RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02564
BRANCH OF SERVICE:  Army	BOARD DATE:  20141120
SEPARATION DATE:  20070607

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (15P/Aviation Operation Specialist) medically separated for a right wrist condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The MEB referred “chronic wrist pain” to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “radial sensory neuritis right (dominant) hand status post radial shaft fracture…” as unfitting, rated at 10% citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “My service connected conditions are worsening.  I wanted to stay Active Duty, but my surgery by Army Physicians did not go well.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right wrist condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20070420	VA - (~1 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Radial Sensory Neuritis Right (Dominant) Hand…	8614	20%	Residuals, Fracture, Right Radius	5212	10%	20070618	
Other x 0 (Not In Scope)	Combined:  40%	
Combined:  20%		

ANALYSIS SUMMARY:  The Board noted the narrative summary (NARSUM) examination to be dated 28 March 2006. The Board unanimously agreed this to be a typo and the correct date to be 28 March 2007.

Right Wrist Condition.  This right hand dominant CI suffered a blunt injury to his right mid forearm of conflicting circumstances on 3 July 2005.  Initial X-rays revealed a minimally displaced traverse fracture of the right forearm bone (radius) at a point two thirds the distance from the elbow to the wrist, with no other bony injury.  The fracture required no reduction at that time and was treated with a forearm splint.  On orthopedic evaluation 4 days later, the fracture was determined to require surgical reduction and stabilization.  Surgical reduction and fracture stabilization was performed on 14 July 2005, with placement of a pin within the bone across the fracture site through a 2 cm wrist incision (intramedullary pin through the radial styloid).  Good alignment and reduction of the fracture site was achieved.  After surgery the fracture healed without malunion or deformity.  X-rays obtained in January 2006, revealed the fracture to be “nearly healed with good anatomic alignment.”  Post-operatively the CI developed pain in the wrist, weakness of grip and numbness on the back of his hand.  On an occupational therapy (OT) evaluation on 24 March 2006, range-of-motion (ROM) of the wrist was palmar flexion (PF-palm toward the ground) of 45 degrees and dorsiflexion/extension (DF/EX-back of hand toward the sky) of 60 degrees (Normal: 80 and 70 degrees respectively).  The CI could make a full fist, but grip strength was decreased in the right hand compared to the left (Right - 95 pounds; left - 103 pounds).  Numbness was present on the back of the hand.  In August 2006, the fracture was felt healed and the pin was removed through the original operative incision in the wrist.  On an OT exam on 13 November 2006, ROM of the wrist was unchanged from evaluation of March 2006.  The CI could make a full fist.  Right grip strength has slightly decreased (Right: 83 pounds; Left: 119 pounds), but finger “pinch strength” in the right and left hands was equal.  On an OT hand evaluation on 19 March 2007, the therapist reported the CI to “perceive his right disability as mild.”  Grip strength was 79 pounds on the right and 110 pounds on the left.  ROM of the right hand fingers was normal with full opposition of the thumb to all digits.  Pinch strength of the right and left hand fingers was equal.  Quantative sensory testing (Semmes-Weinstein monofilaments) was reported as revealing decreased sensation over the back of the hand, and thumb and first two digits but not the finger tips.  On DASH testing (Disability of Arm, Shoulder and Hand), to determine degree of disability a score of 34 was achieved, suggesting the condition to be “mild.”  On an OT evaluation on 20 March 2007, PF of the right wrist was 60 degrees and DF/EX 41 degrees.  Flexion and extension of the right elbow was normal.  On an orthopedic evaluation performed on 28 March 2007, decrease of light touch sensation was present in the right hand, but “less than before surgery.”  

At the MEB/NARSUM exam performed on 28 March 2007 (3 months prior to separation), the hand was described as having “excellent motion and clinical strength.”  The surgical scar was described as supple, but “hypersensitive and tender to palpation.”  Results of the OT evaluations of March 2007, discussed above, were referenced.  

At the VA Compensation and Pension exam performed (approximately 2 weeks after separation), the CI reported working as a “bar bag man” and having missed no work in 12 months.  He reported being able to do all activities of daily living (ADL), but noted intermittent pain mainly in the right wrist when “he uses arm and hand with hand tools.”  He reported wearing a wrist brace.  On examination, good dexterity with full ROM of all digits was noted.  PF of the right wrist was 60 degrees and DF/EX was 55degrees.  Sensory exam of the hands and all reflexes were normal.  Motor strength was clinically normal (5/5) in the upper extremities except the right hand where grip strength was decreased to 4/5.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the hand condition 20% under code 8614 (neuritis radial nerve/mild), IAW §4.123 citing slight decreased grip strength, hand pain and sensitivity.  A higher rating under this code, 30%, for the dominant hand, requires the condition to be moderate.  The VA rated the hand condition 10% coded 5212 (radius, impairment/ malunion).  A higher rating of 20% requires “non-union” of the bone.  The Board unanimously agreed that the wrist condition was not compensable under the codes for reduced ROM of the wrist (code 5215), or forearm (codes 5206, 5207 and 5208).  The Board considered a rating under code 8614, neuritis of the radial nerve, IAW §4.123.  The Board agreed that a neuropathy involving the radial nerve was present with both motor and sensory components.  The Board opined that the sensory component was mild, involving only a portion of the back of the right hand and three fingers, but not the finger tips and had no functional implication.  

The Board agreed that the motor component involved some decreased strength in the wrist and grip but not finger motion or function.  The Board noted the strengths in the upper arms were normal except for a clinical assessment of 4/5 in the right grip.  The Board unanimously agreed that this motor decrease was mild in its functional impact given the results of the activity statements, impact on employment, ADL and the DASH evaluation in record.  The Board unanimously agreed the neuropathy condition was ‘mild’ and did not rise to the level of ‘moderate’ for 30% rating.  The Board noted the surgical scar to be described as tender and hypersensitive and considered a rating under code 7804, (scars), IAW §4.118.  The record recorded the scar to be small, two cm in length, well healed, not irritated and having no stated difficulty with the wearing of a wrist brace.  The Board unanimously agreed that no additional rating could be recommended.  The Board found no other appropriate codes for consideration and no pathway to a rating higher than 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 Hand 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 hand condition and IAW VASRD §4.123, 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 20140529, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150010621 (PD201402564)

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		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA