RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02497
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20091228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Electrical Systems Journeyman, medically separated for “left wrist pain status post (S/P) 2-bone fracture (including ulnar styloid), triangular fibrocartilage tear, and scapholunate interosseous ligament tear” with a disability rating of 20%.

CI CONTENTION:  Review of all conditions requested.  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 - 20091007	VARD - 20100301	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain	5211	20%	S/P Surgery for Left Radial, Ulnar Repair	5299-5210	10%	20091127	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Left (non-dominant) Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI suffered a compound fracture of his left distal radius and ulna/ulnar styloid in a motorcycle accident in January 2008.  He underwent immediate left forearm open reduction internal fixation (ORIF) surgery.  The CI had a nonunion fracture and underwent left wrist arthroscopy in July 2008 for repair of ligament and cartilage tears.  Hand therapy and steroid injections were minimally effective.  X-ray on 26 January 2009 revealed good spacing of the distal radial ulnar joint and no sign of arthrosis.  There was evidence of prior surgery with mild instability of the scapholunate joint.  

The 19 February 2009 MEB NARSUM examination, 10 months prior to separation, noted complaints of left wrist pain and limitations with recurrent inflammation and inability to bear weight over 25 pounds.  Physical examination showed painful left wrist motion.  There was no flexion weakness of the left hand fingers and negative median and ulnar nerve provocative testing.  At the 6 May 2009 orthopedic evaluation, 6 months prior to separation, the CI complained that the pain had returned after short-term relief following surgery.  Physical examination documented “full” wrist range of motion (ROM) with moderate tenderness.  Forearm rotation was “close to full with about 80% of normal supination compared to the opposite side.”  

The 29 June 2009 MEB NARSUM examination, 6 months prior to separation, noted the CI complained of right [sic] left arm muscle atrophy and demonstrated loss of muscle bulk to the physician.  He complained of more pain with gripping and use of forearm muscles, lack of strength, and nerve damage, with an inability to run due to pain in the arm.  The profile had been changed to restrict running over 100 yards and no specific examination was documented.  The physician indicated that the CI’s medical condition was unchanged from the original February 2009 MEB NARSUM examination.  Subsequent nerve conduction studies performed 24 August 2009 were normal.  The 7 October 2009 Formal PEB, 3 months prior to separation, documented that while the CI was present he was able to make a fist with his left hand with acknowledged pain upon gripping and use of the forearm muscles.  There was noted forearm scaring with no forearm deformity.

At the 27 November 2009 VA Compensation and Pension (C&P) orthopedic examination, one month before separation, the CI reported left wrist and hand pain with weakness, stiffness, and numbness.  He described flare-ups of pain following activities with weakness on repetitive use.  Physical examination showed well healed forearm scars with tenderness.  There was painful motion of the wrist and forearm to the measured VASRD normal limits in each plane following repetition.  There was no additional loss of ROM for any plane of motion in the wrist or forearm, but there was pain, fatigue, weakness, lack of endurance and incoordination, with pain being the most significant factor.  There was left forearm tenderness but no deformity, angulation, shortening, intra-articular involvement, malunion, nonunion, false joint, or drainage.  There was no ankylosis.  Grip strength was 30 pounds on the third repetition compared to 110 pounds on the dominant arm.  No focal deficits were noted.  The neurologist stated, “There is painful motion and weakness.  There are no other findings.  There is persistent excruciating pain in the left forearm with exertion, gripping, grasping and movement.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist pain 20%, coded 5211 (ulna, impairment).  The VA rated the S/P surgery for left radial, ulnar repair condition 10%, analogously coded 5299-5210 (radius and ulna, nonunion, with flail false joint) based on the C&P orthopedic examination, citing painful wrist and elbow motion as a result of the radius and ulna fractures.

The panel agreed there was no loss of bone substance or deformity or false movement for any higher rating under code 5211 or 5212 (radius, impairment).  Given full ROMs at the pre-separation VA examination and near normal ROMs proximate to separation, there was no higher alternate rating under code 5213 (supination and pronation impairment).  There was no ankylosis of the elbow or wrist, no flail joint, or limited motion of the forearm or wrist for any higher rating under those codes (5205 through 5210; 5213 through 5215).  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 for 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 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02497.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

								Sincerely,

								XXXXXXXXXX

Attachment:
Record of Proceedings