RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02555
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “right wrist pain, status post non-union of scaphoid fracture,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his right wrist condition continues to bother him.  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 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 - 20060809	VARD - 20061114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Pain Status Post Non-Union of Scaphoid Fracture	5099-5003	10%	Status Post Repair of Nonunion of Scaphoid Fracture (Right Wrist) 	5099-5010	10%	STR	
			Surgical Scar	7804-7801	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right (Dominant) Wrist.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first sought treatment for his right wrist condition 4 December 2005.  He reported a several day history of pain after pushups or heavy lifting.  He was diagnosed with a sprain and treated with medications and duty limitations.  He was seen again 2 days later and reported a 5 day history of right wrist pain without antecedent trauma.  He went on Christmas break and was seen on 21 December 2005 in primary care.  An X-ray was positive for a right scaphoid fracture and was treated with a cast.  He again denied a specific injury.  At an orthopedic appointment on 7 February 2006, he was noted to have tenderness over the scaphoid (wrist bone) and no evidence of healing on X-ray despite 6 weeks of casting.  He was referred to a hand specialist and then had surgical fixation of the non-union on 30 March 2006.  Following surgery, he had persistent pain despite rehabilitation in occupational therapy and was not able to complete training.  He was then referred for an MEB.  

The 10 July 2006 MEB NARSUM examination, 1 month prior to separation the CI noted he fell onto his wrist in the second week of training; the records proximate to the time of injury record that there was no specific trauma though.  On examination, the range of motion was limited as charged below.  X-rays showed good healing and position of the fracture.  

The CI failed to attend his 14 August 2006 VA Compensation and Pension (C&P) evaluation but rated the unfitting condition base on the STR.  The range of motion (ROM) examinations in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Right  Wrist ROM
(Degrees)	Ortho ~2 Mo. Pre-Sep	NARSUM 1 Mo. Pre-Sep	
Dorsiflexion (70 Normal)	45	40	
Comment	NO TTTP of wrist; TTP of scar; Strength 4+/5	Full pronation and supination of the forearm and full ROM of elbow; TTP	
§4.71a Rating	10%	10%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10%, coded 5099-5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the right wrist condition 10% coded 5099-5010 (arthritis, due to trauma), based on the service treatment records citing painful or limited motion.  The panel considered the evidence.  Neither the code 5003 nor 5010 supported a rating higher than the 10% adjudicated by the PEB.  The codes specific for the wrist, 5214 (ankylosis of the wrist) and 5215 (limitation of motion of the wrist), also do not provide a route to a higher rating.  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 right wrist condition.  

BOARD FINDINGS:  In the matter of the right 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 20151122, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013319, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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