RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-04177 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050104

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Supply Specialist, medically separated for “right hand pain” and “right greater trochanteric bursitis,” rated 0% each, with a combined disability rating of 0%.

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:

20041006	VARD – 20070713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hand Pain	5024	0%	Postoperative Residuals, Right Ganglion Cystectomy	5215-5024	10%	20041214	
Right Greater Trochanteric Bursitis	5019	0%	Right Greater Trochanteric Bursitis	5250-5024	0%	20041214	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Right Hand Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right (dominant) hand surgery in February 2004 to remove a ganglion cyst. The 20 August 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain in the area of the surgical scar, which was aggravated by push-ups, firing a weapon, gripping and lifting. Physical examination showed no deformity, effusion or warmth, but there was tenderness over the healed scar. Strength was normal in the metacarpophalangeal joint and wrist, and pinch strength was also normal.   Right wrist range of motion (ROM) testing

showed extension of 35 degrees (normal 70), flexion of 45 degrees (normal 80), ulnar deviation of 35 degrees (normal 45) and radial deviation of 15 degrees (normal 20). Motor strength and sensation were intact.

During the 28 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months before separation, the CI reported that his “right hand bends only so much before [it becomes] too painful to move. Cannot do many repetitive movements with hand without severe pain setting in after about 10 minutes.” Physical examination showed right wrist pain and decreased ROM. The MEB physical therapy (PT) ROM study, the same day, showed 40 degrees of flexion, 35 degrees of extension and 30 degrees each of radial and ulnar deviation. Painful motion was present in all planes of movement.

At the 14 December 2004 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported right wrist pain. Physical examination revealed tenderness and a well-healed surgical scar.  There was 38 degrees of flexion and 32 degrees of extension.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right hand condition 0%, coded 5024 (tenosynovitis), citing normal radiographs. The VA rated the right hand condition 10%, dual coded 5215-5024 (limitation of wrist motion due to tenosynovitis), based on the C&P examination, citing painful or limited motion of a major joint. Panel members agreed that there was no limitation of wrist motion that supported a rating under code 5215, however, there was evidence of painful motion causing functional loss that warranted a 10% rating IAW VASRD §4.40, §4.45 and §4.59). The panel also considered a 30% rating under code 5214 (unfavorable ankylosis of the wrist), but there was no evidence of ankylosis. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right hand condition, coded 5024.

Right Greater Trochanteric Bursitis. According to the STR and MEB NARSUM, the CI’s right hip condition began during basic training while on a road march. Pelvic radiographs showed “subtle” arthritic changes (small osteophyte in the lateral acetabulum). The MEB NARSUM examination noted complaints of right hip pain, aggravated by prolonged sitting, standing, squatting, kneeling, walking and lifting. Physical examination showed no deformity, warmth or discoloration, but there was tenderness over the greater trochanter. Right hip ROM was full without discomfort in external rotation, internal rotation, abduction or adduction. Motor strength was normal (5/5) in both hips. During the MEB examination, the CI reported right hip pain, and the examiner noted decreased ROM and pain over the greater trochanter. The MEB PT ROM study showed right hip flexion to 85 degrees (normal 125) and abduction to 35 degrees (normal 45), with painful motion.

At the C&P examination, the CI reported right hip pain, which restricted physical activities. Physical examination showed a slightly antalgic gait, and goniometrically measured right hip ROM showed flexion to 95 degrees (95 degrees in the left hip) and abduction to 40 degrees (30 degrees in the left hip). The examiner opined that the bilateral hip ROM was normal for the CI’s body type and muscle mass.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right hip condition 0%, coded 5019 (bursitis), citing ROM within acceptable norms and no focal neurovascular deficit. The VA rated the right hip condition 0%, coded 5250-5024 (ankylosis of hip due to tenosynovitis), based on the C&P examination, citing no objective evidence of painful or limited motion of a major joint. Panel members agreed that there was no compensable limitation of flexion, extension or abduction (5251, 5252 or 5253), and no fracture, nonunion, or malunion of the femur to support consideration under code 5255. Although the C&P examination documented ROM that appeared to show limitation, the examiner believed the ROM was normal based on body habitus, and the panel noted that the unaffected left hip had measurements equal to or less than the affected hip.   There was no evidence of painful motion

to support a 10% rating IAW VASRD §4.59. 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 hip condition.

BOARD FINDINGS: In the matter of the right hand condition, the panel recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a. In the matter of the right hip bursitis 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.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Hand Pain	5024	10%	
Chronic Right Greater Trochanteric Bursitis	5019	0%	
	COMBINED	10%	

The following documentary evidence was considered:

PD-2017-04177 

AR20190012068, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

PD-2017-04177