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AF | PDBR | CY2011 | PD2011-00749
Original file (PD2011-00749.pdf) Auto-classification: Denied
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 

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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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