RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxx  	CASE:  PD-2017-05599
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080624

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Fuel Systems Journeyman, medically separated for “left wrist pain” with a disability rating of 10%.  

CI CONTENTION:  “Since I have injured my left wrist, I still have issues with it.  Since I’m left handed, it does make life difficult sometimes.”  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 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 - 20080513	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain	5215	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Wrist Pain.  According to the service treatment record) and MEB narrative summary (NARSUM), the CI developed a left wrist ganglion cyst in 2004 which was surgically removed.  She continued to have pain and underwent a left wrist arthroscopy, which revealed significant scar tissue as well as some inflammation.  The scar tissue was debrided, but she continued to have wrist pain and intermittent numbness in three fingers.  The 8 January 2008 MEB NARSUM examination showed well-healed scars with tenderness over the dorsal surface, but no swelling. Medications included Vicodin (narcotic) as needed.   Physical therapy (PT) range of motion (ROM) measurements, the same day, showed flexion to 30 degrees (normal 80), extension to 60 degrees (normal 70), ulnar deviation (UD) to 15 degrees (normal 45), and radial deviation to (RD) 12 degrees (normal 20).  A follow-up PT visit on 13 February 2008 revealed flexion of 55 degrees, extension of 60 degrees, and UD/RD within normal limits.  

The 23 February 2008 MEB NARSUM addendum, 4 months prior to separation, documented persistent pain, rated at 8/10, with pushups and turning motions of the wrist, but no pain while at rest.  The surgeon opined that she had reached maximum benefit from treatment and recommended limiting activities that caused pain.  The 28 February 2008 MEB PT ROM study showed decreased average left wrist flexion (60, 58, and 61 degrees), with painful motion, as measured by inclinometer.  Goniometrically measured UD and RD showed no significant loss of motion.  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 left wrist condition 10%, coded 5215 (wrist, limitation of motion of).  Panel members agreed that there was evidence of painful motion with functional loss to support a 10% rating (based on §4.59), but no findings from the NARSUM examination of instability, weakness, deformity, arthritis, or favorable ankylosis of dorsiflexion at 20-30 to meet criteria for a rating higher than that adjudicated by the PEB.  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 left wrist condition.  

BOARD FINDINGS:  In the matter of the left wrist condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

SAF/MRB

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05599.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.