion and adduction).  The first MCJ fracture was healed with evidence of bone bruising still present.  The CI was evaluated by a hand surgeon and offered surgery for the wrist, but he declined.  Repeat right hand X-rays performed on 9 June 2005 noted no bony abnormalities; minimal osteoarthritis changes were noted.  The CI continued to report pain of the lateral aspect of the hand and physical examination showed tenderness of the small finger MCJ area.  

A physical therapy evaluation for the MEB on 9 May 2006 noted complaints of right wrist pain with difficulty writing, picking up and holding objects, and turning doorknobs.  There was pain with all wrist ranges of motion (ROM) on the dorsal (top) aspect of the wrist.  Wrist ROM showed flexion of 30 degrees (normal 80), extension of 40 degrees (normal 70), ulnar deviation of 15 degrees (normal 45), and radial deviation of 10 degrees (normal 20).  Forearm pronation was 80 degrees (normal) and supination was 80 degrees (normal 85).  Elbow ROM was extension of 0 degrees (normal) and flexion of 150 degrees (normal 145).  The 19 May 2006 MEB NARSUM examination, 3 months prior to separation, noted right wrist pain and cited the physical therapy evaluation above.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  There was no limitation of wrist dorsiflexion or palmar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5215).  However there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45).  There was no wrist ankylosis (5241) or malunion/nonunion of the ulna (5211) to warrant rating under those codes.  There was no limitation of forearm extension or flexion (5206, 5207), or pronation or supination (5213), for consideration of rating under those codes.  The panel noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating and a 10% rating under 5003 is also VASRD complaint for imaging evidence of wrist arthritis with painful limited motion.  Therefore, no change to the PEB coding choice is recommended.  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 chronic right wrist pain condition. 

BOARD FINDINGS:  In the matter of the chronic right wrist pain 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 there be 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 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180005931, 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