RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-00194
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070722

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty 0-2, Ordinance Officer, medically separated for left wrist pain and a right knee condition.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3L3 profile and referred for a Medical Evaluation Board (MEB).  The left wrist and right knee conditions, characterized as “left wrist arthralgia with decreased range of motion (ROM) secondary to open reduction and internal fixation,” and “status post right knee allograft anterior cruciate ligament (ACL) reconstruction with internal derangement,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic left wrist pain” and “chronic right knee pain” as unfitting rated 10% each with likely application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated. 

CI CONTENTION:  He was not evaluated for any additional conditions.  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 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 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 20070509	VA - (4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain	5215  	10% 	Left Wrist Ununited Scaphoid Fracture	5215	10%	*20071128	
Right Knee Pain	5257	10%	DJD, Post ACL Repair, Right Knee	5010	0%	*20071128	
Other x 0 (In Scope)	Other x 9		
Combined:  20%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20080505 (most proximate to date of separation [DOS]).   *C&P  and Addendum not in evidence.

ANALYSIS SUMMARY:  

Left Wrist Condition.  The CI is right hand dominate.  In July 2005, the CI underwent surgical reconstruction (bone graphing and pinning) of a left wrist fracture.  Post-operative radiologic follow-up indicated non-union of the left scaphoid (wrist) bone.  Specifically, the examiner noted, ‘X-rays show less than satisfactory union from grafted bone with scaphoid.’  Additionally, there were degenerative changes within the wrist joint and painful motion was infrequently present on serial clinical encounters.  He was placed on a permanent profile in March 2007 for left wrist pain and one other peripheral diagnosis.  The final service treatment record (STR) entry within the case file was an orthopedic evaluation dated 18 January 2006 (18 months prior to separation) that revealed limited motion.  At that time, the CI requested to come off of profile and go back to normal activities.      

At the MEB narrative summary (NARSUM) (performed 3 months pre-separation), the CI endorsed the inability to perform push-ups or comfortably firing his weapon due to left wrist pain.  His physical examination (PE) noted severe limited dorsiflexion and normal grip strength.  The commander’s statement did not implicate the CI’s wrist condition, but rather focused on the profile’s second listed diagnosis.  Although absent the original VA C&P examination of 28 November 2007 (4 months post separation), a subsequent VARD indicated 10% impairment rating was adjudicated for painful or limited motion of the left wrist.  The goniometric 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.

Left Wrist ROM (Degrees)	
MEB ~3 Mo. Pre-Sep
	
VA C&P (per VARD) ~4 Mo. Post-Sep
	
Dorsiflexion (70 Normal)	10	40 	
Palmar Flexion (80)	80	45 	
Ulnar Deviation (45)	10	25	
Radial Deviation (20)	10	15	
Comment	-	painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the left wrist condition at 10% using VASRD code 5215 (wrist; limitation of motion), citing chronic pain and painful motion.  Clearly there was decreased left wrist ROM and or painful motion in support of a maximum of 10% impairment rating IAW VASRD §4.71, or §4.59.  Board members did consider other possible coding options given the close anatomical relationship to the involved scaphoid bone; however, despite such attachments, the absence of associated bone loss, mal-union, and or non-union did not support any VASRD forearm codes.  The treatment record frequently documented painful motion, and the Board conceded painful motion IAW VASRD §4.59.  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.

Right Knee Condition.  While deployed, the CI injured his right knee in December 2006 resulting in a torn anterior cruciate ligament (ACL) and medial meniscus.  He was returned to CONUS and underwent an ACL reconstruction with grafting on 20 February 2007.  His mainstay of post-operative treatment remained medications and aggressive physical therapy (PT).  His permanent profile of March 2007 listed right knee pain as the diagnosis.  At the NARSUM examination, the CI endorsed the ability to continue soldiering despite continued right knee pain.  The PE of the right knee was normal.  His diagnosis remained as the described surgical procedure with internal derangement.  The VARD indicated 0% impairment rating was adjudicated for the absence of knee laxity, limited and or painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5257 (Knee; other impairment) citing the condition preventing the CI from full duty performance, whereas the VA coded as 5010 (traumatic arthritis) and assigned a 0% rating citing a normal PE.  While there was no evidence of compensable limitation of motion, painful motion, or instability, the Board agreed that the VA’s 0% rating was an accurate evaluation near the time of separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), members concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee 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 condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right knee condition, 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 20131229, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160001272 (PD201400194)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA