RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03557
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20071004

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4 , Master-at-Arms, medically separated for “chronic left wrist pain secondary to an old left distal radius fracture” with a disability rating of 10%.

CI CONTENTION: “I was only found unfit by the PEB for conditions relating to my broken wrist. The VA found additional conditions not identified during my PDBR [Sic]. These conditions are described in detail in the attached VA letters from 2008 and 2001. Please 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 - 20070727	VARD - 2008105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Wrist Pain Secondary to... Distal Radius Fracture	8711	10%	[Surgical] Residuals ... Distal Radius and Ulna (Non-Dominant)	5215	10%	20080717	
Closed Fracture of Left Wrist	Cat II					
Keloid Scar	Cat II	Scars [Multiple Surgical]	7802	0%	20080717	
Palpitations	Cat III	Palpitations	7099-7010	NSC	20080717	
Habitual Aborter	Cat III	Spontaneous Abortions	7699-7623	NSC	20080717	
Osteopenia	Cat III	No VA Placement	
Squamous Lesion [Cervix]	Cat III	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Left Wrist Pain (Subsuming Associated Category II Conditions). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained distal radius and ulnar styloid fractures of her non-dominant left wrist in March 2005. The fractures healed with ulnar malalignment necessitating surgery (arthroscopic ulnar shortening osteotomy, ligaments intact) in July 2005. There were no post-operative complications, but the wrist pain persisted despite some improvement. Imaging demonstrated some remaining minor malunion issues at the wrist joint (4 mm ulnar variance of joint angle, 1 mm articular step-off of the radius), but surgical remedy was not proposed. The final surgical intervention was hardware removal in May 2006 (17 months before separation).

Provider entries in the STR documented some persistent ulnar tenderness and well-healing surgical scars without note of keloid. There was no indication of nerve involvement or neurological symptoms, and grip strength (including measured) was normal. Range of motion (ROM) measurements recorded dorsiflexion consistently to 70 degrees (normal) and palmar flexion ranging from 65 to 75 degrees (normal 80), with note of painful motion by some examiners. There was no documentation of significant functional impairment, of any additional VASRD-ratable findings, or any indication of elbow involvement. A 17 May 2007 orthopedic addendum to the NARSUM recorded chronic wrist pain interfering with critical specialty requirements (firearms, self-defense). The physical examination showed well-healed surgical incisions without note of keloid, dorsiflexion to 70 degrees, and palmar flexion to 75 degrees (painful motion not addressed). The 28 June 2007 MEB NARSUM examination, 3 months prior to separation, documented complaints of “constant” left wrist pain, rated at 2-6/10, and aggravated by heavy carrying and gripping. The physical examination recorded non-specific limitation of left wrist ROM with painful motion, normal (5/5) grip strength, and a “keloid scar at left wrist” (unelaborated and uncorroborated elsewhere in the STR).

At the 17 July 2008 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported constant pain rated at 4/10 with occasional flares to 9/10 that limited heavy pushing or lifting. The physical examination made no note of any tenderness, swelling, deformity, or abnormal neurological findings. A detailed scar examination recorded some flat to mildly depressed hypopigmented scars contradicting the presence of any keloid. Measured ROM was normal in all planes with no pain or additional limitations following repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left wrist condition 10%, coded 8711 (neuralgia of the applicable nerve group). No rationale was elaborated and the rating was incongruent with code 8711, which provides for a minimum rating of 20% (major and minor) for “mild” nerve impairment. The panel agreed that the PEB’s Category II (conditions that contribute to the unfitting condition) diagnoses of wrist fracture and keloid (if present) were intrinsic to the rated condition such that a separate rating could not be supported without violation of VASRD §4.14 (avoidance of pyramiding), and were thus appropriately subsumed in the same rating. The VA also rated the condition 10%, coded 5215 (limitation of motion), based on the C&P examination and citing applicable ROM criteria, without invoking painful motion. Code 5215 provides solely for a 10% rating (major and minor) for either dorsiflexion limited to 15 degrees or less, or for palmar flexion of 0 degrees.

Panel members agreed that the PEB’s nerve code was not applicable, nor was its 10% rating compatible with the code. Additionally, there was no minimum 10% ROM limitation under code 5215, although the STR arguably provided satisfactory evidence of painful motion to support the minimum 10% rating IAW VASRD §4.59. It was also noted that either code 5211 (ulna, impairment of) or 5212 (radius, impairment of) could be clinically justified, and the evidence supported the 10% criterion (major and minor) of both of these codes, i.e., “malunion of, with bad alignment.” The only alternative joint code for the wrist specifies ankylosis (5214) which was

not present. Thus, no criterion was supported by the evidence that would justify a rating higher than 10% under any applicable code. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left wrist condition.

Contended PEB Conditions: Palpitations, Habitual Abortion, Osteopenia, and Cervical Lesion. There were STR entries indicating that the palpitations were associated with emotional stressors, and no significant arrhythmias or other cardiac pathology was identified. The CI had suffered three miscarriages that were judged to be stress related and the NARSUM stated that she did not desire pregnancy. Mild osteopenia was discovered on a screening scan which the NARSUM stated was currently resolved. She was identified with a cervical low grade squamous intraepithelial lesion by PAP screening that was cleared of malignancy by a follow-up cervical biopsy prior to separation. None of these conditions were noted on limited duty forms, implicated in the in the commander’s non-medical assessment, incompatible with retention standards, or significantly clinically active at separation.

The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting (Category III). There was no performance-based evidence from the record that any of them significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB Category III adjudication for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the left wrist condition (subsuming the above Category II conditions) and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended palpitations, habitual abortion, osteopenia, and cervical lesion, the panel recommends no change from the PEB determinations as Category III. 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.

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER TO,

1850
CORB: 003 20May20

From: Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBRltr

I. Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.