RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-02504
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20141022
SEPARATION DATE:  20030715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PO2/E-5 (AS2/Aviation Support Equipment Technician) medically separated for an unfitting left wrist condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Rating or satisfy physical fitness standards.  She was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The wrist condition, characterized as “degenerative arthrosis, left wrist, status post left total wrist fusion” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “degenerative arthrosis, left wrist, status post left total wrist fusion” as unfitting, rated 20%, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in her application.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting wrist condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20030520 | VA - (6 Mos. Pre -Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Degenerative Arthrosis, Left Wrist, Status Post Left Total Wrist Fusion | 5214 | 20% | Status Post Left Total Wrist Fusion with Degenerative Arthrosis | 5214 | 20% | 20030123
Other x 0 (Not in Scope) | Other x 15 (Not in Scope) | 20030123
Rating:  20% | Combined:  60%
Derived from VA Rating Decision (VARD) dated 20031231 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Degenerative Arthrosis, Left Wrist, Status Post Left Total Wrist Fusion.  The record indicated that the CI had a pre-service injury of her left wrist (1985).  She was without symptoms on service entrance, had a normal exam and indicated that she was right-handed on the Military Entrance Processing Station physical dated 15 April 1993 and the history (SF 93) dated 21 May 1998.  The CI developed left wrist pain and had initial in-service treatment in 2001.  Evaluation and treatment indicated an arthrosis/malunion (poorly healed prior fracture) of the left distal radius (radiocarpal joint is part of the wrist) with chronic wrist pain attributed to her pre-service wrist fracture.  The CI underwent total fusion of the left wrist in January 2002 using a bone graft from her right hip area (iliac crest).  At the MEB exam, the CI reported chronic left wrist pain with weakness.  The MEB physical exam noted a well fused left wrist “in good position” with left wrist grip strength of 38 pounds (78 pound on unaffected side).  Radiographs documented the left wrist as well fused with hardware in good position.  There was full range-of-motion (ROM) of all of her digits.  Prior orthopedic and physical therapy evaluations documented 0 degrees of left wrist motion.  

At the VA Compensation and Pension (C&P) exam performed 6 months prior to separation, the CI reported constant left wrist pain, swelling and weakness of the left wrist with decreased ROM.  She stated that she “cannot write with her left hand, and had to become right-handed.”  The examiner stated that “the musculoskeletal system examination shows that the (CI) is bilateral.  She cannot write with her left-hand even though she claims to be left-handed.  …  Dorsiflexion is 0 degrees, palmar flexion is 0 degrees, radial deviation is 0 degrees, and ulnar deviation is 0 degrees.  …  On the left wrist, there was no range of motion.  There was anklyosis of the left wrist, which was placed in a favorable position without any dorsiflexion, palmar flexion, radial deviation, or ulnar deviation.  The strength of both the right and the left hand were within normal limits.”  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the left wrist condition at 20% using code 5214 (wrist ankylosis) as in a favorable position for the minor (non-dominant) wrist.  Neither the service nor the VA made any pre-existing condition (EPTS) deduction and there was clear permanent service aggravation and no ratable condition at service entrance.

The critical rating elements under code 5214 for any rating above 20% are what position the wrist is fused in (favorable or other) and if the involved wrist is the major or minor side (minor is for the non-dominant hand except if the applicant is ambidextrous).  The Board considered the CI’s entry physical statements on being right-handed as indicating the left wrist was the “minor” wrist for rating purposes.  The VA examiner’s indication of “without any dorsiflexion” did not clearly align with the rating criteria of “Favorable in 20⁰ to 30⁰ dorsiflexion”; however, both the service and VA examiners stated that the wrist was in a favorable position.  The grip strength at the VA exam was considered normal and the service measurement of left grip strength would be normal for the “minor” or non-dominant hand.  The Board determined that the condition did not rise to the level of loss of use of the hand (code 5125), or to an unfavorable ankylosis of the wrist (40% rating level) as there was no palmar, ulnar or radial deviation.  The focus of deliberations was between 20% “Favorable in 20º to 30º dorsiflexion" or 30% (any other position, except favorable).  For rating IAW VASRD-only rules, the Board is not bound by the examiner’s characterization of the wrist.  However, the Board is bound by the rating criteria’s definition.  There were clear definitions under 5214 as to what constitutes favorable ankylosis and unfavorable ankylosis of the wrist.  The Board determined that anything else would fall into “any other position.”  With respect to a rating under diagnostic code 5214, the Board finds that the CI warrants rating at the 30% level, approximating ankylosis of the left wrist at a position that is neither “favorable in 20⁰to 30⁰ dorsiflexion” nor unfavorable.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the left wrist fusion condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left wrist condition, the Board unanimously recommends a disability rating of 30%, coded 5214 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:

UNFITTING CONDITION | VASRD CODE | RATING
Degenerative Arthrosis, Left Wrist, Status Post Left Total Wrist Fusion | 5214 | 30%
COMBINED | 30%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 2013 (no month/day), w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:    (a) DoDI 6040.44
        (b) PDBR ltr dtd 24 Apr 15 ICO XXXXXXXXXXXXXXX    
        (c) PDBR ltr dtd 24 Apr 15 ICO XXXXXXXXXXXXXXX
        (d) PDBR ltr dtd 8 Jan 15 ICO XXXXXXXXXXXXXXX
        (e) PDBR ltr dtd 14 Apr 15 ICO XXXXXXXXXXXXXXX
        (f) PDBR ltr dtd 21 Apr 15 ICO XXXXXXXXXXXXXXX
        (g) PDBR ltr dtd 7 Apr 15 ICO XXXXXXXXXXXXXXX

1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (g).

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

     d. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

     e. XXXXXXXXXXXXXXX, former USN: Entitlement to disability severance pay with a disability rating of 20 percent (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.
 
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.

	XXXXXXXXXXXXXXX
	Assistant General Counsel
                                   (Manpower & Reserve Affairs)

PD-2013-02504