RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03601
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Metal Worker, medically separated for “arthritis due to trauma, left (non-dominant) wrist” and “left hip pain,” rated 10% and 0%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI asks for all conditions to be considered.  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 - 20081120	VARD - 20120423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis Due to Trauma, Left (Non-Dominant) Wrist 	5212-5010	10%	Left Wrist Fracture Post Open Reduction Internal Fixation with Scar	5215	10%	20110512	
Left Hip Pain, Status Post Percutaneous Pinning of a Femoral Neck Stress Fracture	5299-5255	10%	Left Femoral Neck Hip Fracture Post Percutaneous Pinning
	5251	0%	20110512	
Generalized Anxiety Disorder 	Not Unfitting 	Post-Traumatic Stress Disorder (PTSD)	9411	50%	20110512	
Chronic Adjustment Reaction with Depressed Mood						
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Left Wrist.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a fracture to his left (non-dominant) wrist in August 2004, secondary to a motorcycle injury.  The CI underwent open reduction and internal fixation; however, he continued to have wrist pain.  The NARSUM was conducted in August 2008, approximately 5 months before separation.  The CI reported he had pain in his hand when he lifted or bent his left wrist.  He also reported some tingling sensation on the radial aspect of his thumb.  Pain medication was of little benefit.  He was not using a brace.  The CI reported he had flare-ups daily which increased his pain and decreased his functional abilities.  He also reported easy fatigability which also reduced his functional abilities.  Examination of the left wrist revealed a well-healed volar incision, with tenderness to palpation.  He had slight decreased sensation over the radial aspect of his thumb without any other sensory changes in the left wrist.  Motor and vascular function was intact.  Range of motion (ROM) recorded left wrist palmar flexion of 60 degrees (normal 80) and 45 degrees of dorsiflexion (normal 70).  The examiner noted that radiographs performed on the day of the NARSUM demonstrated a well-placed volar plate on his left wrist.  Some chronic changes to his radial carpal joint were noted as mild in nature.  The diagnosis of left wrist pain, status post distal radius fracture with open reduction, internal fixation, was recorded as not meeting retention standards.  Radiographs of the left hand in September 2008 demonstrated a healed fracture of the distal radius with stable appearing plate and screw fixation. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5212-5010 code (arthritis due to trauma-radius impairment), citing for painful motion.  The VA assigned a 10% rating using the 5215 code (wrist, limitation of motion) based on the VA C&P examination 28 months after separation.  The Board considered that exam too remote from separation for Board consideration.  A higher rating of 20% under the 5212 code requires evidence of non-union in the upper half of the radius bone or under the 5010 code, x-ray evidence of involvement in two or more major joint or minor joint groups, with occasional incapacitating exacerbations; not supported by the evidence.  The Board noted the condition was not compensable under the wrist ROM code 5215, or under any of the muscle group, or nerve paralysis/impairment codes.  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 left wrist pain condition. 

Left Hip.  The NARSUM noted that the CI was diagnosed with a left hip femoral neck stress fracture in May 2002, and underwent surgery.  Since then, he has had pain in the left groin and lateral hip, worse when walking, carrying objects, and wearing his full combat gear.  He had physical therapy and took medication that helped some.  The NARSUM dated 27 August 2008 noted that radiographs of the left hip demonstrated a well-healed femoral neck fracture without any significant degenerative joint disease, and well placed surgical screws.  Examination of the left hip documented slight tenderness around the incision area.  The CI ambulated with a limp.  He was noted to have normal muscle strength in the hip muscles and distally in his foot and ankle.  Sensation was intact.  Hip ROM was recorded as “full” on flexion and extension, measured by goniometer, and he had 45 degrees of external rotation.  ROM of internal rotation was 20 degrees (normal 40), opined to have been limited by mechanical block.  He had groin pain with internal rotation and external rotation of the hip.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10%, coded analogously 5299-5255.  More than 2 years after separation, the VA granted a 0% evaluation.  Applicable codes for rating consideration included 5003, 5255, 5251, 5252, and 5253.  A higher rating of 20% under any of the applicable codes required demonstration of moderate hip disability, or limitation of flexion to 45 degrees, or limitation of abduction, motion lost beyond 10 degrees, or radiographic evidence involving two or more joints, with occasional incapacitating exacerbations.  The Board found no evidence to support a higher rating under any of the applicable codes.  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 left hip condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that generalized anxiety disorder (GAD) and chronic adjustment reaction with depressed mood was not unfitting.  The adjustment disorder is not a physical disability and is not ratable or compensable IAW DoDI 1332.38 (in effect at the time).  The Board considered the evidence for the GAD diagnosis and noted the CI received medication to address his anxiety and related insomnia.  The psychiatric addendum noted that this condition had minimal impact on his duty performance, and mild impairment for social and industrial adaptability.  It was noted that he had an “excellent” social support system outside of his family.  The physician noted that he was fit for duty from a mental health perspective.  No mental health condition, including GAD was profiled or implicated in the commander’s statement and none were judged to fail retention standards.  There was no performance based evidence from the record that any mental health condition significantly interfered with satisfactory duty performance.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the arthritis due to trauma, left wrist condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left hip condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended generalized anxiety disorder, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140729, 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 AR20160008669 (PD201403601)

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