RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04876
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Utility Equipment Repairer, medically separated for “right wrist [status post ganglion cysts surgery]”and “left wrist [status post ganglion cysts surgery],” each rated 0%, with a combined disability rating of 0%.

CI CONTENTION:  In addition to his wrists and migraines, the CI requested review of other conditions 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 - 20051021	VARD - 20070110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist 	5215	0%	Residuals of Ganglion Cyst Right Wrist	5002-5215	10%	20060317	
Left Wrist 	5215	0%	Left Wrist Disability	5002-5215	10%	20060317	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	30%	20060317	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Right and Left Wrist Surgeries.  The right and left wrist conditions are presented together for succinctness with separate rating discussions.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had ganglion cysts surgically removed from his left wrist twice and right wrist once.  Following surgery he reported chronic bilateral wrist and hand pain with numbness, paresthesias and weakness.

During the 22 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported right wrist pain associated with tingling and numbness.  Physical examination of the upper extremities was checked normal.  Electrodiagnostic studies on 21 July 2005 were normal although somewhat limited as the CI declined the needle electromyogram.  A neurology consultation on 25 July 2005 revealed subjective sensory loss without neurological correlate and weakness without evidence of nerve damage.  

The 3 August 2005 MEB NARSUM examination, 4 months prior to separation, noted decreased right and left hand sensation and motor function.  Physical examination showed motor function decreased to 4/5 bilaterally in extension, pronation, and supination.  Sensation was decreased over the entire hand, right greater than left.  Muscle tone was normal and atrophy was not documented.  The ROM study showed, in degrees, dorsiflexion of 36 on the left and 29 on the right (normal 70); palmar flexion of 42 on the left and 39 on the right (normal 80); ulnar deviation of 12 on the left and 15 on the right (normal 45) and radial deviation of 21 on the left and 19 on the right (normal 20).  

At the 17 March 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the right-handed CI reported ongoing bilateral wrist pain.  Physical examination showed normal sensation and strength.  The scars were well healed and non-tender.  Guarding was absent, but motion was noted to be stiff and painful.  X-rays also taken on 17 March 2006 were bilaterally normal.  The ROM study showed, in degrees, dorsiflexion of 65 on the left and 60 on the right; palmar flexion of 75 on the left and 70 on the right; ulnar deviation of 30 on the left and 20 on the right and radial deviation of 20 on the left and right with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left wrist conditions 0% each, coded 5215 (wrist, limitation of motion), citing minimal rating criteria not met.  The VA also rated the right and left wrist conditions 0% each, coded 5002-5215 (rheumatoid arthritis causing wrist limitation of motion), based on the C&P examination, citing a non-compensable examination.  Subsequently, the VA increased the rating for each wrist to 10% citing “a clear and unmistakable error” as painful motion was documented for each wrist.  The panel agreed there was no wrist ankylosis (5214) or limitation of motion (5215) to support a 10% rating.  However, there was painful motion to support a 10% rating for each wrist IAW VASRD §4.59, as recorded by the VA examination.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% each for the right and left wrist conditions, each coded 5215.  

Contended PEB Condition:  Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, judged to fail retention standards or implicated in the commander’s statement.  In fact, the commander noted outstanding performance limited by the wrist condition.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  Although the CI was placed on 24 hour quarters 3 to 4 times between February and May 2005, there is no record of quarters in the final 6 months of active service.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right wrist condition, the panel recommends a disability rating of 10%, coded 5215 IAW VASRD §4.71a.  In the matter of the left wrist condition, the panel recommends a disability rating of 10%, coded 5215 IAW VASRD §4.71a.  In the matter of the contended migraine headache condition, the panel recommends no change from the PEB determination as not unfitting.  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	5215	10%	
Left Wrist	5215	10%	
COMBINED	20%	

XXXXXXXXXXXXXXXXXX

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 to 20% 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.

Sincerely,					       
						      					
Enclosure