RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02666
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050622

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 left non dominant wrist pain” with a disability rating of 10%.  

CI CONTENTION:  Requested review of “all conditions,” and additional conditions not identified by the Medical Evaluation Board (MEB) and 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 - 20050322	VARD - 20060324	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Non-Dominant Wrist Pain	5010	10%	Fracture, Distal Radius and Ulna Status Post Open Reduction Internal Fixation with Traumatic Arthritis	5215-5010	10%	20060307	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent open reduction internal fixation of left ulnar and radial fractures with a plate, a pin, screws and wires in September 2004.  Occupational therapy failed to provide relief from pain and disability.  

During the 4 February 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported left wrist pain with pressure or bending the wrist,  lifting heavy weight, and with cold exposure.  However, wrist numbness from median nerve bruising was resolving.  Physical examination showed decreased range of motion (ROM) in all planes with tenderness, and decreased sensation at fingertips in median nerve distribution.  The 16 February 2005 MEB NARSUM examination noted complaints of intermittent left wrist pain, rated at 5/10, and worsened with bending the wrist, lifting more than 20 pounds, or repetitive wrist motions.  Physical examination revealed a well-healed scar, tenderness, and intact sensation and motor function, and wrist ROM was full but painful.  Bent-arm grip strength was 88 pounds on the right and 56 on the left, and lateral punch was 14 pounds on the right compared to 12 on the left.  Three-jaw grasp testing was stronger on the left than the right. 

At the 7 March 2006 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported left wrist pain with weakness but without radiation, and he denied any functional impairment or lost time from work.  Physical examination showed no evidence of inflammation, abnormal movements, instability or weakness.  Dorsiflexion was to 45 degrees (normal 70); palmar flexion to 60 degrees (normal 80); radial deviation was normal; and ulnar deviation was 25 degrees (normal 45).  All motions were accompanied by pain, but not limited by fatigue, weakness, lack of endurance or incoordination after repetitive use.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 10%, coded 5010 (traumatic arthritis), citing a major joint with radiographic and clinical evidence of arthritis and slight loss of motion.  The VA also rated the left wrist condition 10%, analogously coded 5215-5010, based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  There was no limitation of flexion or palmer flexion that supported ratings under diagnostic code 5215 or 5214.  There was also no evidence of hand muscle atrophy to support ratings under code 8515 (median nerve, paralysis of) or 8516 (ulnar nerve, paralysis of), and no evidence of substantial loss of hand or wrist use to support ratings under code 8511 (middle radicular group) or 8512 (lower radicular group).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  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 pain.  

BOARD FINDINGS:  In the matter of the chronic left wrist pain 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 20170427, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007047, 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.