RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00396
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20080115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, F-18 Systems Organization Maintenance Technician, medically separated for “right wrist post-traumatic arthritis” and “post-traumatic arthritis surgically treated [right]” with a combined disability rating of 20%.

CI CONTENTION:  Contends bilateral wrist and hearing impairments.  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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 PEB - 20071017	VARD - 20080327	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Post-Traumatic Arthritis	5299-5212	20%	Right Wrist Residuals, Scaphoid Fracture w/ Surgical Correction	5010-5215	10%	20080228	
Post-Traumatic Arthritis Surgically Treated							
Left Wrist Post-Traumatic Arthralgia	Cat III	Left Wrist, Residuals, Scaphoid Fracture w/ Surgical Correction	5010-5215	10%	20080228	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right Wrist (Subsumes Post-Traumatic Arthritis Surgically Treated).  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-handed CI’s right wrist condition began in March 2005 after falling while performing work-related maintenance.  He sustained a right scaphoid fracture (small bone in wrist) which necessitated surgery in April 2005.  Despite treatment, the condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred to an MEB.  The MEB forwarded “other specified arthropathy involving other specified sites; other postsurgical status; and pain in joint involving other specified sites” to the PEB for adjudication.

The MEB NARSUM examination on 09 August 2007, 5 months before separation, recorded a chief complaint of right wrist pain which required use of a brace for minimal tasks such as ironing.  Examination of the right wrist showed painful motion, but no swelling or tenderness.  Wrist dorsiflexion was 6 degrees (normal 70 degrees) and palmar flexion was 6 degrees (normal 80 degrees).  Forearm pronation was 90 degrees (normal 80 degrees) and supination was 90 degrees (normal 85 degrees).  Radial deviation was 10 degrees (normal 20 degrees) and ulnar deviation was 10 degrees.  X-rays showed a healed scaphoid fracture and moderate posttraumatic arthritis.

During the MEB NARSUM Addendum examination on 09 October 2007, 3 months before separation, the CI complained of 4/10 right wrist pain while at rest which increased in severity with use.  Right wrist extension was 70 degrees, flexion 55 degrees radial deviation 15 degrees and ulnar deviation 25 degrees.  Tenderness was present.  Grip strength on the right was the same as on the left.

At the VA Compensation and Pension (C&P) examination in February 2008, performed 2 months after separation, the CI reported an inability to use hand tools.  He was unable to lift more than 5 pounds, but had no activity restriction and “works with pain.”  Examination showed palmar flexion of 70 degrees, dorsiflexion of 70 degrees, radial deviation of 15 degrees and ulnar deviation of 45 degrees.  Muscle strength in the wrist was normal (5/5).  There was no evidence of additional impairment with repetitive use.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating coded analogously to 5212 code (radius, impairment of).  The VA assigned a 10% rating using a combination 5010-5215 codes (traumatic arthritis and limitation of motion of wrist) based on the VA C&P examination 2 months after separation, citing pain during activities with limitation of motion.

It is likely the PEB chose the 5212 code because the applicable bone in this case (scaphoid) does not have a corresponding VASRD code, but is adjacent to the distal radius.  Conceding this coding option, the 30% rating for a dominant wrist requires “non-union with false movement.”  However, there was no evidence of bony non-union (X-rays showed a healed scaphoid fracture) or of false movement, therefore a 30% rating was not justified using this coding option.  The Board considered other options to a higher rating.  The maximum rating for limitation of wrist motion (5215) is 10%.  There was no loss of supination or pronation to warrant rating under the 5213 code (supination and pronation, impairment of), and no evidence of ankylosis to justify use of the 5214 code (wrist, ankylosis of).  The Board could therefore find no avenue to a rating higher than the PEB’s 20%.  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 post-traumatic arthritis condition.

Contended PEB Conditions:  Left Wrist.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended left wrist post-traumatic arthralgia condition was not unfitting.  According to the MEB NARSUM, the CI’s left wrist condition began in March 2005 after falling off a jet during maintenance.  He sustained a nondisplaced extra-articular (not involving the joint) radius fracture, which was treated with casting in April 2005.  The CI was seen over the next 2 years for persistent right wrist pain.  This contended condition did not cause the CI to receive limited duty and was not implicated in the commander’s non-medical assessment.  The profiling section of the MEB DD FORM 2808 only listed right wrist arthritis.  On the Report of Medical Assessment on 23 August 2007, the CI wrote that only his right wrist pain limited his ability to work in his primary specialty.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended left wrist post-traumatic arthralgia condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right wrist post-traumatic arthritis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left wrist post-traumatic arthralgia condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  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 20140105, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 Sep 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						  
XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel
					(Manpower & Reserve Affairs)