RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
BRANCH OF SERVICE: ARMY
SEPARATION DATE: 20041215
NAME: XXXXXXXXXXXXXXXXXX
CASE NUMBER: PD1100749
BOARD DATE: 20121128
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was mobilized active duty reservist Soldier, SSG/E‐6, (92 G/Food Service
Sergeant), medically separated for chronic pain in the right wrist due to malunion of a right
wrist fracture that occurred in April 2003 during a fall while deployed to Iraq. The CI had right
wrist arthroscopic surgery in February 2004, which helped the pain slightly. Despite all surgical
and conservative treatments, CI continued to have pain and was unable to meet the
requirements of her Military Occupational Specialty (MOS). She was issued a permanent U3/L2
profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded right wrist pain
due to malunion of right wrist fracture along with bilateral bunions and moderate pes planus
were to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40‐501. The PEB
adjudicated the right wrist condition as unfitting, rated 10%, with application of the Veteran’s
Affairs Schedule for Rating Disabilities (VASRD). The remaining condition of bilateral bunions
with moderate pes planus was determined to be not unfitting. The CI made no appeals, and
was medically separated with a 10% disability rating. The CI specifically elected to receive
severance pay in lieu of Reserve Retirement with entitlement to retired pay at age 60.
CI CONTENTION: “I had two major surgeries at one time before I was released from active duty
that was no included in my med board evaluation. I just all the medical conditions to be
included. The staff at Fort Gordon medical board stated that the VA would take care of it.” In
the remarks section: “I just want the surgery to be included in my med board rating. The
counselors at Fort Gordon, Georgia completed the paperwork knowing that the surgery should
have been included. Instead they just had me sign their med board letter. They never stated
that [m]y surgery needs to be included in the med board package. I was a reserve solider and
did not know the process and the active duty staff did not try to correct the matter. Instead,
they just said the VA will take care of you. I worked and did what was asked of me and when it
was time for me to be released, they just did the minimum and sent me home.”
The CI had a total hysterectomy with salpingo‐oophorectomy and appendectomy in October
2004 prior to separation.
SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI
6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined
by the PEB to be specifically unfitting for continued military service; or, when requested by the
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings
for unfitting conditions will be reviewed in all cases. The other requested conditions
(hysterectomy and appendectomy) are not within the Board’s purview. 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 Army Board for Correction of Military
Records.
RATING COMPARISON:
Service IPEB – Dated 20041028
Condition
Code
VA (3 Mos. Pre‐Separation) – All Effective Date 20041216
Code
Rating
Exam
Chronic Right Wrist Pain
due to Malunion of Right
Wrist Fracture
Bilateral Bunions and
Moderate Pes Planus
Rating
10%
5212
Not Unfitting
↓No Addi(cid:415)onal MEB/PEB Entries↓
Condition
Status post Right Wrist Fracture
with Residual Pain and
Degenerative Changes
Left Hallux Valgus
Right Hallux Valgus
Hypertension
Total Hysterectomy with
Bilateral salpingo‐oophorectomy
5215‐5003
5280
5280
7101
7617*
10%
0%
0%
10%
50%
20040914
20040914
20040914
20040914
STR
0% X 1 other / Not Service‐Connected x 0
20040914
Combined: 10%
Combined: 60%**
*7617 rated at 100% effective 20041216 for surgery and then decreased to 50% after convalescence.
** VA combined rating initially 100% based on 7617
ANALYSIS SUMMARY: The Board acknowledges the CI's contention suggesting that ratings
should have been conferred for other conditions documented at the time of separation. The
Board wishes to clarify that it is subject to the same laws for disability entitlements as those
under which the Disability Evaluation System (DES) operates. The Disability Evaluation System
(MDES) is responsible for maintaining a fit and vital fighting force. While the MDES considers all
of the member's medical conditions, compensation can only be offered for those medical
conditions that cut short a member’s career, and then only to the degree of severity present at
the time of final disposition. However the Department of Veterans Affairs (DVA), operating
under a different set of laws (Title 38, United States Code), is empowered to compensate all
service‐connected conditions and to periodically re‐evaluate said conditions for the purpose of
adjusting the Veteran’s disability rating should the degree of impairment vary over time.
Chronic Right Wrist Pain due to Malunion of Right Wrist Fracture. There were two goniometric
range‐of‐motion (ROM) evaluations in evidence, with documentation of additional ratable
criteria, which the Board weighed in arriving at its rating recommendation; as summarized in
the chart below.
Right(nondominant) Wrist
ROM
Dorsiflexion (0‐70⁰)
Palmar Flexion (0‐80⁰)
Ulnar Deviation (0‐45⁰)
Radial Deviation (0‐20⁰)
Comment
MEB ~3 Months
Pre‐Separation
50⁰
20⁰
5⁰
5⁰
10%
VA C&P ~3 Months
Pre‐Separation
30⁰ (Pain at 15°)
15⁰ (Pain at 10°)
30⁰ (Pain at 15°)
15⁰ (Pain at 10°)
Obvious deformity of right wrist with moderate tenderness
to palpation over dorsum of radius and ulnar styloid; Marked
decreased ROM, worse in volar range of motion; Good
pulses and “no nerve signs”; ROM and grip strength
measurements from OT 4 months prior to separation; Right
grip strength 83% of normal, left 107%; All wrist motor
strength at 5/5.
General appearance of
both wrists within normal
limits; ROM limited by
pain; No ankylosis;
Normal neurological
exam.
§4.71a Rating
10%
The MEB narrative summary (NARSUM) examination was completed approximately 3 months
prior to separation and
included ROM and grip strength measurements recoded by
occupational therapy (OT) a month prior. The CI was noted to be left‐handed. The complex
radial fracture of the right wrist occurred in April 2003 while the CI was deployed. She was
medically evacuated to Landstuhl and then to Eisenhower Army medical Center. Although she
had two or three cast changes, she remained in a cast until August 2003. At that time, her wrist
was obviously deformed and ROM was limited. The wrist failed to respond to conservative
2 PD1100749
treatment and she underwent arthroscopic surgery in February 2004. An X‐ray from February
2004 noted a healed fracture, as did a previous X‐ray from December 2003. While her fracture
had healed, she had a significant loss of radial inclination and height and there was a numb
component of intraarticular fracture at the radiocarpal joint. She also had persistent dorsal and
dorsoulnar wrist pain and loss of volar flexion. She was offered a surgical attempt at original
anatomy i.e., distal radius osteotomy. However, she declined and underwent the lessor
procedure of diagnostic and operative arthroscopy as well posterior interosseous nerve
resection in an attempt to stage her arthritis as well as offer her some relief and potential for
improved motion. The operative report noted extensive dorsal wrist fibrosis, synovitis, full
thickness chondrosis of the distal radial cartilage, and a relatively large full thickness chondral
defect on the base of the scaphoid. The partial thickness tear of the triangular fibrocartilage
complex (TNCC) was also noted. The CI reported she had slightly decreased pain after the
surgery but her ROM was unchanged. Her treatment after surgery was occupational therapy
and nonsteroidal anti‐inflammatory medication. The pertinent examination findings at the time
of the NARSUM are noted in the chart above. The MEB history and physical examination was
completed approximately 2 months prior to the NARSUM and it noted wrist dorsiflexion of 60
degrees and palmar flexion of 10 degrees with a normal neurological examination. The
NARSUM examiner opined the CI had significant pain, tenderness, and deformity of the right
wrist and significantly reduced ROM and grip strength. He noted she was unable to perform
routine activities or her usual civilian vocation as a police officer.
The VA Compensation and Pension (C&P) examination was completed approximately a month
after the OT ROM and grip strength measurements were recorded and a week prior to the
NARSUM. It reports a similar history of the injury as the NARSUM and noted continuous wrist
pain and inability to flex her wrist along with a hard time lifting heavy objects. This exam also
stated the CI denied any surgery or any time lost from work. No issue with activities of daily
living was reported although it was noted she would have a difficult time gardening and
pushing a lawn mower. Physical examination findings are noted in the ROM chart above. X‐
rays of the right wrist noted mild generalized demineralization, minimal degenerative changes
at the radiocarpal joints with some minimal cartilage loss. Her pain with ROM was noted to be
significant.
The Board directs attention to its rating recommendation based on the above evidence. While
the PEB rated the right wrist condition as 5212 base on malunion and the VA rated the right
wrist condition as 5215‐5003 based on painful motion IAW with VASRD §4.59, both rating
schemes yield the 10% disability rating. Although the limitation of ROM of the right wrist was
considered significant, it did not reach the minimal compensable level under 5215 Wrist,
limitation of motion of. Neither code offers an advantage to the CI and there is no appropriate
way to rate the condition higher than 10%. After due deliberation, considering all of the
evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was
insufficient cause to recommend a change in the PEB adjudication for the right wrist 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 chronic right wrist pain due to malunion of right wrist
fracture condition and IAW VASRD §4.71a, the Board unanimously recommends no change in
the PEB adjudication. There were no other conditions within the Board’s scope of review for
consideration.
3 PD1100749
RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of
the CI’s disability and separation determination, as follows:
Chronic Right Wrist Pain due to Malunion of Right Wrist Fracture
UNFITTING CONDITION
VASRD CODE RATING
5212
COMBINED
10%
10%
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20110914, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record
SFMR‐RB
XXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD‐ZB / XXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202‐3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for
XXXXXXXXXXXXXXXXX, AR20120022716 (PD201100749)
I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD
PDBR) recommendation and record of proceedings pertaining to the subject individual. Under
the authority of Title 10, United States Code, section 1554a, I accept the Board’s
recommendation and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress
who have shown interest in this application have been notified of this decision by mail.
BY ORDER OF THE SECRETARY OF THE ARMY:
Encl
XXXXXXXXXXXXX
Deputy Assistant Secretary
(Army Review Boards)
CF:
( ) DoD PDBR
( ) DVA
4 PD1100749
5 PD1100749
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