RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02044
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Cannon Crewmember, medically separated for “chronic pain left non-dominate hand…scaphoid nonunion,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his left wrist and neck conditions.  His 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 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 – 20050805	VARD - 20051004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left (non-dominant) Hand …Scaphoid Nonunion 	5099-5003	10%	Left Scaphoid Nonunion…	5010-5215	10%	STR	
			Left Volar Wrist Scar	7804	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Left Hand (Scaphoid Nonunion).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left wrist condition began in June 2004 after falling in the shower.  Diagnostic imaging (X-rays and MRI) revealed the nonunion of a left scaphoid [carpal bone of the wrist] fracture with avascular necrosis.  Surgery (scaphotrapezial fusion) was performed on 16 December 2004.  The MEB forwarded “left scaphoid nonunion with post-traumatic arthritis” for PEB adjudication.

An occupational therapy (OT) consultation (referenced by the MEB NARSUM) on 2 August 2004, 13 months before separation, noted complaints of loss of active range of motion (ROM).  The physical examination revealed decreased left grip strength and pinch strength.  ROM was left dorsiflexion (extension) 40 degrees (normal 70) and palmar flexion (flexion) 45 (normal 80).  The left thumb ROM was within normal limits.  An OT examination dated 6 January 2005, 8 months prior to separation, noted complaints of constant pain around the incision site with the inability to lift heavy objects without increased pain.  X-rays showed absence of the distal navicular and probable disruption of the scapholunate ligament.  Physical examination showed ROM of the left wrist with dorsiflexion (extension) 30 degrees and palmar flexion (flexion) 10 degrees.

An OT examination dated 31 January 2005, 7 months prior to separation, noted left wrist pain with extension.  Physical examination showed ROM of left dorsiflexion (extension) 30 degrees and palmar flexion (flexion) 10 degrees.  An orthopedic examination dated 22 March 2005 documented similar wrist flexion with tenderness over the snuff box.  An orthopedic examination dated 12 May 2005, 4 months before separation, revealed well healed scars with a painful left wrist with a limited arc of motion.  There was dorsal intercalated segment instability (DISI) of the wrist with diagnoses of nonunion of fracture carpal bones scaphoid and osteoarthritis.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 14 June 2005, 2 months prior to separation, the physical examination showed grip strength weakness at 4/5 (normal 5/5) with decreased ROM in all movements.  There was tenderness to palpation in the snuff box and over the surgical scar with hypersensitivity around the surgical scar down into the little finger- side of the hand.

The MEB NARSUM examination on 20 July 2005, 1 month prior to separation, noted complaints of left wrist pain which was worse since surgery and markedly decreased strength.  The CI was unable to do push-ups, put on his protective mask, or lift more than 30 pounds.  “He had difficulty getting dressed because of pain in his left hand.”  Physical examination showed intact sensation to light touch throughout with decreased motor strength 4/5 for grip, finger abduction and flexion, with 4/5 strength for wrist extension.  The ROM and quantified grip strength were completed by the aforementioned OT consultation.

There was no VA Compensation and Pension (C&P) examination proximate to separation for this Board’s analysis.  The VA utilized the CI’s STR to reach its initial rating decision.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic pain left hand (scaphoid nonunion) condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing pain-limited motion and the US Army Physical Disability Agency (USAPDA) pain policy rated for slight/constant pain.

The VA rated the left scaphoid nonunion condition 10%, coded 5010-5215 (arthritis, due to trauma - wrist, limitation of motion) based on the CI’s STR, citing dorsiflexion of the wrist less than 15 degrees; with an additional 10% disability rating for a painful wrist scar coded 7804 (scars, superficial, painful on examination).

The Board agreed that the ROM examinations proximate to separation detailed above documented dorsiflexion less than 15 degrees, meeting the 10% rating criteria under code 5215.  There was no ankylosis of the wrist (frozen wrist) for a higher rating under code 5214 (wrist, ankylosis).  The Board next addressed if the tender surgical scar, as rated by the VA, was an unfitting residual of the left wrist pain condition, or if alternative coding analogous to a pain syndrome/neuritis, rather than or in addition to coding for loss of motion, was warranted.  There was insufficient evidence of a separately limiting and unfitting scar residual.  However, given the overall picture of post-surgical pain with weakness of the grip and remaining wrist motion, hypersensitivity down into the fingers, and the overall disability picture, the Board majority agreed that additional rating with analogous coding to 8699-8615 (neuritis of the median nerve) was warranted.  The CI’s non-dominate hand disability picture was closer to “mild” incomplete paralysis, as there was no true paralysis for any higher rating.

After due deliberation, considering all of the evidence and mindful of the preponderance of the evidence and VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 10% for the chronic pain left non-dominate hand…scaphoid nonunion condition, coded 5010-5215, with an additional 10% rating coded 8699-8615.

BOARD FINDINGS:  In the matter of the chronic pain left non-dominate hand…scaphoid nonunion condition, the Board majority recommends a disability rating of 10%, coded 5010-5215, and a disability rating of 10%, coded 8699-8615 IAW VASRD §4.71a and §4.124a respectively.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain Left (Non-Dominate) Hand…Scaphoid Nonunion	5010-5215	10%	
	8699-8615	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

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 XXXXXXXXXXXXXXXXXXXXX, AR20160018773 (PD201502044)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA