RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03536
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060807

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Vehicle Operations Apprentice, medically separated for “right wrist pain” with a disability rating of 0%.  

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 - 20060626	VARD - 20070626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Pain	5099-5024	0%	Right Wrist Strain	5215	10%	20061102	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right (dominant) wrist pain began in June 2005 without injury or trauma, and he then reported dropping objects in August 2005.  Treatment included prednisone (steroid) and occupational therapy, and a hand orthopedist diagnosed De Quervain’s tenosynovitis.  Wrist X-rays were normal, but a CT showed distal radial-ulnar calcifications suggestive of capsular or prior ligament injury, and an MRI indicated a scapholunate ligament tear of no surgical significance.  Despite several months of occupational therapy, repeat imaging, and consultations, the CI continued to have pain severe.  

During the 30 April 2006 MEB NARSUM examination, 2 months prior to separation, the CI reported right wrist pain that was “unabated and of significant severity to prevent him from driving which [was] almost 100% of his duty AFSC.”  Physical examination showed normal right wrist strength, but tenderness over the scaphoid and first metacarpal radially, and “pain with extreme supination against resistance.”  Prior orthopedic evaluations showed significant crepitus (with “shuck test” and forearm motion) without substantial instability of the distal radio-ulnar joint (DRUJ); range of motion (ROM) was not addressed. 

At the 2 November 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the provider noted significant right wrist pain with pronation or supination.  A C&P examination on 13 March 2007, 7 months after separation, documented right upper extremity pain, decreased manual dexterity and strength, lifting and carrying limitations, lack of stamina, weakness, and fatigue.  There was severe impairment with driving and moderate to severe effects on most daily activities.  Physical examination revealed painful ROM without limitations from repetition; X-rays showed faint calcifications proximal to the DRUJ without acute changes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 0%, analogously coded 5099-5024 (tenosynovitis), citing normal radiological and clinical findings.  The VA rated the right wrist condition 10%, coded 5215 (wrist, limitation of motion of), based on the STR and C&P examinations, citing functional loss and painful motion.  The panel majority agreed that while there was no limitation of wrist or forearm motion (5213, 5214, or 5215) that supported a higher rating, the NARSUM and C&P examinations documented sufficient evidence of functional loss with painful motion to warrant a 10% rating (based on §4.59, §4.40 and §4.45).  There was no fracture, nonunion or malunion of the radius, ulna or wrist for rating under codes 5210 thru 5212.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the right wrist condition, coded 5099-5215.  

BOARD FINDINGS:  In the matter of the right wrist pain condition, the panel majority recommends a disability rating of 10%, coded 5099-5215 IAW VASRD §4.71a.  The single voter for dissent recommends no change, but did not elect to submit a minority opinion.  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	
Right Wrist Pain	5099-5215	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170329, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03536.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

						Sincerely,

		

								

Attachments:
1. Record of Proceedings 
2. Directive