RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05186
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20071219

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “chronic right wrist pain” with a disability rating of 10%.

CI CONTENTION: Review of all conditions requested. 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 - 20070911	VARD - 20080624	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Wrist Pain	5099-5003	10%	Right Wrist Residuals of ORIF	5099-5003	10%	20080404	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Right Wrist Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-hand dominant CI’s right wrist condition began in July 2006 after falling on his outstretched hand. On 22 September 2006, the CI underwent surgical fixation of a nonunion of the right scaphoid (wrist) bone. A second surgery of the same was performed on 19 January 2007. Despite surgical intervention and rehabilitation, the CI’s right wrist pain continued. At the 2 August 2007 MEB NARSUM examination, 4 months prior to separation, the CI endorsed the inability to lift greater than 2 to 3 pounds as well as pain upon grasping with the right hand. The physical examination (PE) revealed painful and decreased range of motion (ROM) of the right wrist noting dorsiflexion to 57 degrees (normal 70) and palmer flexion to 50 degrees (normal 80).

At the 4 April 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported continued pain and weakness about his right wrist. His PE revealed painful and decreased ROM after repetition, noting dorsiflexion to 60 degrees and palmer flexion to 75 degrees. Strength was assessed as 3 of 5.

The panel directed attention to its rating recommendation based on the above evidence. Both the PEB and VA rated the right wrist condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing limitation of motion and joint arthritis, respectively. Clearly there was decreased right wrist ROM on both pre- and post-separation examinations and all panel members agreed that absent evidence of wrist ankylosis (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 (wrist; limitation of motion), 10% is the only rating available. Additionally considered was the CI’s weakness as seen in gripping with the right hand and therefore, a possible muscle code was reviewed. Anatomically, either forearm muscle codes of 5307 and or 5308 (Group 7 and or Group 8) would be appropriate. The corresponding muscle codes intensity rating scales included slight, moderate, moderately severe, and severe. Panel members further agreed that the weakness described as 3 of 5 would support an intensity level no greater than that of moderate with a maximum of 10%. There were no other coding options available that would render a higher rating than the 10% as 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 right wrist condition.

BOARD FINDINGS: In the matter of the right wrist 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.

2	PD-2017-05186

ARXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXXX:

	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,