RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:            BRANCH OF SERVICE:  AIR FORCE
CASE NUMBER:  PD1000104           BOARD DATE:  20110128
SEPARATION DATE:  20060515
____________________________________________________________________________
__

SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered individual (CI) was a  right-handed  active  duty
SSGT (Contracting Specialist, 6C051) medically separated from the Air  Force
in 2006 after 11 years of service.  The medical  basis  for  the  separation
was chronic right wrist pain.  The CI developed right  wrist  pain  in  1994
while training as a dental technician.  She was eventually diagnosed with  a
symptomatic dorsal wrist ganglion cyst which was excised  in  November  1995
and, again in September 1996.  The CI was able to perform  well  within  her
AFSC, however, she did not respond to treatment adequately enough to  handle
a weapon or to deploy.  Her inability to fire  a  weapon  rendered  her  not
qualified for world-wide duty.  She was issued a permanent U-4, L-4  profile
in  March  2006  and  was  referred  for  Medical  Evaluation  Board   (MEB)
processing for her right wrist condition.  The L-4 portion  of  the  profile
reflected temporary limitations due  to  right  knee  surgery  performed  in
January 2006.  The right  wrist  was  forwarded  to  the  informal  Physical
Evaluation Board (IPEB) on the AF Form 618 as medically unacceptable and  no
other  conditions  appeared  on  the  MEB  Report.   Additional   conditions
included in the MEB narrative summary  (NARSUM)  and  disability  evaluation
system (DES) packet are discussed below, but  were  not  forwarded  for  PEB
adjudication.  The IPEB found the CI unfit for the  right  wrist  condition,
with a disability rating of 10%  IAW  Department  of  Defense  and  Veterans
Affairs Schedule for Rating Disabilities (VASRD) guidelines.   The  CI  made
no appeals, and  was  thus  medically  separated  on  15  May  2006  with  a
disability rating of 10%.
____________________________________________________________________________
__

CI CONTENTION:  The CI states:  “The pain  in  my  wrist  affects  me  every
day.”  She contends for a higher rating on her wrist noting difficulty  with
repetitive motions, typing, missed work, and difficulty finding  work.   She
additionally contends  for  PTSD  [Post-Traumatic  Stress  Disorder],  ovary
removal, asthma, chronic bronchitis and sinusitis.
____________________________________________________________________________
__
RATING COMPARISON:
|Service PEB – Dated 20060327   |VA (Pre sep and 5  Mo. after Sep) – All |
|                               |Effective 20060516                      |
|Condition                      |Code                                    |
|TOTAL Combined:  10%           |TOTAL Combined (Includes Non-PEB        |
|                               |Conditions):  50%                       |


ANALYSIS SUMMARY:  The Board acknowledges the  sentiment  expressed  in  the
CI’s application regarding the significant impact that her  service-incurred
condition has had on her current quality of life.  It is  a  fact,  however,
that the DES has neither the role nor the authority  to  compensate  service
members for  anticipated  future  severity  or  potential  complications  of
conditions resulting in medical separation.   This  role  and  authority  is
granted by Congress to the Veterans Administration.  The Board evaluates  VA
evidence proximal to separation in arriving at its recommendations, but  its
authority resides in evaluating the fairness of DES  fitness  decisions  and
rating determinations for disability at the time of separation.

Right Wrist Condition:  There were three range of motion  (ROM)  evaluations
in  evidence  which  the  Board  weighed   in   arriving   at   its   rating
recommendation.  All of these exams are summarized in the chart below.

|Right Wrist    |Separation Date:  20060515                                |
|ROM            |C&P -       |MEB -        |NARSUM -        |C&P -        |
|               |20050124    |20050406     |20060209        |20061030     |
|Palmar flexion |0-70⁰       |⁰            |0-80⁰           |0-80⁰        |
|80⁰            |            |             |                |             |
|Ulnar deviation|0-40⁰       |⁰            |0-45⁰           |0-45⁰        |
|45⁰            |            |             |                |             |
|Radial         |0-20⁰       |⁰            |0-20⁰           |0-20⁰        |
|deviation 20⁰  |            |             |                |             |
|Comments       |            |             |Painful motion  |Painful      |
|               |            |             |                |motion       |
|§4.71a Rating  |            |             |10%             |10%          |

Chronic right wrist pain with activity was well documented  in  the  service
record.  Wrist radiographs taken in January 2005 were  reported  as  normal.
The PEB and VA chose different coding options for the  condition,  but  this
did not bear on the level  of  rating.   The  PEB  chose  5299-5215,  wrist,
limitation  of  motion;  while  the  VA  chose  5024,  tenosynovitis,   with
application of painful motion.  Neither code is predominant, and  both  were
at 10% for painful motion.  The CI had painful range  of  motion  documented
on the NARSUM exam done three months prior to separation and on the VA post-
separation exam which did  not  approach  ankylosis  of  the  wrist  or  any
compensable limited motion without application of  §4.59  (painful  motion).
Comprehensive review of the record indicated that the CI did  not  meet  the
criteria of VASRD §4.40 (functional loss) or §4.63 (Loss  of  use  of  hand)
given the consistent results from multiple pre- and post-  separating  wrist
and hand examinations.  All evidence considered,  there  is  not  reasonable
doubt  in  the  CI’s  favor  supporting  recharacterization   of   the   PEB
adjudication for the right wrist condition as 5299-5215 at 10%.

Contended Conditions (PTSD, Ovary Removal, Asthma, Chronic Bronchitis and
Sinusitis).

PTSD:  The CI was treated for panic disorder, anxiety disorder,  post-partum
adjustment disorder, depression and PTSD.  She was diagnosed  with  PTSD  in
1996 due to a traumatic event that occurred in 1990, at the age of 14.   She
had some worsening of her anxiety and depression in 2006, related to an  OSI
investigation.   Despite  these  symptoms,  she  maintained  her   worldwide
mobility and no mental health profile was  initiated.   On  the  Commander’s
statement there was no mention of PTSD or any  other  mental  health  issues
affecting her performance.  The CI’s profiles were S-1 and  her  performance
evaluations were all top block.  There is also no mention of PTSD or  mental
health concerns in the CI’s memorandum to the MEB.  No link  to  fitness  is
in evidence.

Left ovary removal and sex cord tumor removal:   The  CI  underwent  a  left
adnexal cystectomy in February 1998 for removal of a benign sex cord  tumor.
 In March 2006, another  left  ovarian  cyst  was  noted  as  an  incidental
finding on a CT scan done for left flank pain and  hematuria.   At  time  of
discharge from the military, the CI had both of her ovaries and she did  not
assert to the MEB that this condition was  affecting  her  job  performance.
In September 2009, three years after discharge from  the  military,  the  CI
underwent removal of her left ovary and tube.  No  link  to  fitness  is  in
evidence.

Chronic bronchitis, asthma and sinusitis:  The  CI  did  seek  treatment  on
occasion for symptoms of bronchitis, allergic rhinitis and  sinusitis.   She
asserts that these conditions likely resulted from unprotected  exposure  to
methyl methacrylate during her work  as  an  Air  Force  dental  technician.
These conditions did not impact her job performance and were  not  mentioned
in the CI memorandum or the Commander’s statement to the MEB.   No  link  to
fitness is in evidence.

Neither  the  CI  memorandum  to  the  MEB  nor  the  Commander’s  statement
identified any conditions other than the right wrist.  The  only  documented
physical limitations were those attributed  to  the  adjudicated  condition.
No link to fitness can be drawn for the  other  contended  conditions.   The
Board, therefore, has no reasonable basis for  recommending  any  additional
unfitting conditions for separation rating.

Remaining Conditions:  The medical  conditions  of  migraine  headaches  and
right knee strain, noted in the VA rating decision, were identified  in  the
DES package and NARSUM.  The CI had been placed on a temporary  L-4  profile
following right knee arthroscopy in January  2006.   At  the  post-operative
follow-up appointment three weeks later, orthopedic  clinic  notes  indicate
that she had full extension of the right knee, was “essentially  cured”  and
“doing fine”.  The permanent profile issued in March 2006 included the post-
operative knee limitations with an L-4 profile.  However, because the  right
knee limitations were temporary, this condition was  not  forwarded  to  the
MEB.  At the post-separation C&P exam in October 2006, the CI’s  right  knee
had full range of motion, without instability.  No link  to  fitness  is  in
evidence.  The migraine headaches were not  identified  by  the  CI  or  her
Commander as resulting in  any  duty  limitations.   There  is  no  link  to
fitness in evidence.  The Board has no  reasonable  basis  for  recommending
migraine headaches or right knee strain as additional  unfitting  conditions
for separation rating.

Other Conditions.  The only additional conditions rated by the VA at 10%  or
higher were low back strain  and  TMJ  syndrome.   However,  they  were  not
documented in the DES packet.  The Board does not have the  authority  under
DoDI 6040.44 to render fitness or rating recommendations for any  conditions
not considered by the DES.  Low back strain and TMJ syndrome conditions  and
any other contended  conditions  not  associated  with  the  recommendations
already rendered by the Board remain eligible for consideration by  the  Air
Force Board for Correction of Military Records (AFBCMR).
____________________________________________________________________________
__

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 right wrist condition and IAW VASRD  4.71a,
the Board unanimously recommends no change in the PEB adjudication of  5299-
5215 at 10%.  In the matter of the  Post-Traumatic  Stress  Disorder,  Ovary
Removal, Asthma, Chronic Bronchitis, and  Sinusitis  the  Board  unanimously
agrees that it cannot recommend any findings of unfit for additional  rating
at separation.  In the matter of the headaches and right knee conditions  or
any other medical conditions eligible for  Board  consideration;  the  Board
unanimously agrees that it  cannot  recommend  any  findings  of  unfit  for
additional rating at separation.
____________________________________________________________________________
__

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

|UNFITTING CONDITION                               |VASRD CODE  |RATING  |
|Right Wrist, Tenosynovitis                        |5299-5215   |10%     |
|COMBINED    |10%     |


____________________________________________________________________________
__

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20100109, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans Affairs Treatment Record.





                                        Deputy Director
                                                                    Physical
Disability Board of Review
SAF/MRB

1535 Command Drive, Suite E-302
Andrews AFB, MD  20762-7002



      Reference your application submitted under the provisions of DoDI
6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2010-00104.

      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
with severance pay.

      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







                                       Director
                                       Air Force Review Boards
                                       Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR