RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX	 	CASE: PD-2013-01733
BRANCH OF SERVICE:  ARMY		BOARD DATE:  20140527
SEPARATION DATE:  20050605

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (91W/Healthcare Specialist) medically separated for a chronic left wrist condition.  The condition was treated, but could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent U3 and referred for a Medical Evaluation Board (MEB).  The MEB characterized her condition, “chronic left wrist pain,” as medically unacceptable.  The MEB also identified and forwarded one other condition, “history of ganglion cysts in the left wrist” as medically acceptable for the Physical Evaluation Board (PEB) adjudication.  The Informal PEB adjudicated the condition as “chronic left wrist pain (right dominant)” unfitting, rated 10% with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Lower Back Pain:  I injured my back on a JROTC Rotation Aug 2004 and was seen at TMC 1.  Upon return I did follow up at TMC 1 @ Ft. Benning and have since reported issues since work has not allowed for proper therapy.  Currently hinders activity.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left wrist condition is addressed below.  The not unfitting ganglion cysts, left wrist was not contended; and, thus is not within the Board’s defined DoDI 6040.44 purview.  The contended low back pain was not identified by the MEB or PEB, and thus is not within the Board’s purview.  These, and any condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20050415	VA* - (Exam ~ 2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Wrist Pain (Right Dominant)	5099-5003	10%	Chronic Left Wrist Pain with History of Recurrent Ganglion Cysts	5299-5215	10%	20050405	
Ganglion Cysts Left Wrist	Not Unfitting					
Other x 0 (Not in Scope)	Other x 3	20050405 	
Combined:  10%	Combined:  10%	
* Derived from VA Rating Decision (VARD) dated 20050707 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Chronic Left Wrist Pain.  After the right hand dominant CI was treated for a cyst in her left wrist in 2003, she continued to complain of left wrist pain which was deemed by an orthopedist to be a non-surgical issue.  A magnetic resonance imaging study was normal.  On 15 February 2005 (4 months prior to separation), the MEB exam noted painful motion.  At the narrative summary exam on 1 March 2005, the CI complained of pain in her wrist that was “present 50% of the time.”  She reported an inability to lift heavy objects or perform certain overhead activities due to left wrist pain.  Physical examination noted use of a wrist splint.  There was no wrist swelling.  Tenderness of the dorsal wrist was present and there was mild left grip strength weakness.

At the VA Compensation and Pension exam performed 2 months prior to separation, the CI reported constant left wrist pain that was not incapacitating.  She was not receiving any treatment for her wrist at that time.  Repetitive use did not result in additional limitation of motion.  The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Wrist ROM
(Degrees)	NARSUM ~3 Mos. Pre-Sep	VA C&P ~2 Mo. Pre-Sep	
Dorsiflexion (0-70)	60	70	
Palmar Flexion (0-80)	80	80	
Ulnar Deviation (0-45)	35	45	
Radial Deviation (0-20)	15	20	
Comment	+tenderness	--	
§4.71a Rating	10%*	10%*	
		*IAW §4.40 (functional loss) or §4.59 (painful motion)

The Board directs attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis) with application of the USAPDA pain policy.  The VA likewise assigned a 10% rating, but used an analogous 5215 code (wrist, limitation of motion of).  Although non-compensable limitation of motion was present, Board members agreed that functional loss or painful motion were reasonably conceded, therefore supporting a 10% rating IAW VASRD §4.40 or §4.59.  The only wrist coding option that permits a rating higher than 10% is 5214 (wrist, ankylosis of).  Since wrist ankylosis was not present, a higher rating was not justified in this case.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic left wrist pain condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy for rating chronic left wrist pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic left wrist pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131022, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150000986 (PD201301733)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA