RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03778
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Motor Transport Operator, medically separated for “supination 30 degrees, left (non-dominant) upper extremity [LUE] status post ORIF [open reduction internal fixation], scaphoid fracture” and “chronic back pain,” rated 10% and 10%, respectively, with a combined disability rating of 20%.   

CI CONTENTION:  “Please review all conditions.” The CI’s complete submission, with attachments, 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 upon a 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 - 20051209	VARD - 20060525	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Upper Extremity Condition, Status Post Wrist Fracture	5213	10%	Left Wrist Condition	5215	10%	20060425	
Chronic Back Pain	5235	10%	Fracture of the Spine at T8	5235	10%		
Head Injury	Not Unfitting	Scar of the Forehead and Scalp	7800	10%		
		Fractured Frontal Sinus	6599-6512	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY: 

LUE Condition.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this right-handed CI fell and injured his left (non-dominant) wrist in February 2005, while deployed overseas.  Surgery was done to repair the wrist.  After surgery, he was treated with medication, physical therapy (PT), occupational therapy (OT), and other therapeutic measures.  However, in spite of all treatment efforts, he continued to have significant problems with his left wrist and an MEB was initiated.

The MEB NARSUM evaluation was dated 4 October 2005.  The CI reported occasional pain, but he was mostly bothered by the decreased range of motion (ROM). On physical examination (PE) of the left wrist, the surgical scar was well-healed.  The CI could appose his thumb to all fingers, but grip strength was decreased.  Wrist ROM was measured and is summarized in the chart below.  Neurosensory function was intact.  The CI was seen by Orthopedics on 21 October 2005.  The surgical scar was well-healed. He had a full composite fist, with weakened grip strength.  ROM testing revealed supination of 5 degrees, and wrist dorsiflexion (extension) of 5 degrees.  LUE pronation was “full.” 

The CI separated from service on 9 December 2005.  Five months later, on 6 May 2006, he had a VA Compensation and Pension (C&P) examination.  He reported pain and decreased ROM of his left wrist.  On PE, he was in no acute distress.  PE of the left wrist revealed decreased grip strength and decreased ROM.  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.

Left Wrist and Forearm
(Degrees)	MEB ~ 9 weeks Pre-Sep
(20051004)	Ortho ~ 7 weeks Pre-Sep
(20051021)	VA C&P ~5 mos. Post-Sep
(20060506)	
Dorsiflexion (70 Normal)	20	5	10	
Palmar Flexion (80)	30	35	20	
Ulnar Deviation (45)	10	(not recorded)	10	
Radial Deviation (20)	10	(not recorded)	5	
Supination (85)	10	5	45	
Pronation (80)	80	“full”	80	

The Board directed attention to its rating recommendation based on the evidence.  The orthopedic examination on 21 October 2005 was just 7 weeks before separation.  At that examination, there was 5 degrees of dorsiflexion (extension), and 5 degrees of supination.  IAW the VA Schedule for Rating Disabilities (VASRD) §4.71a codes for loss of wrist motion (5214 and 5215), a 10% disability rating is warranted when dorsiflexion is less than 15 degrees.  A 10% disability rating is also warranted when supination is 30 degrees or less (VASRD code 5213).  Therefore, the Board determined that a rating of 10% was appropriate in this case.  There was no path to a higher rating since there was insufficient evidence of a seriously disabling bone or joint abnormality that would justify a higher rating.  After due deliberation and consideration of all the evidence, and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the unfitting LUE condition.  

Chronic Back Pain.  In October 2004, the CI injured his back in a motor vehicle accident (MVA).  In February 2005, he suffered a re-injury to his back when he fell to the ground from a truck.  In September 2005, X-rays showed a mild grade 1 compression fracture of T-8.  His back pain was treated with medication, PT, chiropractic manipulation, and other therapeutic measures.  At the October 2005 MEB narrative summary (NARSUM) evaluation, the CI reported that his back pain was aggravated by prolonged sitting, prolonged standing, or bending.  He felt somewhat better with heat and stretching.  Posture and gait were normal.  On PE of the back, there was tenderness to the mid-thoracic spine, as well as the lower lumbar area.  Straight leg raise (SLR) was negative, and muscle strength in the legs was normal. Back ROM was measured and is summarized in the chart below.  

The CI was seen in the spine clinic on 1 November 2005.  All segments of the spine had a normal appearance.  PE of the spine was normal, and ROM testing was normal.  Posture, gait, and stance were normal, and neurological examination of the legs was normal.  At the May 2006 C&P examination, the CI reported that a MVA had occurred about 2-3 weeks previously, which had exacerbated his back pain.  Back ROM was measured and is summarized in the chart below.  PE of the lumbar spine revealed no tenderness or spasm.  Neurological examination of the legs was normal.  The ROM evaluations in evidence which the Board weighed in arriving at its recommendation, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~2 mos. Pre-Sep
(20051004)	VA C&P ~5 mos. Post-Sep
(20060506)	
Flexion (90 Normal)	110	90	
Extension (30)	30	10	
R Lat Flexion (30)	50	30	
L Lat Flexion (30)	50	30	
R Rotation (30)	43	30	
L Rotation (30)	46	30	
Combined (240)	240	220	

The Board directed attention to its rating recommendation based on the evidence.  The Army PEB and the VA chose identical coding and rating options for the back pain.  Both used VASRD code 5235 (Vertebral fracture or dislocation), and both assigned a 10% disability rating.  The Board determined that the 1 November 2005 visit to the spine clinic was just 5 weeks before separation, and therefore had significant probative value.  At that examination, all segments of the spine had a normal appearance.  PE of the spine was normal, and ROM testing was normal.  There was some mild tenderness of the back, over the right costovertebral angle (CVA).  Posture, gait, and stance were normal, and neurological examination of the legs was normal. The examiner wrote: “Thoracolumbar spine demonstrated full range of motion.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the Chronic back pain condition.

Contended PEB Conditions:  Head Injury.  In February 2005, when the CI fell to the ground from a truck, he also injured his head, and suffered multiple fractures. Surgery was done to repair the injuries to his face and paranasal sinuses.  After surgery, he continued to have drainage problems with his sinuses.  He was seen by ophthalmology, and was cleared of any visual problems.  At the October 2005 MEB narrative summary (NARSUM) evaluation, the CI reported sharp pain in the top of his head, which was occurring daily.  He also had occasional headaches 3 times a week.  PE of the head showed the scalp fractures to be well-healed.  Eye examination was normal.  Motor examination showed normal muscle strength, except for the LUE (described above).  On 1 May 2006, the CI had a C&P examination for his eyes.  The examiner wrote: “Veteran status post fall while in service, fracturing multiple facial bones.  Veteran doing well.  Only residual findings from the injury are palpable plates, facial numbness V-2 distribution right side, and scar above left brow.”

The head injury condition was adjudicated by the Army PEB as “not unfitting, not rated.”  The Board’s main charge with regard to this condition is to assess the fairness of the PEB’s determination.  In the STR, there was not sufficient performance-based evidence that the head injury condition significantly interfered with satisfactory duty performance.  Although the CI had facial numbness on the right, the presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  Therefore the critical decision, is whether or not there was a significant neurologic deficit which would impact his military duties.  There was no evidence in this case that such a deficit existed to any degree that could be described as functionally impairing.  The Board therefore concluded that no additional disability rating was justified. After due deliberation, and in consideration of the evidence, the Board found insufficient cause to recommend a change in the PEB fitness determination for the head injury condition.  

BOARD FINDINGS:  In the matter of the left (non-dominant) upper extremity condition, and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the chronic back pain and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the head injury condition, 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 20140516, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017226 (PD201403778)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA