RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01055
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Fire Support Specialist, medically separated for “right (dominant) wrist limitation of motion status post (S/P) 4 corner fusion for scaphoid non-union dorsiflexion less than 15 degrees” and “limitation of motion of left ankle dorsiflexion 0 degrees,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI made no specific contention.  The 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 - 20041209	VARD - 20050510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominant) Wrist Limitation of Motion….	5215	10%	Residuals, Nonunion Fracture S/P Fusion/Resection, Right Wrist (Dominant)	5215	10%	20050329	
Limitation of Motion of Left Ankle…	5271	10%	S/P Open reduction and Internal Fixation (ORIF), Left Ankle Fracture	5271	10%	20050329	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right (Dominant) Wrist Limitation of Motion.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right wrist condition began in July 2003 after a motorcycle accident.  He underwent surgical repair of a scaphoid fracture in July 2003, and subsequent scaphoid excision with four-corner fusion in February 2004.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right wrist pain” for PEB adjudication.
At the MEB examination (recorded on DD Forms 2807 and 2808) dated 2 September 2004, 5 months prior to separation (6 months after surgery), the CI noted wrist pain with occasional tingling and locking up.  Physical examination showed a well healed scar.  There was “essentially no ROM [range of motion].  Mild swelling, moderate tenderness.  Very poor grip right hand.”  The MEB NARSUM examination on 7 October 2004, 3 months prior to separation, noted complaints of right (dominant) wrist limitations and pain.  Radiographs of the right wrist showed intact hardware with good alignment.  Physical examination showed painful and limited wrist motion as charted below.  There was tenderness with no gross deformity.  Surgical scar was well healed and neurologic and vascular testing was normal.  Grip strength was 40 pounds on the right (120 pounds on the left).  The ROM was dorsiflexion to 0 degrees (normal 70), palmar flexion was 30 degrees (normal 80), ulnar deviation was 0 degrees (normal 45) and radial deviation was 10 degrees (normal 20); painful motion was present.

At the 29 March 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported using a wrist support with chronic right wrist pain and loss of mobility.  Pain increased with activity.  Physical examination showed the right wrist slightly larger than the left.  Surgical scar was well healed.  The ROM was dorsiflexion to 0 degrees, palmar flexion was 35 degrees, ulnar deviation was 0 degrees and radial deviation was 0 degrees; painful motion was not addressed.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10%, coded 5215 (wrist, limitation of motion), citing dorsiflexion less than 15 degrees.  The VA rated the right wrist condition 10% also coded 5215, based on the C&P examination 2 months after separation, citing loss of mobility with the need for a brace and no ankylosis.  The MEB examination was within 6 months of the CI’s four-corner fusion surgery and was adjudged to have less probative value for rating at separation.  There was retained motion in the right wrist of at least 30 degrees on both the MEB NARSUM and VA examinations indicating that there was no ankylosis (frozen joint).  Code 5215 has a maximum of 10% for wrist limitation of motion as awarded by the PEB.  There was therefore no VASRD §4.71a route to a higher rating under any applicable code.  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.

Limitation of Motion of Left Ankle…. According to STRs and the MEB NARSUM, the CI’s left ankle condition began in July 2003 after a motorcycle accident.  He underwent surgery for a left talus fracture in July 2003.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left ankle pain” for PEB adjudication.  At the MEB examination the CI complained of ankle pain and swelling at times.  Physical examination showed minimal swelling and tenderness with 30% loss of plantar flexion, 40% loss of dorsiflexion and 15% loss of eversion and inversion.  The MEB NARSUM examination noted complaints of left ankle pain and limitations.  Radiographs revealed hardware in place with no displacement.  Physical examination showed limited ROM of dorsiflexion to 0 degrees (normal 20) and plantar flexion to 30 degrees (normal 45); painful motion was not addressed.  There was no evidence of instability, tenderness or crepitus.  Neurovascular examination was normal.

At the VA Compensation and Pension (C&P) evaluation the CI reported use of an ankle brace with increased discomfort: in the ankle with prolonged standing and walking and occasional swelling.  He complained of ankle instability and that the ankle easily inverted when walking up uneven surfaces.  Physical examination showed a normal gait.  ROM was dorsiflexion to 5 degrees, plantar flexion to 45 degrees, both inversion and eversion were 15 degrees; painful motion was not addressed.  The surgical scar appeared well healed and motor, reflex, and sensory testing were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5271 (ankle, limited motion), citing dorsiflexion of 0 degrees and rated as moderate.  The VA also rated the left ankle condition 10% also coded 5271, based on the C&P examination citing chronic pain and occasional swelling without marked limitation of motion.  The rating criteria under code 5271 for limitation of motion are “moderate” (10%) or “marked” (20%).  Only the MEB NARSUM examination approximated the “marked” criteria, and examinations both before and after that evaluation more nearly approximated the 10% (moderate) criteria.  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 ankle 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.  In the matter of the left ankle 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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005672, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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