RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-03071
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “left (non-dominant) distal radius fracture” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 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 - 20060516	VARD - 20070430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Distal Radius Fracture	5099-5010	10%	Residuals of Left Distal Radial Fracture	5213	20%	20070307	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Wrist Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained a closed distal radius fracture of his non-dominant left wrist on 22 April 2005 when he fell off a flatbed trailer.  He underwent external fixation followed by open reduction and internal fixation with iliac crest bone grafting.  Post-operative X-rays showed the distal radius fracture had healed with approximately 30 degrees of volar (palmar) tilt.  No further surgery was recommended.  The CI had residual wrist pain, stiffness and significant limitation of motion that impaired his ability to do push-ups, fire a weapon, climb into vehicles or lift more than 5 pounds.  

The 15 February 2006 MEB NARSUM examination, 6 months prior to separation, noted complaints of left wrist pain and limitation of motion.  Physical examination showed no tenderness over the distal radius, ulna or wrist.  Left wrist range of motion (ROM) testing showed palmar flexion (PF) of 45 degrees (normal 80) and dorsiflexion (DF) of 40 degrees (normal 70).  Left forearm ROM testing showed supination of 65 degrees (normal 80) and full pronation (normal 80).  A goniometric ROM study on 10 April 2006, 4 months prior to separation, showed PF of 45 degrees and DF of 20 degrees, with painful motion.  

At the 7 March 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported left wrist pain aggravated by activity with occasional swelling, limitation of motion and some weakness,.  Physical examination showed 4/5 left wrist and 3/5 left hand grip weakness with rapid fatiguing, lack of endurance and increased pain with resistance.  There was tenderness of the distal radius.  Left wrist ROM testing showed PF and DF of 40 degrees each.  Left forearm pronation was 45 degrees and supination was 25 degrees.  All limitations were due pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 10%, analogously coded 5010 (arthritis, due to trauma), citing loss of non-ratable motion due to arthritis.  The VA rated the left wrist condition 20%, coded 5213 (supination and pronation, impairment of), based on the C&P examination, citing pronation lost beyond last quarter of arc and the hand does not approach full pronation.  

There was no limitation of motion which supported a rating under the diagnostic code for limitation of wrist (5215) motion.  The limitation of forearm supination/pronation documented at the MEB NARSUM examination supported a 10% rating, however, at the post-separation VA examination limitation of pronation supported a 20% rating for “motion lost beyond the last quarter of the arc, the hand does not approach full pronation.”  The MEB NARSUM and VA examinations were of similar proximity to the date of separation, but the VA examination was more complete with ROM after repetition documented; therefore, the panel placed greater probative value on the VA examination for its rating recommendation.  There was no higher than a 20% rating supported under any applicable VASRD code and there was no evidence of limited finger motion, muscle or nerve injury due to the wrist for additional rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left wrist condition, coded 5213.  

BOARD FINDINGS:  In the matter of the left wrist condition, the panel recommends a disability rating of 20%, coded 5213 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	
Closed Left (Non-Dominant) Distal Radius Fracture	5213	20%	

The following documentary evidence was considered:  

	PD-2017-03071
[AR NUMBER], XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

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 also been provided to the Department of Veterans Affairs.

Enclosure

	PD-2017-03071