RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04382
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20071223

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic left wrist limitation of motion and pain” with a disability rating of 0%.

CI CONTENTION: The left wrist condition continues to worsen and negatively impact daily activities of life. The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20071012	VARD - 20080709	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Wrist Limitation of Motion and Pain	5215	0%	Status Post ORIF, Intra-Articular Distal Left Wrist Fracture	5215	10%	20071101	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Chronic Left Wrist Limitation of Motion and Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right hand-dominant CI’s left wrist condition began in March 2007 after falling and suffering a comminuted displaced intra-articular distal radius fracture (with associated ulnar styloid fracture). In May 2007 the CI had open reduction internal fixation (ORIF) of the distal radius fracture. The 13 August 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, noted complaints of left wrist pain. Physical examination showed left wrist scar with decreased range of motion (ROM) of the left

wrist. Left wrist strength was 3/5. At the MEB NARSUM examination 9 days later the CI reported continued left wrist pain, limited mobility, and lack of strength. Physical examination showed the left wrist with a well-healed incision and tenderness over the styloid. There was no instability, or sensory or vascular deficit. Motor was intact. The examiner noted active range of motion (ROM) measurements from a 6 September 2007 occupational therapy (OT) visit as flexion of 62 degrees and extension to 45 degrees, with pain on flexion greater than extension. OT ROMs from 1 October 2007, 3 months prior to separation, measured in degrees was wrist extension of 47 degrees (normal 70), wrist flexion 60 (normal 70), radial deviation 21 (normal 20), ulnar deviation 37 (examiner normal noted as 30; VASRD normal is 45), with limitation due to adherence of scar tissue volar surface.

At the 1 November 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported left wrist pain, weakness, stiffness, and fatigability. Physical examination showed left wrist tenderness over the distal radius. There was decreased strength against resistance 4/5 (right wrist was 5/5). ROM in degrees was dorsiflexion 35 degrees (normal 70), palmar flexion 70 degrees (normal 80), radial deviation 20 and ulnar deviation 30 degrees (normal 45), with pain on ROM.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic left wrist limitation of motion and pain 0%, coded 5215 (limitation of motion of wrist), citing tenderness to palpation but no erythema, cyanosis or edema; ROM and strength measurements were slightly decreased. Using the same code, the VA rated the wrist condition 10% based on the C&P examination, citing painful limitation of motion.

An evaluation of 10% for dorsiflexion of the wrist less than 15 degrees or palmar flexion limited in line with the forearm was not supported by the ROMs in evidence, and there was no ankylosis for rating under code 5214. However, there was sufficient evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45), and scar-limiting motion of the wrist joint. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left wrist condition, coded 5299-5215.

BOARD FINDINGS: In the matter of the chronic left wrist limitation of motion and pain, the panel recommends a disability rating of 10%, coded 5299-5215 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	
Chronic Left Wrist Limitation of Motion and Pain	5299-5215	10%	

The following documentary evidence was considered:

	PD-2017-04382
AR20190012729, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX

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.