RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02618
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Automated Logistical Specialist, medically separated for “right (dominant) wrist pain,” with a disability rating of 0%.  

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 based on 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 - 20050729	VARD – 20110818*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Pain	5215	0%	Scapholunate Ligament Tear on the Right Wrist, Status Post Surgery with Fusion	5215	10%	20051108	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	
* Earlier VARD implied, but not available in evidence.  

ANALYSIS SUMMARY:  

Right (Dominant) Wrist Pain with Limitation of Motion.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right wrist condition began in October 2003 after a hyperextension injury with overhead lifting.  In September 2004 the CI underwent surgery to fuse the triquetral and lunate bones due to a torn triangular fibrocartilage complex.  The CI underwent a second right wrist surgery in June 2005 to repair the same area.  

The MEB forwarded “Injury to triangular fibrocartilage complex of the right wrist with evidence of degenerative changes S/P cartilage repair & lunotriquetral fusion with persistent pain and reduced range of motion [ROM] - Right hand dominant” for PEB adjudication.  

At the NARSUM examination dated May 2005, 4 months prior to separation (despite the NARSUM date, this was after the CI’s June 2005 surgery), the CI reported pain and reduced mobility of the right wrist and inability to perform push-ups or lift over 20 pounds.  Limited right wrist motion did not allow firing of his M16 from either hand.  Diagnostic imaging in April 2005 documented degenerative changes and incomplete fusion of the lunate and triquetral bones.  Physical examination showed pain on palpation and painful limited motion as charted below.  Right (dominant) grip strength was 65 pounds compared to 75 pounds on the non-dominant side.  

At the VA Compensation and Pension (C&P) examination in November 2005, performed 2 months after separation, the CI reported right wrist aching and stiffness with limited ROM.  He had daily pain, reduced grip strength, and he wore a brace.  Physical examination showed “exquisite tenderness to the dorsum of the right wrist,” limited motion as charted below with decreased grip strength, and atrophy of the forearm (27 cm versus non-dominate 28 cm).  

The ROM examinations 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)	MEB ~3 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
Dorsiflexion (70 Normal)	20, 20, 20	20	
Palmar Flexion (80)	30, 30, 30	15	
Ulnar Deviation (45)	10, 15, 15	30	
Radial Deviation (20)	15, 15, 15	10	
Comment:  Surgery ~4 Mo. Pre-Sep	Painful motion; decreased grip strength	3/5 grip strength; atrophy; and tenderness	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5215 code (wrist, limitation of motion of), citing wrist ROM.  The VA assigned a 10% rating using the code 5215 based on the VA C&P examination 2 months after separation.  

The NARSUM examination documented painful motion which warrants a 10% rating IAW VASRD §4.59 (painful motion). The post-separation VA examination likewise documented sufficient functional loss IAW VASRD §4.40, §4.45, and §4.59 to support a 10% rating.  There was no ankylosis of the wrist or loss of use of the hand to warrant any higher rating.  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 condition, coded 5215.  

BOARD FINDINGS:  In the matter of the right wrist condition, the Board unanimously recommends a disability rating of 10%, coded 5215 IAW VASRD §4.71a.  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	5215	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140602, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160016963 (PD201402618)

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 10% 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