RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00494
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20061130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic pain, left wrist secondary to non-union of the scaphoid” with a disability rating of 10%.  

CI CONTENTION:  “I still find it difficult to leave the house most days and have difficulty dealing with other people.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20061011	VARD - 20061215	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Wrist … 	5099-5003	10%	Non-Union Scaphoid Fracture, Lt Wrist	5215	10%	20060223	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Left Wrist Chronic Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured his left (non-dominant) wrist in March 2005.  He was diagnosed (promptly) with a scaphoid fracture (comminuted, displaced) and underwent surgery (open reduction with screw fixation) a few days later.  Post-operative STR entries documented an uncomplicated recovery with gradually improving range of motion (ROM).  An orthopedic entry in January 2006 reported measured ROM as dorsiflexion (DF) to 55 degrees (normal 70) and palmar flexion (PF) to 30 degrees (normal 80), without addressing painful motion.  The final orthopedic outpatient note 4 months later characterized ROM as “good” in both planes.  Imaging (X-ray and CT) was interpreted as a well-aligned fracture with “possible” non-union.  Additional surgical intervention was not recommended.  There were no STR entries after rehabilitation that suggested any more significant ROM limitation or serious functional impairment, and none that documented any additional VASRD-ratable findings.

The 28 August 2006 MEB NARSUM examination, 3 months prior to separation, documented persistent left wrist pain rated “slight” and “frequent” and which interfered with multiple general soldiering requirements.  The only documented functional limitations relevant to general activities were lifting more than 25 pounds and “difficulty turning doorknobs secondary to pain.”  The physical examination recorded a well-healed surgical scar, intact neurovascular findings, and “able to make a fist.”  Measured ROM was DF to 60 degrees and PF to 20 degrees without addressing painful motion.

There was a VA Compensation and Pension (C&P) examination dated the same day as the NARSUM, with identical evidence from an earlier version of the C&P dated 23 February 2006.  These documented “daily” pain rated 2-3/10 without elaboration of functional limitations.  The physical examination recorded tenderness at the base of the wrist with full strength.  Measured ROM was DF to 30 degrees and PF to 55 degrees without addressing painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5099-5003 (analogous to degenerative arthritis) cited criteria of the US Army Physical Disability Agency pain policy, but was consistent with VASRD §4.71a criteria for the service evidence. The VA‘s 10% rating under code 5215 (limitation of motion) was based on the C&P evidence and cited “pain and tenderness which is productive of painful motion and functional loss.”  The only alternative joint code for the wrist specifies ankylosis (5214) which was not present.  No criterion was supported by the evidence that would justify a rating higher than the PEB’s 10% under any applicable code available in §4.71a.  After due deliberation, considering all 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 left wrist condition.

BOARD FINDINGS:  In the matter of the left wrist condition and IAW VASRD §4.71a, the panel 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 20170217, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180006333, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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