RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00064
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:   20051120 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aviation Machinist Mate, medically separated for “chronic left wrist pain and stiffness …,” with a disability rating of 10%.  

CI CONTENTION:  The CI submitted a lengthy contention.  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 - 20051012	VARD - 20141118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Wrist Pain and Stiffness as a Result of the Above Stated Injury and Subsequent Surgical Treatment	5251	10%	Status Post Left Wrist Fracture	5215	10%	20140610	
History of Comminuted Displaced Intraarticular Fracture of the Left Distal Radius, Status Post Open Reduction Internal Fixation	Cat II					
Nondisplaced Right Radial Styloid Fracture	Cat III	Right Wrist Sprain Status Post Nondisplaced Distal Radius Fracture	5215	10%	20140610	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Wrist Pain and Stiffness.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left wrist pain condition began in January 2005 after a falling injury.  On 11 January 2005 the CI underwent surgery of open reduction internal fixation (ORIF) of a comminuted displaced fracture of the left distal radius.  He had post-surgery left wrist pain and limitations that did not improve with limited (LIMDU x2) and therapy.  The CI was not a candidate for further surgery.  

During the 6 September 2005 MEB examination (recorded on DD Forms 2807 and 2808), 2 months prior to separation, the CI reported post-surgical left wrist pain with lifting or twisting motions and limited wrist motion.  Physical examination showed limited extension of the left wrist with a 10 cm surgical scar on the dorsum of the left wrist.  

The 25 August 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of left wrist pain, decreased range of motion (ROM), weakness, and inability to perform certain tasks with his dominant left hand.  Physical examination showed a well healed left wrist surgical scar with mild tenderness to palpation.  There was full symmetric ROM of the elbows with flexion, extension, pronation and supination (of the forearms).  Circumferences of the wrists and forearms were within 0.5 cm of each other.  Grip strength on the left was 85, 82, and 78 pounds which was less than the non-dominant right side (95-100 pounds).  Left wrist ROM was 65 degrees of extension (normal 70) and 58 degrees of flexion (normal 80).  X-rays showed postoperative changes with retained hardware with a well healed fracture in good alignment, with mild radial carpal joint space narrowing.  

There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist pain condition 10%, coded 5215 (limitation of motion of wrist).  The Navy PEB also listed history of comminuted displaced intraarticular fracture of the left distal radius, status post ORIF as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The impairment from the comminuted displaced intraarticular fracture of the left distal radius, status post ORIF was properly subsumed under the overall rating for the left wrist pain condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA also rated the left wrist pain condition 10%, coded 5215 (limitation of motion of wrist), based on the C&P examination over 8 years months after separation, citing painful motion.  

The 10% awarded by the PEB and the VA is the highest rating available under code 5215 for wrist limitation of motion.  There was no ankylosis of the wrist (immobile/frozen wrist) for any higher rating under code 5214 (wrist ankylosis), and no ratable limitations of the digits or thumb was documented.  There was no malunion or non-union of the radius and no painful motion or limitation of left forearm supination or pronation for alternative or additional rating based on the forearm bone (codes 5212 [radius impairment] or 5213 [supination and pronation impairment]).  

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 left wrist pain condition.  

Contended PEB Condition:  Nondisplaced Right Radial Styloid Fracture.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended right wrist condition was not unfitting.  The CI’s right wrist was fractured at the same time as the unfitting left wrist, but did not require surgery (treatment was casting).  The non-medical assessment did not mention any specific injury and the source LIMDUs were not in evidence.  The NARSUM listed the right wrist condition as “nondisplaced right styloid fracture, treated with cast immobilization, now healed.”  The MEB examination did not note any right wrist impairment and the NARSUM did not attribute significant functional impairment to the right wrist condition.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left wrist pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended history of comminuted displaced intraarticular fracture of the left distal radius, status post ORIF condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  In the matter of the contended nondisplaced right radial styloid fracture condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160120, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
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	     				  Acting