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AF | PDBR | CY2013 | PD-2013-02055
Original file (PD-2013-02055.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02055
BRANCH OF SERVICE: Army  BOARD DATE: 20140822
SEPARATION DATE: 20040429


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (15Q/Air Traffic Control Operator) medically separated for chronic right wrist pain. The 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 condition was characterized by the MEB as “persistent right wrist pain” and was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “chronic pain, right wrist” as unfitting, rated 10% referencing the US Army Physical Disability Agency (USAPDA) pain policy . The CI made no appeals and was medically separated.


CI CONTENTION: “I was told at my final medical evaluation that over time the condition of my wrist would deteriorate and that my wrist would become arthritic. My wrist has become more and more painful and I am finding it increasingly more difficult to stay physically active and perform duties around the house. It is also bothering me emotionally that I am not able to participate in a majority of sporting activities with my children.” His complete submission is at Exhibit A.


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 chronic right wrist condition is addressed below and, no additional conditions are within the DoDI 6040.44 defined 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 his service-connected condition continues to burden him; 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, operating under a different set of laws. 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 20040223
 VA - (~3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain, Right Wrist 5099-5003 10% Fracture, Right Wrist, s/p ORIF 5215 10% 20040721
Other x 0 (Not in Scope)
 Other x 2 20040721
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 41115 ( most proximate to date of separation [ DOS ] ).

ANALYSIS SUMMARY:

Right Wrist Condition. The CI was right-handed. The CI initial injured his right wrist while playing basketball in July 2002. An arthrogram (radiology examination) performed in December 2002 revealed a triangular fibrocartilage complex (TFCC) tear and scaphoid-lunate ligament tear in his right wrist. On 10 October 2003, he had arthroscopic debridement and repair of his ligamentous injuries. Despite uncomplicated healing, his wrist pain and limited motion remained. An orthopedic note dated 29 January 2004 noted right wrist pain with activity.

The MEB orthopedic narrative summary was dictated on 2 February 2004 (3 months prior to separation). The CI endorsed the inability to carry/fire his weapon or perform push-ups and or sit-ups due to pain. The physical examination (PE) noted decreased grip strength by dynamometer measurements of 52 vice 81 pounds to the right and left wrist, respectively. The examiner’s prognosis was “fair” and rated the CI’s pain as “slight” and “frequent.” At the VA Compensation and Pension examination performed on 21 July 2004 (3 months after separation), the CI reported constant, but non-incapacitating right wrist pain. The PE noted normal, but painful 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.


Right Wrist ROM
(Degrees)		 MEB ~3 Mo. Pre-Sep
(20040202)
VA C&P ~3 Mo. Post-Sep
(20040721)
Dorsiflexion (70 Normal) 45 70
Palmar Flexion (80) 30 80
Ulnar Deviation (45) 15 45
Radial Deviation (20) 5 20
Comment poor grip (weak) painful motion
§4.71a Rating 10% 10 %

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic right wrist pain condition at 10% using the analogous arthritis code under the VA Schedule for Rating Disabilities (VASRD) 5009-5003 and citing the USAPDA pain policy. The VA rating of 10% was under 5215 (wrist; limited motion) citing painful motion. Clearly there was decreased right wrist ROM on the MEB examination, but not compensable under VASRD criteria for the wrist limitation of motion disability codes. Painful motion would yield a maximum of 10% equivalent to the PEB’s rating. Board members also considered the application of §4.40 (functional loss) due to decreased grip strength, but absent any muscle loss or muscle damage, the wrist weakness was judged as principally related to “pain on use;” and, was well below that being equally served by an amputation. Given the intricate anatomical presentation of the TFCC involving the distal aspect of both forearm bones, Board members also considered and deliberated a higher rating under code 5211 (impairment of ulna) or 5212 (impairment of radius), both at [20%, 30% or 40%]. However, despite anatomic attachments, the absence of associated bone loss, mal-union and or non-union does not support the forearm codes. The treatment record consistently documented painful motion and the Board conceded painful motion IAW VASRD §4.59 for a major joint IAW VASRD §4.45. Board members agreed that there are no available alternative or analogous coding options which were applicable and or advantageous to the CI’s current 10% rating. 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 right wrist condition.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB were not considered by the Board to the extent that 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 the right wrist condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the right wrist 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131101, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                          
XXXXXXXXXXXXXXX
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, AR20150004756 (PD201302055)

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

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