RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03567
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080727

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

CI CONTENTION:  The CI contends that his right wrist condition and the facts surrounding the injury and treatment.  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 - 20080715	VARD - 20090603	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (dominant) Wrist Pain	5099-5003	10%	Chronic Right Wrist Pain…	5215	10%	20080801	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Right (dominant) Wrist Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI’s right wrist pain condition began in April 2005 while deployed after the base plate of a Howitzer fell on his hand.  Initial X-rays showed no fracture, but after redeployment, the CI was in a motorcycle accident in July 2005 and wrist X-rays at that time showed an old navicular fracture (also known as scaphoid bone).  Imaging studies including CT scan and MRI showed a nonunion of the fracture with arthritis.  The CI underwent two surgeries on the wrist January 2006 and August 2007.  A second surgery was performed to decrease functional limitations due to degenerative changes at the wrist.  The CI reported continued pain and limited ROM and X-rays showed surgical changes and moderate wrist arthritis.  An occupational therapy visit in January 2008 noted wrist extension of 43 degrees and flexion of 36 with pain and an orthopedic evaluation on 4 February 2008 showed “about” 45 degrees of flexion and 35 of extension with “a little bit of pain at the limits of motion, which is not too surprising.”  Pronation and supination of the forearm were normal.  Following the second surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right (dominant hand) wrist pain” for PEB adjudication.

On 20 February 2008, 5 months before separation, occupational therapy measured wrist ROM for the MEB (with three repetitions was dorsiflexion (extension) of 40 degrees (normal) and palmar flexion (flexion) of 40 (normal 80).  Right hand grip strength was 70% of normal age related values and 65% of the left hand and right pinch strength values were approximately 80% of the left.

At the MEB NARSUM examination on 25 March 2008, 4 months prior to separation, the CI reported right wrist pain.  On physical examination the examiner reported wrist flexion and extension of 15 degrees, limited by pain, and noted that “repetitive flexion and extension decreased ROM to less than 15 degrees.”  Physical limitations included no push-ups or pull-ups and upper body weight training as tolerated.

At the VA Compensation and Pension (C&P) examination 1 August 2008, 1 week after separation, the CI reported pain with wrist extension.  Physical examination showed a raised scar over the top of the wrist without tenderness, adherence or breakdown.  There was tenderness to palpation of the wrist and hand bones.  Grip strength was 3/5 and there was decreased wrist flexion and extension.  Wrist extension was 25 degrees and flexion was 35, with painful motion.  There no additional loss of ROM with repetition.  The examination noted all four extremities including pulses were normal.  The examination noted no sensory or reflex abnormalities of the RUE.  The VA examiner indicated that the wrist condition caused no problems with routine daily activities driving, except mild effects on bathing and recreation and moderate effects on chores, shopping, and exercise, with severe effects on sports activities.

A disability examination for the state on 31 March 2008 showed wrist ROM of extension of 30 degrees and flexion of 40 with right hand strength 3/5.  There was no joint effusion or instability.  Sensation and reflexes were normal.  The examiner indicated the CI was able to use the right hand to zip, button, and tie and the assessment was that the CI had “mild to moderate limitation in use of the right hand/wrist” due to the injury and surgeries.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist pain condition 10% analogously coded 5099-5003 (degenerative arthritis) citing functional loss due to painful motion.  The VA also rated the right wrist pain condition 10% coded 5215 (limitation of wrist motion) based on the VA C&P examination 1 week after separation, citing limitation of motion.

The Board agreed there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  There was no limitation of wrist plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5215), but the MEB NARSUM examiner noted after repetition that ROM decreased below 15 degrees of both extension and flexion.  However, dorsiflexion of less than 15 degrees coded as 5215 is also a 10% rating, providing no ratings benefit.  The Board also considered if the objective weakness of the right hand supported a higher rating alternatively coded as a muscle injury IAW VASRD 4.73 (muscle injuries).  Utilizing 5309 (Group IX muscles), muscles responsible for grasping and manipulative movements of the hand, “moderate” muscle injury of the dominant upper extremity is rated at 10%.  Based upon the functional use of the hand as described at cited examinations Board agreed that the muscle weakness did not reach the threshold of “moderately severe” for the next higher rating of 30%.  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:  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.  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 20140428, 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

29 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
AR20160017683 (PD201403567)

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.

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA