RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00866
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Chemical Operations Specialist, medically separated for “wrist, limited motion of right (dominant) wrist pain” with a disability rating of 10%.

CI CONTENTION:  The CI contends he was given a higher rating for his conditions by the VA and the Service did not rate for PTSD.  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 confined to 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 - 20090331	VARD - 20091002	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Wrist, Limited Motion of Right (Dominant) Wrist Pain	5215	10%	Right Ulnar Styloid Fracture	5211	20%	20090406	
History of Anxiety Disorder	Not Unfitting	PTSD	9411	30%	20090414	
History of Back Pain	Not Unfitting	Chronic Thoracolumbar Strain	5237	10%	20090406	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Right Wrist Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right wrist condition began in February 2004 when the CI slipped on stairs resulting in a right ulnar styloid bone fracture.  He separated from the service with a 20% disability for nonunion of the fracture and wrist pain.  He reenlisted in August 2007 with a normal entrance exam that documented wrist pain of 3-4/10.  While performing land navigation training he tripped, heard a snapping sound but did not seek medical treatment.  After experiencing increased pain with pushups, radiographic imaging was taken which showed nonunion of the ulnar styloid and the presence of a complex tear.  In March 2008 he received surgery to repair these conditions.  Despite therapy, 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 “right wrist pain secondary to a nonunion of an ulnar fracture” for Physical Evaluation Board (PEB) adjudication.

During the MEB NARSUM in March 2009, 3 months before separation, the CI reported right wrist pain.  There was no visible abnormality or specific focal point tenderness.  The physical examination revealed range of motion (ROM) dorsiflexion to 15 degrees (normal 70), palmar flexion to 20 degrees (normal 80) using a bubble goniometer.  Due to the CI’s progressive pain, the examiner estimated the CI would loss an additional 10 degrees when applying DeLuca criteria (repetitive ROM to test for additional pain, weakness, fatigue or incoordination).

At the VA Compensation and Pension (C&P) examination in April 2009, performed 1 month before separation, the CI reported daily pain that lasted all day and missed 20 days of work in the past 12 months.  He did not wear a brace.  Flare-ups occurred with cold weather changes, heavy lifting and excessive use of the hand.  The physical examination revealed no tenderness or swelling.  The ROM was dorsiflexion 70 degrees, palmar flexion 80 degrees, ulnar deviation 45 degrees (normal 45) and radial deviation 20 degrees (normal 20) with painful motion.  There were no changes after repetitive ROM and resistance times three.  During this same period, VA radiographic imagining showed wrist bones in anatomic alignment without fracture, subluxation, soft tissue swelling or erosions.  A non-union of wrist to ulnar was not cited.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating coded 5215 (wrist, limitation of motion of) citing dorsiflexion less than 15 degrees with consideration to functional ability VASRD §4.10, §4.40, and §4.59.  The VA assigned a 20% rating coded 5211 (ulna, impairment) based on the C&P examination 1 month after separation, citing nonunion of the lower half of the ulna.  The CI’s wrist limitation of motion (code 5215) did not meet the minimal compensable findings; however, the Board agreed there was sufficient evidence in the record to support a 10% rating based on VASRD §4.40 (functional loss) due to painful motion (§4.59).  The Board next considered code 5211 and agreed there was not clear evidence that the CI’s nonunion of ulna had been remedied after corrective surgery.  The Board next reviewed the C&P examination radiographic findings, 1 month after separation, and determined the nonunion of ulnar was corrected.  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.

Contended PEB Conditions:  Anxiety Disorder and Back Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that these contended conditions were not unfitting.  The CI reported to a psychological evaluation in May 2008 due to developing insomnia and irritability after he separated from the Marines and his wife died in a car accident.  The mental status examination (MSE) was unremarkable.  He was not in therapy and did not like to take medications.  A PTSD diagnosis was rendered.  He deployed to Iraq from February 2003 to July 2003.

The VA C&P examination (1 month after separation) noted he had five to seven therapy sessions with a psychologist that were helpful.  He did not take medication.  He reported symptoms of PTSD, including nightmares of being in Iraq, anxiety with loud noises, and sleep problems.  He was working and denied missing work.  The mental status exam was normal.  A PTSD diagnosis was rendered with a Global Assessment of Functioning (GAF) score of 62 (mild symptoms, impairment.)

The anxiety disorder and back pain conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance-based evidence from the record that these contended conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 these contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right wrist condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder and back pain conditions, the Board recommends no change from the PEB determinations as not unfitting.  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 20140220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR2016001 0337 (PD201400866)

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