RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04339
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051216

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

CI CONTENTION:  In addition to the right wrist condition, the CI requested review of another condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20051020	VARD - 20050811	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominant) Wrist Pain	5215	0%	Right Wrist Lunate Dislocation	5215	0%	STR	
			Right Wrist Carpal Tunnel Syndrome	5215-8515	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Right Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-handed CI underwent right carpel tunnel release and perilunate repair after a motor vehicle accident in February 2005.  The CI did not regain full motion of the wrist or sensation in the median nerve distribution of the right hand.  Electrodiagnostic studies showed mild borderline median neuropathy of the right wrist.  

During the 1 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported pain in his right wrist.  Physical examination showed decreased range of motion (ROM) of the right wrist with pain on the dorsal (dorsiflexion – palm up) and palmar (palmar flexion – palm down) aspects.  Wrist strength was 2/5.  

The 11 August 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of significant right wrist pain and continued median neuropathy.  Physical examination showed significant tenderness dorsally over the scapholunate region as well as the carpal tunnel.  There was decreased light touch sensation diffusely throughout the median nerve distribution.  Abductor pollicis brevis strength was slightly diminished.  There was no thenar (thumb part of palm) atrophy.  Ulnar nerve sensation was normal.  There was a positive Tinel sign over the volar carpal tunnel and a positive carpal compression test.  The right wrist ROM study showed extension (dorsiflexion) of 30 degrees (normal 70) and flexion (palmar flexion) of 45 degrees (normal 80).  The examiner opined that the CI had significant right wrist pain and median neuropathy that failed to improve with all conservative and operative measures.  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 0%, coded 5215 (wrist, limitation of motion), citing residual right wrist numbness and pain; noncompensable passive ROM; and non-ratable decreased light touch throughout the right median nerve distribution.  The VA also rated the right wrist condition 0%, also coded 5215, based on the STR, citing a noncompensable evaluation.  The VA additionally rated the right wrist condition 0%, dual coded 5215-8515 (wrist, limitation of motion-median nerve, mild paralysis), citing a noncompensable evaluation.

The panel reviewed the evidence and was not able to definitively determine which right wrist functional impairments were caused by the right wrist arthrofibrosis versus the right wrist median neuropathy.  Consequently, in avoidance of pyramiding (VASRD §4.14) and IAW VASRD §4.7 (higher of two evaluations), the panel determined the examination evidence for the medial neuropathy provided for a higher VASRD rating than the right wrist arthrofibrosis condition.  The panel then considered its rating recommendation for the right wrist median neuropathy condition at the time of separation.

VASRD codes 8515 (median nerve paralysis), 8615 (median nerve neuritis) and 8715 (median nerve neuralgia) rely on mild (10%), moderate (30%) and severe (50%) incomplete paralysis disability designations to rate the condition.  The panel agreed that a rigid assessment could require 3/5 or worse strength testing to merit a moderate rating.  A more liberal moderate rating could apply any objective motor impairment or atrophy.  In this case, electrodiagnostic studies revealed right wrist median neuropathy, significant pain with motion, mildly decreased sensation and 2/5 weakness.  The CI’s permanent U3 profile prohibited push-ups, pulls-ups, lifting greater than 5 pounds and carrying and firing a weapon.  The panel majority agreed that the objective clinical and diagnostic evidence was best rated under code 8515 (carpel tunnel) and most approximated a “moderate” 30% rating for the right-handed CI at the time of separation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 30% for the right wrist condition, coded 8515.

BOARD FINDINGS:  In the matter of the right wrist condition, the panel majority recommends a disability rating of 30%, coded 8515 IAW VASRD §4.124a.  The single voter for dissent recommends modification to 10% but does 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right (Dominant) Wrist Pain	8515	30%	

The following documentary evidence was considered:

[AR Number], XXXXXXXXXX

Dear XXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with [severance pay] [Reserve retirement].  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation [minus the amount of severance pay you were previously paid at separation].
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (TAPD-ZB / XXXXXXXXXX), XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

	A copy of this decision has also been provided to the Department of Veterans Affairs [and to the counsel you listed on your application; [name and address]].