RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01252
BRANCH OF SERVICE:  Army	BOARD DATE:  20150219
DATE OF PLACEMENT ON TDRL:  20070725
Date of REMOVAL FROM TDRL: 20090421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Military Police) medically separated for right wrist pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was authorized to take the alternate aerobic portion of the Army physical fitness test.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The right wrist condition, characterized as “right wrist scaphoid fracture…” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (“hereditary spherocytosis”) for PEB adjudication.  No other conditions were submitted by the MEB.  The Informal (IPEB) adjudicated “fractured right dominant scaphoid” as unfitting, rated 30%, and the referred hereditary spherocytosis as not unfit.  The CI made no appeals and was placed on Temporary Disability Retired List (TDRL).  Approximately a year and 8 months later, the IPEB reevaluated the CI’s condition, reduced the rating from 30% to 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) and changed the VASRD code from 5299-5212 to 5010.  The CI appealed to the Formal PEB, which affirmed the IPEB’s findings.  The CI made no further appeals and was medically separated.

CI CONTENTION:  “I believe my right wrist injury is worse than what was said when my rating was lowered from 30% to 20%.

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:

FPEB – 20090325	VA Rating Decision1 - 20120227	
TDRL Placement – 20070725	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL2
Placement	TDRL3 Removal	
Fractured Right Dominant Scaphoid…	5299-5212	30%	---	Right Wrist Fracture	5003-5215	NA	10%	
Arthritis Due to Trauma, Right (Dominant) Wrist	5010	---	10%					
Other x 1 (Not in Scope)	Other x 2	
RATING:  30% → 10%	RATING:  20%	
1. Most proximate to TDRL Placement
2. No VARDs or C&P exams prior to 20120227 VARD
3. Rating derived from C&P exam dated 20111201 (2 years and 9 months post-TDRL removal)

ANALYSIS SUMMARY:

Right Wrist Condition.  The CI sustained an injury to his dominant right wrist in October 2005 when he fell on it while deployed to Afghanistan.  He was ultimately diagnosed with a scaphoid fracture that required surgery in May 2006.  Despite occupational therapy, the CI continued to experience pain that was associated with radiographic evidence of nonunion of the fracture site.  Although further surgery was discussed, the CI declined because the outcome was uncertain.  An orthopedist on 23 January 2007 (6 months prior to separation) indicated a diagnosis of nonunion and osteoarthritis.

At the narrative summary (NARSUM) evaluation on 21 March 2007 (4 months prior to placement on TDRL) the CI complained of constant right wrist pain that was aggravated by lifting, gripping or significant wrist contact.  He could lift a maximum of 10 pounds with the right hand, and could not perform push-ups.

At an occupational therapy evaluation on 18 November 2008 (5 months prior to TDRL removal), the CI reported that he was not fully able to manage heavy household tasks, participate in sports or lift greater than 10 pounds.  He could only write for short periods.  Examination showed an average left hand grip strength of 123 pounds, and right grip strength of 51 pounds.  X-rays showed that the scaphoid fracture site had healed.

At the NARSUM re-evaluation on 20 November 2008 (5 months prior to removal from TDRL), the CI reported he had no further evaluation or care for the right wrist and was working full-time at a casino as a floor surveillance officer.  He became accustomed to using his left hand for certain activities such as holding and turning the steering wheel, grabbing objects and opening doors.  Use of a wrist splint was helpful in reducing the painful effects of aggravating activities.

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)	NARSUM 4 Mos. Pre-TDRL Placement	MEB ~5 Mos. Pre-TDRL Removal	Ortho ~5 Mos. Pre-TDRL Removal	
Dorsiflexion (70 Normal)	30, 30, 30	30, 30, 30	30	
Palmar Flexion (80)	20, 20, 20	15, 15, 15	45	
Ulnar Deviation (45)	10, 10, 10	15, 15, 15	-	
Radial Deviation (20)	10, 15, 15	5, 5, 5	-	
Comment	+Painful motion, tenderness	+Painful motion	+Tenderness; painful motion at extremes of motion	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 30% rating at the time of placement on TDRL under an analogous 5212 code (radius, impairment of).  Board members agreed this code was a reasonable option since the affected scaphoid is adjacent to the distal radius.  Since there was no loss of bone substance or deformity to warrant the highest 40% rating, the 30% rating was supported.  There was no ankylosis of the wrist to support a rating under the 5214 code (wrist, ankylosis of).

Next the Board turned its attention to a permanent rating at the time of removal from TDRL.  Because the fracture site had healed (i.e. malunion resolved), the PEB changed the code to 5010 (arthritis due to trauma) which defaults to 5215 criteria (wrist, limitation of motion of) later used by the VA.  Although ROM was non-compensable, Board members agreed there was sufficient evidence of functional loss (VASRD §4.40) and painful motion (§4.59) to warrant the highest 10% rating under this code.  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 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 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 20140117, 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 AR20150011034 (PD201401252)

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						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA