RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2021-00109
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070613

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 “posttraumatic arthritis left (non-dominant) wrist” with a disability rating of 10%.   

CI CONTENTION:  “My initial VA disability rating upon separation was 70%.  It is now 90%.  I have been hospitalized for PTSD and depression.  I am currently not employed, largely due to worsening/continued symptoms of PTSD that have been resistant to treatment.  These symptoms started when I returned from Iraq and was still in service…  Lastly, my left wrist has significantly reduced range of motion and I have had arthritic pain in that joint since the injury.”  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 – 20070504 	VARD - 20080619	
Condition	Code	Rating	Condition	Rating	Exam	
Posttraumatic Arthritis Left (Non-Dominant) Wrist	5010	10%	Traumatic Fracture Left Wrist Status Post Reconstruction	0%	20070213	
Obstructive Sleep Apnea (OSA)	Not Unfitting	OSA	50%	20070213	
Retropatellar Pain Syndrome of Bilateral Knees	Not Unfitting	Left Knee Subluxation with Chondromalacia	10%	20070213	
		Right Knee Vastus Lateralis Muscle Rupture 	0%	20070213	
Chronic Low Back Pain	Not Unfitting	Lumbar Disc Disease and Mild Scoliosis	20%	20070213	
Tinnitus	Not Unfitting	Tinnitus Right Ear	10%	20070213	
Right Plantar Fasciitis	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Posttraumatic Arthritis Left Wrist.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained a severely comminuted, displaced left radius fracture in early July 2006.  When the cast was removed, he had significant deformity, pain, and instability.  A detailed radiographic study at the time demonstrated a displaced intraarticular distal radius malunion with intraarticular step-off, significant angulation, and shortening.  In September 2006, the CI underwent complex operative reconstruction with open reduction, internal fixation, and bone grafting, as well as repair of a triangular fiber cartilage complex tear.  Cast immobilization was followed by extensive occupational therapy (OT).  At an OT visit on 11 January 2007, 5 months before separation, active left wrist range of motion (ROM) showed flexion to 45 degrees (normal 70), extension to 65 degrees (normal 80), radial motion to 20 degrees (normal), and ulnar motion to 15 degrees (normal 45).  

At the 13 February 2007 VA Compensation and Pension (C&P) examination, 4 months prior to separation, the CI reported pain, swelling, and decreased ROM.  The examiner noted no tenderness and muscle strength at 3/5.  Left wrist ROM tests revealed dorsiflexion to 45 degrees, palmar flexion to 50 degrees, ulnar deviation to 22 degrees, and radial deviation to 15 degrees, with no change in ROM after repetitive motion.  

The 22 February 2007 MEB NARSUM examination noted CI complaints of persistent ulnar-sided wrist stiffness and pain rated at 2/10 with rest, and 8/10 with motion.  Upon examination, neurovascular findings for the hand were normal.  Measured ROM showed volar flexion to 45 degrees, dorsiflexion to 65 degrees, radial deviation to 20 degrees, and ulnar deviation to 15 degrees, with forearm supination to 55 degrees (normal 85) and normal pronation (80 degrees).   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 10%, citing a non-compensable limitation of motion.  The VA also rated the left wrist condition 0%, based on the C&P examination, citing a non-compensable evaluation with dorsiflexion greater than 15 degrees.  Panel members noted there was no ankylosis of the wrist (5214), nonunion of the radius or ulna (5010-5012), or limitation of dorsiflexion, palmar flexion, pronation, or supination that supported a rating under the VASRD diagnostic codes for limitation of motion (5215, 5213).  However, there was evidence of painful motion causing functional loss (based on §4.59, §4.40 and §4.45) which warranted the 10% rating granted 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.  

Contended PEB Conditions:  Obstructive Sleep Apnea (OSA), Retropatellar Pain Syndrome of Bilateral Knees, Right Plantar Fasciitis, Chronic Low Back Pain, and Tinnitus. 

The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The OSA was profiled in April 2007 when the CI was processing through the disability evaluation system.  The PEB found the OSA not separately unfitting because it was controlled with a continuous positive airway pressure (CPAP) device and did not interfere with duty performance.  The OSA was not implicated in the commander’s statement, and there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  

The panel next assessed the remaining contended conditions and noted that none were profiled or implicated in the commander’s statement nor failed retention standards.  There was no performance-based evidence from the record that any these conditions 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 fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left wrist condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended OSA, retropatellar pain syndrome of bilateral knees, right plantar fasciitis, chronic low back pain, and tinnitus, the panel recommends no change from the PEB determinations as not unfitting.  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.   

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20191025, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20220010431

Dear XXXXXXXXXXX:

	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.