RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00853
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Light Wheeled Vehicle Mechanic, medically separated for “right wrist pain,” with a disability rating of 20%.

CI CONTENTION:  “Medically separated due to broken wrist/surgery.  Still have pain/discomfort/loss of mobility in wrist.  Carpal Tunnel has severely worsened.”  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 - 20040709	VARD - 20050322	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Pain	5099-5003	20%	Right Wrist Fracture	5299-5215	0%	20050112	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Wrist Pain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), injured the right wrist after a fall from a military van on 25 July 2002.  X-rays revealed a fracture of the scaphoid with minimal displacement.  The CI was then placed in a series of casts and splints.  Because of scaphoid nonunion the CI underwent an open reduction internal fixation (ORIF) of the scaphoid with an autologous bone graft on 12 November 2002.  Fluoroscopic review of the right wrist revealed the scaphoid moved as a unit 2 months post-surgery, although the CI still had pain in the volar (underside) radial wrist region and the snuff box (overlying the scaphoid).  The CI had an undated borderline abnormal electro-diagnostic study consistent with a mild right carpal tunnel syndrome.  Elavil (amitriptyline for nerve pain) was recommended to assist with sleep dysfunction.  In July 2003 the CI complained of pain with pushups and in December 2003 he had pain with firing his weapon.  X-rays showed a well-healed scaphoid bone in good position without obvious arthritis.  Because of safety and deployment concerns, a P3 profile was issued.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right scaphoid fracture” for PEB adjudication.
 
At the MEB examination (recorded on DD Forms 2807-1 and 2808) dated February 2002, 8 months prior to separation, the CI reported right wrist chronic pain and tenderness status post ORIF.  Examination revealed a right wrist scar on the volar surface.  The MEB NARSUM examination on 2 April 2008, 6 months prior to separation, noted complaints of right wrist pain which precluded the CI from upper body physical training, lifting greater than 40 pounds, turning a wrench, firing a weapon, or lifting a rucksack over his head to place it on his back.  On examination the right wrist had a well-healed scar.  There was mild tenderness to palpation about the snuff box (the anatomical area where the scaphoid is located).  There was no erythema or swelling of the wrist or hand and the CI was neurologically intact in the right upper extremity with normal motor strength of the hand.  

At the 12 January 2005 VA Compensation and Pension (C&P) evaluation dated 12 January 2005, 3 months after separation, the CI reported when he used his wrist too much, such as turning a wrench or mechanical work for about 1 hour, it hurt.  He took over-the-counter medication for relief and used a thumb spica splint, from which he cut the thumb out, as needed.  On examination there was a scar on the palmar side of the wrist that was nontender, not adherent to the underlying tissues, not indurated, and slightly hypopigmented without ulcerations.  There was no heat, redness or tenderness of the right wrist.  ROM measurements were recorded (per chart below).  With repetitive motion, the CI could not actively dorsiflex beyond 50 degrees; however, there was no weakness and no fatigue of the right wrist joint.

The range of motion (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 ~6 Mos. Pre-Sep
	OT ~4 Mos. Pre-Sep
	VA C&P ~3 Mos. Post-Sep
	
Dorsiflexion (70 Normal)	0-75	0-75	50	
Palmar Flexion (80)	0-70	0-70	80	
Ulnar Deviation (45)	0-30	0-30	45	
Radial Deviation (20)	0-20	0-20	20	
Comment			No  weakness or fatigue with repetition	
§4.71a Rating	PEB 20%%	PEB 20%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating for the right wrist pain condition under an analogous 5099-5003 code (Arthritis, degenerative), citing painful motion. The VA assigned a 0% for the right wrist pain condition under an analogous 5299-5215 code (Wrist, limitation of motion), based on the VA C&P examination 3 months after separation, citing a noncompensable evaluation unless there is dorsiflexion of the wrist which is less than 15 degrees, or for palmar flexion limited in line with the forearm.  Board members considered the PEB’s assigned 20% rating to the right wrist using an analogous 5003 code.  Under this coding, a 10% rating is for a noncompensable joint with objective findings of swelling, muscle spasm, or satisfactory evidence of painful motion.  A 20% rating requires X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitation exacerbations.  In the absence of wrist ankylosis (code 5214), there was no route to a higher rating.  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 pain condition.  

BOARD FINDINGS:  In the matter of the right wrist pain 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 20150606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011726, XXXXXXXXXXXXXXXXXX

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,