RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02827
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “nonunion right scaphoid” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20051004	VARD - 20060510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Nonunion Right Scaphoid	5099-5003	10%	Right Scaphoid Nonunion, Right Wrist	5215	10%	20060330 	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Nonunion Right Scaphoid.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained an injury to his right (dominant) scaphoid (wrist bone) in early 2004.  The fracture was initially placed in a splint and then taken for open reduction and internal fixation (ORIF) as well as a bone graft from the radius in March 2004.  An MRI revealed a non-vascularized (no blood vessels) portion of the bone was not healing, and he underwent a second ORIF in June 2004.  

The 18 August 2005 MEB NARSUM examination, 4 months prior to separation, noted the inability to complete push-ups or sit-ups or any of the tasks required of his military specialty.  He reported intermittent pain and difficulty performing many activities due to decreased range of motion (ROM).  Physical examination showed a neurovascularly intact right upper extremity.  The CI had a normal ROM of all the digits and metacarpophalangeal joints, and excellent capillary refill and 2/2 radial pulse.  The goniometric right and left wrist ROM was flexion to 38 and 80 degrees, respectively; extension to 20 and 80 degrees; radial deviation to 10 and 25 degrees; ulnar deviation to 15 and 30 degrees; pronation to 80 and 90 degrees; and supination to 80 and 90 degrees.  

At the 30 March 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported right wrist pain that was not incapacitating but required pain medication.  The CI was able to perform activities of daily living.  Physical examination showed right wrist joint tenderness and abnormal movement.  An X-ray showed scaphalar widening, degenerative changes, and bone fragments.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right scaphoid condition 10%, analogously coded 5099-5003 (arthritis, degenerative).  The VA also rated the right scaphoid condition 10%, coded 5215 (wrist, limitation of motion), based on the C&P examination, citing limitation of dorsiflexion or palmar flexion.  

The panel agreed there was no limitation of motion which supported a rating under the diagnostic code for limitation of dorsiflexion or palmar flexion (5215), or ankylosis under code 5214.  There was no evidence to support a rating under muscle codes 5307 or 5308.  There was no higher rating option than the 10% 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 right scaphoid condition.  

BOARD FINDINGS:  In the matter of the nonunion right scaphoid 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 20170418, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008723, 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