RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04075
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  200507111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “chronic pain, right wrist” with a disability rating of 10%.  

CI CONTENTION:  A lengthy contention requests review the ratings for the right wrist, neck and back. 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 - 20050525	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Chronic Pain	5099-5003	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Wrist (Dominant).  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right wrist surgery in August 2004 for a right wrist capsulodesis (orthopedic surgical technique that reduces flexion by 20%) and placement of internal fixation.  Occupational therapy on 15 February 2005, noted right wrist supination pronation and digits within normal limits.  

The 17 March 2005 MEB NARSUM examination, 4 months prior to separation, showed 2+ tenderness of the dorsal wrist with neuropathic pain into digits two, three and four.  There was limited range of motion (ROM) with dorsal flexion of 5 degrees (normal 70) and palmar flexion of 40 degrees (normal 80).  The examiner noted significant residual loss of right wrist ROM.  The hand surgeon noted the CI could have further problems with time and use.  There was severe pain with exertion.  He could not lift more than 10 pounds.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The NARSUM examination noted the CI had some limitation of motion in dorsiflexion and palmar flexion but occupational therapy noted he had full ability to supinate and pronate.  The limitation of motion interfered with his ability to perform some activities.  Severe pain was intermittent and he required pain medication as needed about three times per month. The panel noted there was no ankylosis (5214) and the rating options for limitation of motion (5215) to did not support a higher rating higher than the 10% adjudicated by the PEB.  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 right wrist condition.  

BOARD FINDINGS:  In the matter of the right 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.  

AR20180016618, 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.