RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2015-00539
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030909

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “degenerative arthritis, left wrist with non-union of scaphoid fracture,” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the Panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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 conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service connected conditions after separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel 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 - 20030718	VARD - 20040407	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Left Wrist with Non-union of Scaphoid Fracture	5003	10%	Nonunion Left Scaphoid with Arthritis	5215-5010	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Degenerative Arthritis, Left Wrist with Non-union of Scaphoid Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s wrist condition began in May 2002 after falling during physical training.  Multiple radiographic evaluations from July to December 2002, and further studies in January 2003 documented post traumatic and degenerative changes of the wrist joint and nonunion of the scaphoid ligaments.  There was no surgical indication and despite treatment, the left wrist condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “nonunion left scaphoid with subsequent degenerative arthritis” for PEB adjudication.  At two separate visits to physical medicine visit in March and April 2003, 5 months before separation, the ranges of motion (ROM) showed a  dorsiflexion of 30 degrees (normal 75), palmar flexion of 55 and 35 degrees (normal 75) respectively, ulnar deviation of 15 and 0 degrees (normal 30) respectively, and radial deviation of 20 and 15 degrees (normal) respectively.  Painful motion was present at both visits.  At the 5 May 2003 MEB examination (recorded on DD Forms 2807 and 2808), 4 months before separation, the CI reported pain and limited use, with occasional numbness and tingling.  The physical examination showed decreased grip strength with decreased ROM.  At the 25 June 2003 MEB orthopedic NARSUM examination, 3 months before separation, the physical examination showed tenderness of the scaphoid bone, limitation of motion with pain at the extremes.  The examiner referenced the physical therapy ROMs from March 2003.  

There was no VA Compensation and Pension examination in evidence.  However, there was a VA primary care visit on 30 January 2004, during which the CI reported inability to write, overall weakness, decreased hand grip, and paresthesias.  The physical examination showed tenderness of the entire wrist with increased tenderness in the scaphoid area.  The hand grip was noted to be “slightly weaker” than the right.  The examiner approximated 30 degrees of dorsiflexion and 50 degrees of palmar flexion with pain at the extreme of ROM.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the left wrist condition, coded 5003 (degenerative arthritis).  The VA also rated 10% for the left scaphoid nonunion with arthritis condition analogously coded 5215-5010 (wrist, limitation of motion; arthritis due to trauma), based on the STR evidence, citing painful motion.  There was evidence of painful motion and radiographic evidence of degenerative arthritis IAW §4.59 in support of a 10% rating most appropriately coded as 5215-5010 for the residuals of the wrist trauma.  Rating under code 5215 was of no advantage as dorsiflexion and palmar flexion were greater that than required for rating on all examinations and only provides a maximum 10% rating.  There was no documentation of ankylosis for a higher rating under 5214.  There was no documentation of deficits in pronation or supination for analogous rating under code 5213.  There was evidence of radial or ulnar nonunion for a rating under 5211 or 5212.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left wrist condition.

PANEL FINDINGS:  In the matter of the left wrist condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150531, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004778, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure