RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02126
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Administrative Specialist, medically separated for “posttraumatic arthritis left wrist” with a  disability rating of 0%.  

CI CONTENTION:  Review requested of the left wrist, as well as other conditions not identified by the Medical Evaluation Board (MEB) or the Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060309	VARD - 20080410	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthritis Left Wrist	5010	0%	Left Wrist Injury 	5215-5014	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Left Wrist Posttraumatic Arthritis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent repair of a left wrist cartilage tear in December 2004 after a motorcycle accident.    In June 2005, she underwent a second surgery for left distal radius malunion with ulnar impaction.  Wrist range of motion (ROM), as recorded by occupational therapy in November 2005, showed flexion of 45 degrees (normal 70), extension of 60 degrees (normal 70), radial deviation of 15 degrees (normal 20) and ulnar deviation of 20 degrees (normal 45), with pain.  Grip strength was 25 pounds in the left hand compared to 75 pounds in the right hand.  During an orthopedic consult 4 days after the OT visit, ROM measurements, in degrees, were:  flexion to 30, extension to 30, ulnar deviation to 15 and radial deviation to 25.  Moderate tenderness was present during ROM testing.

The 1 March 2006 MEB NARSUM examination, 1 month prior to separation, noted CI complaints of “pain all the time from my left elbow to my pinky.”  She reported that wrist pain limited her ability to fully perform duties as an administrative specialist, and that she was unable to lift objects.  She also noted that any jarring movement in her wrist while marching or running caused significant pain. Physical examination showed a mild decrease in motor strength in the left wrist and hand secondary to pain, but there was no clubbing or cyanosis, and sensation was intact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 0%, coded 5010 (arthritis due to trauma), citing no ratable limitation of motion.  The VA rated the left wrist condition 10%, dual coded 5215-5014 (limitation of wrist motion due to osteomalacia), based on the STR, citing painful and limited motion of a major joint.  Members agreed that there was no limitation of dorsiflexion or palmer flexion which warranted ratings under code 5215, and no evidence of wrist ankylosis for rating under code 5214.  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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left wrist condition, coded 5010.  

BOARD FINDINGS:  In the matter of the left wrist condition, the panel recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Posttraumatic Arthritis Left Wrist	5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007029, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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 been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure