72RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-04972
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a  National Guard E6, Motor Transport Operator, medically separated for “chronic right wrist pain” with a disability rating of 0%.

CI CONTENTION:  In addition to the right wrist condition, the CI also requested review of additional 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 Physical Evaluation Board (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 - 20050310	VARD - 20060828	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Wrist Pain	5099-5003	0%	Posttraumatic Changes of the Wrist	5215	10%	20051020	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Chronic Right Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right wrist surgery in April 2004.  A right wrist MRI showed ulnar styloid irregularity consistent with an old ulnar styloid fracture and triangular fibrocartilage tear.  
The 19 January 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic right wrist pain.  Physical examination revealed right wrist tenderness, minimal swelling and no instability.  Dorsiflexion was 35 degrees (normal 70), palmar flexion 5 degrees (normal 80), radial deviation 11 degrees (normal 20), ulnar deviation 16 degrees (normal 45).  Painful motion was present.  Additionally, right wrist supination was 30 degrees and pronation was 40 degrees.  

At the 20 October 2005 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported achy right wrist pain and stiffness.  Physical examination showed right wrist tenderness, swelling and guarding.  Dorsiflexion was 60 degrees, palmar flexion 60 degrees, radial deviation 15 degrees and ulnar deviation 35 degrees. Painful motion was noted.  Wrist supination and pronation were not addressed.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing pain limited motion.  The VA rated the right wrist condition 10%, coded 5215 (wrist, limitation of motion), based on the  C&P examination, citing limitation of dorsiflexion of the wrist less than 15 degrees and palmar flexion limited in line with the forearm.  

Panel members agreed there was no limitation of motion that supported a rating under the VASRD diagnostic code for limitation of motion (5215).  However, there was evidence in the NARSUM and C&P examinations of painful motion with functional loss supporting a 10% rating, based on §4.59, §4.40 and §4.45.  The panel considered alternative VASRD wrist and analogous codes, but all were less applicable and/or not advantageous to rating.  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 wrist condition, coded 5299-5215.

BOARD FINDINGS:  In the matter of the right wrist condition, the panel recommends a disability rating of 10%, coded 5299-5215 IAW VASRD §4.71a.  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	
Chronic Right Wrist Pain	5299-5215	10%	

 

XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

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 and to the counsel you listed on your application, XXXXXXXXX, NSO, DAV.

Sincerely,

Enclosure