RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02418
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “chronic left (non-dominant) wrist pain…” with a disability rating of 0%.

CI CONTENTION:  The CI contended knees, left hip and left leg.  The 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 condition(s) at the time of separation.  The panel 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 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 - 20060407	VARD - 20070912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Wrist pain…	5099-5003	0%	Status Post Left Wrist Fracture	5099-5010	10%	20070417	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Wrist Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left wrist pain condition began in June 2005 after falling on his left hand  The CI sustained a left distal radius fracture and underwent open reduction and internal fixation on 13 June 2005.  Post-operatively the CI continued to report left wrist loss of mobility and pain with numbness and tingling in the hand.  

The 9 March 2006MEB NARSUM examination, 2 months prior to separation, noted complaints of loss of mobility and pain in the left wrist with tingling and numbness in the hand.  Physical examination showed pain on extremes of range of motion (ROM) of the wrist in all planes.  ROM was noted as extension 70 degrees (normal, 70 degrees), flexion 50 degrees (normal, 80 degrees), radial deviation 15 degrees (normal, 20 degrees), ulnar deviation 30 degrees (normal 45 degrees), supination of the forearm 70 degrees, and pronation of the forearm 80 degrees.  The examiner also noted the Phalen’s test was positive for numbness of the ring finger and long fingers of the left hand. 

At the 17 April 2007 VA Compensation and Pension (C&P) evaluation, performed 11 months after separation, the CI reported sharp left wrist pain that occurred three times per week, lasted ten minutes and rated as a 6/10.  The CI stated that he had weakness, stiffness, fatigability, lack of endurance and sometimes the left wrist “gives way on him.” He said that he had flare-ups two to three times per week, 6 out of 10 pain rating that lasted for ten minutes. The CI did have a wrist brace. The CI took Hydrocodone every day which helped his left wrist pain without any side effects.  Physical examination showed passive and active ROMs of the left wrist were dorsiflexion 56 degrees (normal, 70 degrees), palmar flexion 55 degrees (normal, 80 degrees), ulnar deviation 15 degrees (normal, 45 degrees), radial deviation 10 degrees (normal, 20 degrees), all without pain; however with repeated ROMs of the left wrist, the CI complained of pain.  The examiner noted the CI was right hand dominant.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left wrist condition 10%, on 12 September 2007, analogously coded 5099-5010 (arthritis due to trauma), and based on the VA C&P examination 11 months after separation, citing functional loss due to painful motion.  

There was no limitation of motion or radius dysfunction which supported a rating under the diagnostic codes 5210 5212, 5215. However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left wrist pain condition, coded 5099-5010.  

BOARD FINDINGS:  In the matter of the chronic left (non-dominant) wrist pain secondary to fracture of the distal radius condition, the panel unanimously recommends a disability rating of 10% coded 5099-5010 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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 Left Wrist Pain…	5099-5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150929, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012897, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure