RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03394
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an E-5, Structural Craftsman, medically separated for “left wrist pain” with a disability rating of 10%.   

CI CONTENTION:  “Review all conditions.”  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 – 20090506	VARD - 20100414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain	5003	10%	Residual Post Traumatic Arthritis and Scar, Status Post Surgical Repair of Scaphoid Fracture and Non Union of Left Wrist	5010-5215	10%	20091210	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Left Wrist Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the right-handed CI fractured his left wrist three times during the period of 1998 through 2000.  After each incident, the CI recuperated well and in 2001 he enlisted having full range of motion (ROM) of the left wrist and no activity limitations.  The CI performed full duty until late 2007, whereby his left wrist became progressively painful.  Eventually, the CI underwent surgical removal of multiple wrist bones.  Post-operatively, the CI suffered progressive and unrelenting left wrist pain.  

At the 17 February 2009 MEB NARSUM examination, 6 months prior to separation, the CI complained that “weight-bearing and push-ups cause me pain in my left wrist.”  The physical examination (PE) was limited but noted decreased (unquantified) ROM of the left wrist.  Both the CI’s orthopedist and pain management specialist opined that the CI’s pain would likely be a lifelong cause of disability.

At the 10 December 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant moderate-to-severe left wrist and hand pain.  His PE revealed decreased and painful motion of the left wrist.  Wrist dorsiflexion (extension) was measured at 12 degrees (normal 70), palmer flexion (flexion) to 20 degrees (normal 80), ulnar and radial deviations measured 10 and 8 degrees (normal 45 and 20, respectively).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 10%, coded 5003 (arthritis, degenerative).  The VA also rated the left wrist condition 10%, coded 5010-5215 (arthritis, due to trauma, causing limitation of wrist motion) based on the C&P examination, citing dorsiflexion of the wrist less than 15 degrees or palmar flexion which is limited in line with the forearm.  The VASRD criteria in regards to the wrist is based upon two categories which includes either joint ankylosis (essentially, a fused joint) or limitation of motion.  Clearly there was decreased left wrist ROM on both pre and post separation examinations and all panel members agreed that absent evidence of wrist ankylosis (VASRD code 5214) or periods of incapacitation under code 5003, 10% is the maximum impairment level supported in this case.  Specifically, under the appropriate code of 5215, 10% is the only rating available.  There were no other coding options that would render a higher rating 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 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 were 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.  

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03394.

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.