RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02866
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20061201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “left (non-dominant) hand/wrist pain from non-union of the scaphoid” with a disability rating of 20%.   

CI CONTENTION:  He continues to have problems with his left hand.  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 - 20060829	VARD - 20070313	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Non-Dominant) Hand/Wrist Pain…	5099-5003	20%	Nonunion Fracture of the Left Scapula (sic)	5299-5215	10%	20061113	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left (Non-Dominant) Hand/Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI fell onto his outstretched left hand in April 2005.  Although X-rays were normal, he was treated with a splint for an occult scaphoid injury.  He was found to have a non-union of a scaphoid fracture on X-ray in August 2005, and underwent a left wrist open reduction and internal fixation on 15 September 2005, with two additional revisions over the next 6 months.  At the 7 August 2006 physical therapy examination, 4 months prior to separation, the examiner recorded, in degrees:  flexion of 25 (normal 80), abduction of 32, radial deviation of 14 (normal 20), ulnar deviation of 22 (normal 45) and supination of 45.  All movement was limited by pain and decreased compared to the unaffected right wrist.  One week later, X-rays showed that the fracture was still not healed.  

The 24 August 2006 MEB NARSUM examination, 3 months before separation, noted CI complaints of persistent pain and decreased left hand function.  Physical examination showed a well-healed scar with some muscle wasting of the thenar eminence (muscles at the base of the thumb).  He was unable to extend or flex his wrist.  At an orthopedic visit on 13 September 2006, the scaphoid bone was still not healed and a bone stimulator was ordered.  

At the 13 November 2006 VA Compensation and Pension examination, 1 month prior to separation, the CI reported no difficulties performing activities as a college student.  He could only lift 5 pounds and used a bone stimulator at night, but denied use of medications or a brace.   On physical examination, ROM tests showed, in degrees: flexion of 30, extension of 45 (normal 70), radial deviation of 10, and ulnar deviation of 10.  Finger movement and thumb opposition was normal but painful; grip strength was not recorded.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left (non-dominant) hand/wrist pain condition 20%, coded analogously as 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the non-union fracture 10%, coded analogously as 5215 (limitation of motion of wrist), citing painful motion or dorsiflexion of the wrist less than 15 degrees and for palmar flexion limited in line with the forearm.  Upon deliberation, members agreed that both code 5003 and 5215 support a 10% rating, but no higher, for the left wrist limitation in motion, and there were no other applicable codes warranting a higher rating.  After due deliberation, considering all of 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 (non-dominant) hand/wrist pain condition.  

BOARD FINDINGS:  In the matter of the left (non-dominant) hand/wrist pain 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 20170425, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008727, 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