RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE: PD-2014-01880
BRANCH OF SERVICE:  Army	BOARD DATE:  20141217
SEPARATION DATE:  20040220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 (Signal Support System Specialist) medically separated for a right wrist condition.  The wrist condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The right wrist condition, characterized as “right wrist status post extensor carpi ulnaris tendon debridement and repair” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “pain right wrist post debridement extensor carpi ulnaris tendon” as unfitting, rated 0%, with likely application VA Schedule for Rating Disabilities (VASRD).  The CI non-concurred with the PEB, but chose not to submit a written appeal.  He was then medically separated.

CI CONTENTION:  “All conditions.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20031105 | VA - (2 Mos. Post-Separation
Condition | Code | Rating | Condition | Code | Rating | Exam
Pain Right Wrist Post Debridement Extensor Carpi Ulnaris Tendon | 5099-5003 | 0% | Traumatic Arthritis Right Wrist Status Post Tendon Repair | 5010-5215 | 10% | 20040421
Other x 0 (Not in Scope) | Other x 3 |
Combined:  0% | Combined: 20%
Derived from VA Rating Decision (VARD) dated 20040914 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Pain Right Wrist Post Debridement Extensor Carpi Ulnaris Tendon Condition.  The CI sustained a right wrist injury in February 2002.  Radiographic evaluation on 11 April 2002 demonstrated cystic changes at the ulnar bone and two of the small wrist bones with evidence of early arthritis.  The CI continued to present with right wrist pain and underwent an extensor carpi ulnaris (ECU) tendon debridement on 18 February 2003.  Despite surgical and conservative management the CI continued to report right wrist pain.

At the narrative summary (NARSUM) examination the CI reported that he worked at a desk on a computer all day.  He described difficulty using a mouse, twisting open a jar, lifting more than 10 pounds and doing push-ups.  The examiner noted a mildly hypertrophic right wrist scar, tenderness directly over the ECU to the head of the ulnar and tenderness at dorsal ulnar border of the forearm.  There was no swelling or redness in the wrist or forearm.  A diagnosis of right wrist pain status post extensor carpi ulnaris tendon debridement and repair was rendered.

At the VA Compensation and Pension examination performed 2 months after separation, the CI reported recurrent right wrist pain, decreased grip, and decreased ability to strenuously dorsiflex the wrist.  He reported Percocet use for pain about twice a week, if the pain interfered with his sleep.  The physical examination was significant for a nontender scar on the ulnar aspect of the wrist and limitation of motion in most planes.  Radiographic evaluations documented evidence of prior trauma involving the ulnar styloid process, demineralization of bones and mild degenerative changes above the wrist.

The goniometric range-of-motion 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.

Right Wrist ROM
(Degrees)

MEB ~ 5 Mo. Pre-Sep

OT ~ 7 Mo. Pre-Sep

VA C&P ~ 2 Mo. Post-Sep

Dorsiflexion (70 Normal) | 60 | 55 | 30
Palmar Flexion (80) | 60 | 60 | 45
Ulnar Deviation (45) | 30 | 15 | 15
Radial Deviation (20) | 10 | # | 20
Comment | Limitation of motion with tenderness. | Decreased grip strength, pain limitation of motion ulnar deviation | Percocet for pain 2X/week, painful motion, but no additional decrease with repetition or pain.  Degenerative changes on x-ray
§4.71a Rating | 10% | 10% | 10%

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the pain right wrist post debridement extensor carpi ulnaris tendon condition as unfitting and assigned a 0% disability rating coded analogous to degenerative arthritis, 5009-5003; with cited application of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the right wrist pain condition at 10%; coded 5010 (traumatic arthritis)-5215 (wrist limitation of motion).  The NARSUM and VA examinations documented right wrist limitation of motion and tenderness to palpation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the pain right wrist post debridement extensor carpi ulnaris tendon 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 DoDI 1332.39 for rating pain right wrist post debridement extensor carpi ulnaris tendon was operant in this case and the condition was adjudicated independently of that policy/instruction by the Board.  In the matter of the pain right wrist post debridement extensor carpi ulnaris tendon condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5215 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION | VASRD CODE | RATING
Pain right wrist post debridement extensor carpi ulnaris tendon | 5299-5215 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140421, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD 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, AR20150009956 (PD201401880)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD-2014-01880