RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04401
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050924

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Wheeled Vehicle Mechanic, medically separated for “chronic right ankle pain” and “chronic bilateral wrist pain,” rated 0% each, with a combined disability rating of 0%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20050623	VARD - 20060607	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain…	5099-5003	0%	Right Ankle Sprain	5271	0%	20051202	
Chronic Bilateral Wrist Pain…	5099-5003	0%	Right Wrist Carpal Tunnel	8515	10%	20051202	
			Left Wrist Carpal Tunnel	8516	10%	20051202	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began in March 2004.  Absent history of direct trauma, the CI developed ankle pain and instability to the point where he would repeatedly “roll” his right ankle.  Despite aggressive physical therapy (PT), his symptoms remained.   At the 1 April 2005 MEB NARSUM examination, 6 months prior to separation, the CI’s chief complaint was “right ankle pain and instability.”  Physical examination (PE) revealed decreased range of motion (ROM) and tenderness in the right ankle.  ROM measurements included 30 degrees of plantar flexion (normal 45) and 15 degrees of dorsiflexion (normal 20).  There was no comment with regard to painful motion.  

At the 2 December 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported aching of the right ankle that was aggravated by prolonged walking and relieved by rest.  Additionally, he endorsed occasional swelling of both ankles.  The PE noted tenderness about the right lower extremity.  Right ankle ROM was normal and pain-free.      

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also rated the right ankle condition 0%, coded 5271 (ankle, limited motion), based on both the STR and C&P examination.

With significant variation in pre- and post-separation examination findings the panel first considered probative value and concluded that the VA examination is apportioned a greater degree of probative value due to its closer proximity to the service separation date.  Panel members then deliberated extensively and concluded that although the right ankle ROM had normalized by the time of the VA examination, the presence of right-sided lower extremity tenderness coupled with subjective pain upon walking supported a decision that at least a slight degree of ankle disability remained and presumably was a residual finding from a musculoskeletal involvement of the lower extremity.  Therefore, 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 ankle condition, analogously coded as 5299-5262 (tibia/fibula; impairment).

Chronic Bilateral Wrist Pain.  According to the STR and MEB NARSUM the CI’s bilateral wrist pain began insidiously in May 2004.  The 31 January 2005 MEB NARSUM examination, 8 months prior to separation, noted complaints of bilateral wrist pain that interfered with the activities of his job and daily living.  The PE revealed decreased ROM noting 60 degrees of dorsiflexion and 75 degrees of plantar flexion of each wrist (normal 70 and 80 degrees, respectively).   

Clinical records dated 20 June 2005, 3 months prior to separation, noted the CI’s bilateral wrist pain intensity as 1/10.  On 28 October 2005, one month after separation, the CI was clinically assessed as having bilateral carpel tunnel syndrome (CTS) without the means of electro-diagnostic testing.  At the VA C&P examination, the CI reported nocturnal aching of both wrists as well as numbness in the fingers of both hands.  The PE noted normal and non-painful ROM of both wrists.

The panel directed attention to its rating recommendation based on the above evidence.  Utilizing the analogous code 5099-5003 (degenerative arthritis), the PEB bundled both wrists into a single condition and rated 0% whereas the VA separately rated each wrist at 10% under code 8515 (incomplete paralysis of the median nerve).  The panel first considered if each wrist, having been de-coupled from the combined PEB adjudication, remained independently unfitting and ratable.  In consideration of separate ratings, the panel must also consider separate fitness assessments which justify each disability rating.  

The panel first considered and agreed that the CI’s permanent profile of restricting the carry and/or firing of a weapon would support either wrist as being found separately unfitting and ratable.  Additionally, the panel acknowledged there was the minimal level of wrist pain intensity at 3 months pre-separation which, coupled with poor ROM, completely normalized within 2 months after separation.  Members further agreed that despite the findings of separate unfitness, such physical improvements of minimal symptoms would not support any degree of a positive impairment rating.  Therefore, 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’s adjudication for the bilateral wrist condition.

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 10%, analogously coded as 5299-5262 IAW VASRD §4.71a.  In the matter of the chronic bilateral 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.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Right Ankle Pain	5299-5262	10%	
Chronic Bilateral Wrist Pain	5099-5003	0%	
COMBINED	10%	

The following documentary evidence was considered:

AR20190004843, XXXXXXXXXX

Dear XXXXXXXXXX:

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