RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX	CASE:  PD-2013-01790
BRANCH OF SERVICE: AIR FORCE	BOARD DATE:  20140717
SEPARATION DATE:  20040806

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty 1stLt/O-2 (11A2K/Pilot) medically separated for bilateral wrist pain.  The wrist condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a temporary U4 profile and referred for a Medical Evaluation Board (MEB).  The wrist condition, characterized as “bilateral chronic hand pain,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “bilateral chronic wrist pain” as unfitting, rating the left and right wrist at 10% each with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION: The CI writes: “In 2012XXX from the Pain Clinic at the VA Hospital in Little Rock.  AR diagnosed the likely etiology of my chronic bilateral hand pain to be radiculopathy from disk protrusion at C4-5 and right central disk protrusion at C5-6.  Dr. A---, as well as Dr. K-- in Physical Rehabilitation, have also theorized that osteoarthritis may also be a part of the etiology of my hand pain.  Dr. A-- performed two procedures in 2012 which helped alleviate the pain in my hands, albeit temporarily.  Dr. K-- advised me that osteoarthritis is identified with a clinical diagnosis.  She stated there was possibility osteoarthritis began with the pain in my hands.  She referenced pain I have had in my knees, left elbow and lower back as contributing to her theory.  Dr. K-- stated the procedures performed by Dr. A-- may have alleviated pain from osteoarthritis, just the same as it could have alleviated pain from disc protrusion.  I believe that had I been given an MRI on my neck while still active duty the protruding discs would have been found, which would have led to a different outcome.  In addition, I tried to return to active duty and was told that any issue with the spine is completely disqualifying.  Therefore, I feel my medical discharge should be changed to a medical retirement since what made me unfit for duty is keeping me from returning to duty.”

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 bilateral wrist condition is addressed below.  The cervical spine and osteoarthritis conditions as contended by the CI, were not considered by the MEB or PEB and are therefore not within the purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.  The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20040602	VA - (Same month as Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Chronic Wrist Pain—L Wrist	8715	10%	Cubital Tunnel/Over-Use Syndrome, L Wrist	8599-8515	10%	20040805	
Bilateral Chronic Wrist Pain-R Wrist	8715	10%	Cubital Tunnel/Over-Use Syndrome, R Wrist	8599-8515	10%	20040805	
Other x 0 (Not in Scope)	Other x 4	20040805	
Combined:  20%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20040915 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board will discuss the right and left hand conditions together as most clinical evaluations addressed both en gros but then separate them for rating consideration.

Bilateral Wrist Pain.  The narrative summary (NARSUM) notes this right-hand dominant CI developed pain, tingling and weakness in both hands during pilot training.  These symptoms occurred predominately when flying with the left worse when flying in the pilot’s seat and the right worse when in the co-pilot’s seat.  An extensive medical evaluation to include evaluations by multiple rheumatologists, cardiologists, neurologists, ophthalmologists, physical and occupational therapists and extensive laboratory testing revealed no detectable organic etiology for these symptoms.  X-rays of the hands and cervical spine, magnetic resonance imaging of the brain, nerve conduction studies and clinical evaluations for carpel and cubital tunnel syndromes revealed no etiology.  At the MEB/NARSUM evaluation on 13 April 2004, 4 months prior to separation, the CI reported inability to do simple tasks involving fine or gross motor activity of her upper extremities.  The MEB physical exam noted no swelling or deformity of hand, wrist, elbow or shoulder.  Range-of-motion (ROM), motor strength, sensation and reflexes were normal in both upper extremities.  At the VA Compensation and Pension exam performed the same month as separation, the CI reported increasing discomfort with relief achieved only with hot paraffin wax treatments or nonuse of her hands.  On physical exam, some tenderness to palpation of the finger joints without swelling or deformity was reported.  ROM and sensation in the hands was normal.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated each hand 10%, code 8715, neuralgia of the median nerve; mild IAW 4.12a.  A higher rating under this code requires the condition to be of “moderate severity.”  The VA rated each hand 10%, code 8515, paralysis of the median nerve, citing symptoms similar to the cubital tunnel syndrome although this diagnosis was not established.  The Board next undertook to rate the left and right hand conditions.

Left Wrist Condition:  The Board unanimously agreed that the record in evidence supported a 10% rating under code 8715 but not a higher rating of 20% given the normal motor and sensory examinations and unrevealing nerve conduction studies.  The Board agreed that the condition rose to the level of 10% for painful motion but no higher IAW §4.40 and §4.59.  Given the totality of the negative clinical evaluation, the Board found no other appropriate codes for consideration.

Right Wrist Condition: The Board unanimously agreed that the record in evidence supported a 10% rating under code 8715 but not a higher rating of 30% given the normal motor and sensory examinations and unrevealing nerve conduction studies.  The Board agreed that the condition rose to the level of 10% for painful motion but no higher IAW §4.40 and §4.59.  Given the totality of the negative clinical evaluation, the Board found no other appropriate codes for consideration.

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 either the left or the right wrist 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left wrist pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right 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 20130924, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-01790.

	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 re-characterization or modification 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 re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

							
XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings