SEPARATION DATE:  20031107 

                          BRANCH OF SERVICE:  NAVY 

 
NAME:  XX                 
CASE NUMBER:  PD1200592                            
BOARD DATE:  20130116   
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty IT2/E-5 (Information Systems Technician), medically 
separated  for  chronic  right  wrist  pain/instability  and  chronic  left  wrist  pain/instability 
conditions.    The  CI  injured  her  wrists  in  March  1999  when  a  75  pound  box  fell  on  both  her 
wrists.    After  extensive  treatment,  including  surgery  on  both  wrists,  the  CI  could  not  be 
adequately rehabilitated to meet medical requirements of her service.  She was consequently 
placed  on  limited  duty  and  referred  for  a  Medical  Evaluation  Board  (MEB).    The  MEB 
recommended the CI be disqualified from further military service due to chronic bilateral wrist 
pain/instability,  left  wrist  ganglion  cyst,  osteoporosis,  and  osteoarthritis  conditions,  and 
forwarded these conditions to the Physical Evaluation Board (PEB).  No other conditions were 
submitted by the MEB.  The PEB adjudicated the chronic right wrist pain/instability and chronic 
left wrist pain/instability conditions as unfitting, rated 10% for each wrist, with a bilateral factor 
of  1.9%  applied,  providing  a  combined  20%  permanent  disability  rating,  citing  criteria  of  the 
Veterans Affairs Schedule for Rating Disabilities (VASRD).  The PEB adjudicated the CI’s left wrist 
ganglion  cyst  as  a  Category  II  condition,  relating  it  to  her  chronic  left  wrist  pain/instability 
condition.  The PEB determined the osteoporosis and osteoarthritis conditions to be Category 
III, conditions that are not separately unfitting and do not contribute to the unfitting conditions.  
The CI made no appeals, and was medically separated with 20% disability rating.   
 
 
CI CONTENTION: “I believe that I should have been awarded permanent disability retirement 
because my disability is permanent and has worsened over the years.  I respectfully request a 
reconsideration  because  I  am  no  longer  able to  perform  some  everyday  tasks.    I  often  think 
about the way I was separated and at the time, I really did not know that I had the option to 
disagree  with  the  decision,  as  I  was  not  advised  of  it  until  many  years  later.    If  I  was  found 
unable to perform my simple job duties while on active duty, then what would I be able to do 
outside the military.”   
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of Defense Instruction (DoDI) 6040.44 (Enclosure 3, paragraph 5.e.2) is limited to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military  service;  or,  when  requested  by  the  CI,  those  condition(s)  “identified  but  not 
determined to be unfitting by the PEB.”  The ratings for the unfitting chronic right and left wrist 
pain/instability  conditions  and  the  related  left  wrist  ganglion  are  addressed  below.    The 
osteoporosis and osteoarthritis conditions will be addressed only as they relate to the unfitting 
chronic  wrist  pain  and  instability  conditions.    Any  other  conditions  intended  in  request  for 
Board  consideration,  or  any  condition  or  contention  outside  the  Board’s  defined  scope  of 
review,  remain  eligible  for  future  consideration  by  the  Board  for  the  Correction  of  Naval 
Records.   
 
 

RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

Instability,  Status 

Rating 
10% 

Exam 
20040507 

10% 

20040507 

20040507 

Combined:  20%* 

Code 
5215 

5215 

Rating 
10% 

10% 

Code 
5299-5003 

0% X 1 / Not Service Connected x 1 

5299-5003 
Cat II 
Not Unfitting 
Not Unfitting 

VA (~6 Mos. Post-Separation) – Effective 20031108 
Condition 
Right  Wrist 
Post Reconstruction Surgery 
Left Wrist Instability, Status Post 
Ganglion Cyst Removal 

RATING COMPARISON:   
 
Service IPEB – Dated 20030903 
Condition 
Chronic  Right  Wrist  Pain/ 
Instability 
Chronic  Left  Wrist  Pain/ 
Instability 
Left Wrist Ganglion Cyst 
Osteoporosis 
Osteoarthritis 
↓No Additional MEB/PEB Entries↓ 
Combined:  20%* 
* Additional VA ratings for the right and left hands added by VARD 20100802 (neuralgia right palm/fingers @30% and left palm 
and fingers @20%) effective 20080225 (combined 60%); Subsequent right wrist surgery and painful scar ratings were added 
with additional conditions resulting in a combined 90% rating effective 20120110.   
 
 
ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant 
impairment  with  which  his  service-connected  conditions  continues  to  burden  her;  but,  must 
emphasize that the Disability Evaluation System (DES) 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.   
 
Chronic  Right  and  Left  Wrist  Conditions:    All  exams  and  the  preponderance  of  notes  in  the 
record addressed both the left and right wrist in the same history and exam.  The wrist exams 
and 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.  The CI was right hand dominant.  The MEB narrative summary 
stated the CI injured her right and left wrists in early 1999 and was diagnosed with bilateral 
wrist  instability  (right  greater  than  left).    As  a  result  of  her  injury,  she  had  two  right  wrist 
surgeries  due  to 
  Orthopedics  then  determined  that  the  residual  right 
wrist/ligamentous instability was non-operable.  The CI had a left wrist ganglion cyst at the time 
of the MEB examination, with surgical removal pending.  The present condition was described 
as pain with activities of daily living such as carrying bags, cooking, typing, writing, etc.  Right 
wrist  radiographs  indicated  surgical  changes  including  a  widened  scapholunate  interval  and 
diffuse osteoporosis.  Left wrist X-rays were normal, with magnetic resonance imaging (MRI) 
evidence  of  left  wrist  dorsal  ganglion  cyst.    The  diagnoses  were  chronic  bilateral  wrist 
pain/instability,  left  wrist  ganglion  cyst,  osteoarthritis,  and  osteoporosis.    After  the  MEB 
NARSUM, the CI underwent left wrist ganglion cyst surgical removal with no complications.  The 
wrist ROM exam at the MEB exam is summarized in the chart below.   
 

instability. 

 

   2                                                           PD1200592 
 

 

Wrist ROM 
(In degrees) 
Dorsiflexion (0-70) 
Palmar Flexion (0-80) 
Ulnar Deviation (0-45) 
Radial Deviation (0-20) 

O.T. ~15 Mos. Pre-Sep 
Right 
52 
35 
30 
30 

Left 
60 
52 
20 
25 

MEB~7 Mos. Pre-Sep 
Right 
Left 

“Bilateral decreased ROM” 

Pain 
and 
tenderness 
10% 

 

10% 

Left 
45 
40 
- 
- 

VA C&P ~6 Mos. Post-Sep  
Right 
40 
35 
- 
- 
pain,  weakness,  fatigability,  and 
lack of endurance with repetitive 
movement of both wrists 
10% 

10% 

Comment:   

§4.71a Rating 

tenderness 

Bilateral 
to 
palpation;  +  palpable  tender 
mass over right scaphoid 
(10%) PEB 

(10%)PEB 

 
The  VA  Compensation  and  Pension  exam  indicated  the  CI  had  right  wrist  discomfort  with 
repetitive use, but not at rest.  The CI stated that her left wrist was not painful all the time, but 
would flare with repetitive use.  She was treating the flares with occasional non-prescription 
medication and temporary splinting.  There was left wrist pain with lifting items such as cans of 
soup.  X-ray of the right hand/wrist showed no significant interval change from the X-rays cited 
by the MEB.  X-ray of the left hand/wrist was within normal.  The diagnosis was bilateral wrist 
instability  with  functional  impairment.    On  exam  there  was  evidence  of  pain,  weakness, 
fatigability,  and  lack  of endurance  with  repetitive  movement  of  both wrists.    The  wrist  ROM 
exam is summarized in the table above.   
 
Chronic Right Wrist Pain/Instability.  The Board directs attention to its rating recommendation 
based on the above evidence.  The PEB rated the chronic right wrist pain/instability as 5299-
5003  (right  wrist  impairment  analogous  to  arthritis)  at  10%.    The  VA  rated  the  right  wrist 
instability, status post (s/p) reconstruction surgery as 5215 (wrist limitation of motion) at 10%.   
 
The medical record supported right wrist instability and pain s/p two surgeries which resulted 
in limitation of motion and painful motion of the right wrist.  The right wrist instability and pain 
can  be  rated  as  code  5215,  with  application  of  VASRD  §4.59  (Painful  motion)  at  10%.  
Alternative use of code 5299-5003 (wrist impairment analogous to arthritis) with application of 
VASRD  §4.59  (Painful  motion)  would  also  result  in  a  rating  of  10%.    After  due  deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the 
Board  concluded  that  there  was  insufficient  cause  to  recommend  a  change  in  the  PEB 
adjudication of the chronic right wrist pain/instability condition.   
 
Chronic Left Wrist Pain/Instability.  The Board directs attention to its rating recommendation 
based on the above evidence.  The PEB rated the chronic left wrist pain/instability as 5299-5003 
(left wrist impairment analogous to arthritis) at 10%.  The VA rated the left wrist instability, s/p 
ganglion cyst removal as 5215 (wrist, limitation of motion) at 10%.  The medical record supports 
left wrist instability and pain s/p ganglion surgery which resulted in limitation of motion and 
painful motion of the left wrist.  As with the CI’s dominant right wrist, all exams in evidence for 
the left wrist supported a 10% rating with application of VASRD §4.59 under analogous coding 
to either 5215 or 5003.  After due deliberation, considering all of the evidence and mindful of 
VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was insufficient 
cause to recommend a change in the PEB adjudication for the chronic left wrist pain/instability 
condition.   
 
Contended  PEB  Conditions.    The  Board’s  main  charge  is  to  assess  the  fairness  of  the  PEB’s 
determination  that  the  contended 
left  wrist  ganglion  cyst,  osteoporosis  (wrist),  and 
osteoarthritis  (wrist)  conditions  were  not  unfitting  or  separately  compensable.    The  Board’s 
threshold for countering fitness determinations is higher than the VASRD §4.3 (Resolution of 
reasonable doubt) standard used for its rating recommendations, but remains adherent to the 
DoDI 6040.44 “fair and equitable” standard.  Regarding the contended left wrist ganglion cyst 

   3                                                           PD1200592 
 

condition, there was no evidence of any separately compensable disability to the left wrist pain 
and  instability  due  to  the  ganglion  cyst  removal.    The  contended  left  wrist  ganglion  cyst, 
osteoporosis (wrist), and osteoarthritis (wrist) conditions were all part of the CIs unfitting left 
and  right  wrist  pain/instability  conditions  and  any  disability  from  these  conditions  were 
considered under the above rating for each wrist.  After due deliberation in consideration of the 
preponderance  of  the  evidence,  the  Board  concluded  that  there  was  insufficient  cause  to 
recommend a change in the PEB fitness determination for any of the contended conditions and 
no additional disability ratings are recommended.   
 
 
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 chronic right wrist pain/instability and IAW VASRD §4.71a, 
the Board unanimously recommends no change in the PEB adjudication.  In the matter of the 
chronic left wrist pain/instability and IAW VASRD §4.71a, the Board unanimously recommends 
no  change  in  the  PEB  adjudication.    In  the  matter  of  the  contended  left  wrist  ganglion  cyst, 
osteoporosis (wrist), and osteoarthritis (wrist) conditions, the Board unanimously recommends 
no change from the PEB determinations as not unfitting.  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, as follows:   
 

UNFITTING CONDITION 
Chronic Right Wrist Pain/ Instability 
Chronic Left Wrist Pain/ Instability 

VASRD CODE  RATING 
5299-5003 
5299-5003 

10% 
10% 
COMBINED (w/ BLF)  20% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120604 w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans’ Affairs Treatment Record. 
 
 
 
 
 
 
 
 
 

 

          xx 
           Director 
           Physical Disability Board of Review 

   4                                                           PD1200592 
 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW  
                                        BOARDS  

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 

Ref:   (a) DoDI 6040.44 

             (b) CORB ltr dtd 21 Feb 13 
 

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for 
the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR 
that the following individual’s records not be corrected to reflect a change in either characterization 
of separation or in the disability rating previously assigned by the Department of the Navy’s 
Physical Evaluation Board: 
 
 
 
 
 

 
 
 
 

 

 

     
 
 
 
 
 

-  former USN  
-  former USN  
-  former USMC 
-  former USN   
-  former USMC 
-  former USN  
-  former USN   
-  former USN 
-  former USMC 
-  former USMC 
-  former USMC 
-  former USMC 
 
  

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

  xxxx 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

   5                                                           PD1200592