RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00596
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20040406

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Electrical/Mechanical Equipment Repairman, medically separated for “right wrist stiffness following open reduction with internal fixation of scaphoid nonunion fracture” with a disability rating of 20%.  

CI CONTENTION:  Details multiple current complaints and limitations associated with the wrist condition in addition to medication side effects and other symptoms which are attributed to the condition.  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 - 20040310	VARD - 20040624	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Wrist Stiffness …	5299-5212	20%	Fracture of the Right Wrist	5215-5214	30%	20040108	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Wrist Stiffness.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed atraumatic right (dominant) wrist pain in basic training, and a remote scaphoid fracture complicated by non-union (clinically clear this was an undiagnosed pre-enlistment injury) was discovered.  He underwent an open reduction and internal fixation on 18 November 2003, 5 months before separation, and there were no STR entries probative to range of motion (ROM) or other ratable findings in the interval between surgery and the evidence below.  

During the 8 January 2004 VA orthopedic Compensation and Pension (C&P) evaluation, 3 months before separation, the examiner documented non-specific joint pain without elaborating functional limitations.  Physical examination revealed “mild” tenderness over the scar without specifying other local findings, and opined that there was “severe” weakness, assessing strength at 3/5 for both extensors and flexors.  Measured ROM was dorsiflexion to 15 degrees (normal 70) and palmar flexion to 15 degrees (normal 80) specifying “mild” painful motion.  Although no repetitions were recorded, the examiner opined that there was “severe” lack of endurance.

The 12 January 2004 MEB NARSUM examination, 4 days later, documented non-specific pain that prohibited heavy lifting and various service physical requirements.  Physical examination recorded a non-tender scar with no point tenderness over the joint.  Proximal motor strength was not documented, but the examiner reported a right grip strength of 65 pounds versus 90 pounds for the left (moderately below average).  Measured ROM was dorsiflexion and palmar flexion to 55 degrees each, without specifying painful motion.  An orthopedic entry on 21 January (11 days after the NARSUM) documented a pain assessment of 0/10 with improving strength, and recorded dorsiflexion to 25 degrees and palmar flexion to 30 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 20%, coded 5299-5212 (analogous to impairment of the radius).  The applicable VASRD §4.71a criterion is “nonunion in upper half,” and this is the maximum rating under that code consistent with the evidence.  The VA rated the right wrist condition 30%, coded 5215-5214 (limitation of motion rated as ankylosis), based on the C&P evidence.  The rationale cited in the VA rating decision was 10% for painful motion with an additional 20% “due to severe weakness and lack of endurance.”  Members noted that the additional rating is not grounded in the VASRD or applicable to the criteria of code 5214.  It was presumably based on DeLuca principles, but is not codified in any known formal guidance applicable to panel recommendations.  

The panel considered that the significant ROM limitation, weakness, and lack of endurance documented by the C&P examiner was not consistent with the subsequent NARSUM and follow-up STR evidence; and, agreed that the latter was of greater probative value.  The subsequent service evidence was temporally approaching separation, mutually corroborative, and more aligned with the CI’s overall clinical features (minimal pain and tenderness, mild painful motion, no additional joint findings, etc.).  There was no ROM evidence (including the significant limitation reflected by the C&P measurements) that would justify a rating greater than 10% under the only ROM code available for the wrist (5215).  Members agreed that rating under code 5214 for ankylosis, even analogously, could not be justified given the degree of preserved joint motion in evidence and the anticipated clinical course.  Members also concurred that the additional rating conferred by the VA could not be endorsed as the basis for a higher rating recommendation from the panel; not only for the lack of a sanctioned basis, as previously noted, but also for the mitigated probative value of the evidence on which it relied.  Other than the PEB’s analogous rating under criteria of code 5212, with the maximum justifiable rating of 20%, there was no criterion supported by the evidence that would justify a higher rating under any other code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication of 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 are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends 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 20160913, 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN