RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02077
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Infantryman, medically separated for “right wrist pain and neuropathy of the median nerve secondary to a fracture of the ulnar” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”  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 - 20051018	VARD - 20060501	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Pain and Neuropathy…	5099-5003	10%	Residual of Right Wrist Fracture…Osteoarthritis	5010-5213	10%	20060401	
			Medial Neuropathy, Right Wrist…	8515	10%	20060401	
Hypercholesterolemia	Not Unfitting	No VA Placement	
PTSD	Not Unfitting	PTSD	9411	10%	20060401	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Wrist Pain and Neuropathy of the Median Nerve Secondary to a Fracture of the Ulna.  The CI was right-handed.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right wrist condition began in May 2004 after a distal radial ulnar fracture (forearm bones) and dislocation of the right wrist.  Initial conservative treatment was unsuccessful and the CI underwent surgery with a distal radial ulnar joint reconstruction and ulnar styloid reduction due to persistent nonunion and median nerve neuropathy in August 2004.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right wrist pain and median neuropathy s/p right radial ulnar fracture-dislocation with persistent decreased range of motion (ROM), pain and median neuropathy” for PEB adjudication.  

At the MEB NARSUM exams dated July and August 2005 (4 and 3 months prior to separation), the CI reported right wrist pain of 6-7/10, difficulty carrying and using his weapon, inability to lift greater than 8 to 10 pounds with his right hand, perform push-ups, pull-ups or sit-ups and had fatigue and pain in the right wrist with performing any significant functions with the right hand such as typing or writing for extended periods.  The CI reported occasional numbness in his small finger.  Physical exam showed that the right wrist was noticeably weak compared to the left with otherwise normal strength in the left upper extremity.  Right grip strength was 3+/5, wrist dorsiflexion 3/5, and palmar flexion 3+/5; all “significantly limited by pain.”  There was no wrist instability and scars were well healed.  Testing for nerve compression/irritation at the wrist was positive (Phalen, Tinel sign, and carpal compression tests).  Formal physical therapy evaluation showed average active ROM of the right wrist as:  extension 45 degrees (normal 70); flexion 45 degrees (normal 80); pronation 50 degrees (normal 80); and supination 50 degrees (normal 85).  Diagnostic imaging showed a healed, but shortened radius, an absent ulnar styloid, and some ligament calcification without other abnormalities.  

At the VA Compensation and Pension (C&P) examination in April 2006, performed 5 months after separation, the CI reported persistent wrist pain and decreased ROM with difficulty lifting and gripping, opening bottles and participating in recreational activities.  Physical exam showed right wrist extension to 45 degrees (normal 70), flexion to 30 degrees (normal 80), supination to 30 degrees (normal 85), and pronation to 90 degrees (normal 80).  Strength was intact to the right hand including thenar musculature (muscular pad at base of the thumb), and reflexes were normal.  There was decreased (though present) sensation over the thenar eminence.  Diagnostic imaging showed an old healed fracture with degenerative narrowing at the radial carpal joint diagnosed as osteoarthritis.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA assigned a 10% rating using an analogous 5010-5213 code (arthritis, due to trauma- supination and pronation, impairment) based on the VA C&P examination 5 months after separation, citing painful restricted motion, X-ray evidence of degenerative changes and limitation of supination to 30 degrees or less.  The VA also assigned a 10% rating using the 8515 code (median nerve, incomplete paralysis-mild) citing decreased sensation in the right thenar eminence.  

The Board considered the entirety of the record and considered that there was radiographic evidence of joint degeneration with objective evidence of limited motion sufficient to warrant a 10% rating analogous to 5003.  There was additional functional loss (VASRD §4.40) due to right median neuropathy to warrant a 10% (mild) disability rating for neuritis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right wrist s/p fracture condition, coded 5099-5003, plus an additional disability rating of 10% for the right wrist neuropathy condition coded 8615-8515.  

Contended PEB Conditions:  Hypercholesterolemia and PTSD.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  The hypercholesterolemia is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right wrist condition, the Board unanimously recommends a disability rating of recommends a disability rating of 10% for the right wrist s/p fracture condition, coded 5099-5003, IAW VASTD $4.71a; plus an additional disability rating of 10% for the right wrist neuropathy condition coded 8615-8515 IAW VASRD §4.124a.  In the matter of the contended hypercholesterolemia and PTSD conditions, the Board unanimously 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Wrist Pain And Neuropathy of The Median Nerve Secondary to a Fracture of the Ulnar	5099-5003	10%	
	8615-8515	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140416, 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 XXXXXXXXXXXXXXXXXX, AR20160013532 (PD201402077)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA