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AF | PDBR | CY2012 | PD2012 01520
Original file (PD2012 01520.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XX         CASE: PD1201520
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130507
SEPARATION DATE: 20030501


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PO2/E-5 (ET2/1413/Electronics Technician) medically separated for post-traumatic degenerative changes in the left wrist status post (s/p) open reduction bone grafting of the left distal radial non-union and distal radial ulnar joint (DRUJ) disruption. In April 2000, the CI was the restrained passenger in a GOV on duty when the vehicle was involved in a motor vehicle accident (MVA) with a semi-tractor trailer which pulled out in front of the GOV. Among other things, at that time, the CI fractured his left wrist. Over the next 2 years he had five surgeries on that wrist. The condition could not be adequately rehabilitated to meet the physical requirements of his Navy rating or satisfy physical fitness standards. He was placed on limited duty multiple times and eventually referred for a Medical Evaluation Board (MEB). The MEB forwarded post-traumatic degenerative changes, left wrist, s/p open reduction bone grafting, significant limited left wrist range-of-motion (ROM), left wrist pain, left wrist instability, and nonunion left distal radius conditions to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB submitted no other conditions. The PEB adjudicated post-traumatic degenerative changes in the left wrist s/p open reduction bone grafting of the distal radial left non-union and DRUJ disruption as unfitting, rated 20%. The CI made no appeals, and was medically separated with that disability rating.


CI CONTENTION: “I have severe arthritis and pain every day from numerous broken or sprained joints.” The CI also noted that “The VA rated me at 70% (seventy) service connected disability.”


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 left wrist condition is addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 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 respective Service Board for Correction of Naval Records.



RATING COMPARISON :

Service IPEB – Dated 20030325
 VA - (Exam ~9.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Wrist Condition 5212 20% Post-Op Residuals of Left Wrist Fracture 5211 30% 20040115
No Additional MEB/PEB Entries
 Other x 8 20040115
Combined: 20%
 Combined: 70%
Derived from VA Rating Decision (VA RD ) dated 200 40401 (most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the significant impairment with which the CI’s service-connected condition continues to burden him but must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations and DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Left Wrist Condition. The enlistment medical exam (March 1996) indicated a history of a closed reduction of a left distal ulna fracture at eight years of age, but a normal upper extremity exam. The right-handed CI experienced an intra-articular displaced Colles (distal radial) fracture of the left wrist during an MVA in April 2000. The injury required treatment with closed reduction and external fixation, and separate external fixation of a radial styloid fracture one week later. Persistent pain and loss of wrist supination secondary to radio-ulnar joint arthritis led to surgical removal of the articular ulnar surface and un-united ulnar styloid in January 2001. Post-operatively “…the forearm was able to be supinated fully.” Radial styloid fracture non-union and radiocarpal arthritis caused persistent left wrist pain and decreased flexion. In May 2002 the CI underwent a radioscapholunate arthrodesis (fusion) with bone grafting. The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Wrist ROM
(Degrees)
 MEB ~ 6 Mo. Pre-Sep VA C&P ~ 9 .5 Mo. Post-Sep
Dorsiflexion (70 Normal)
 15 15
Palmar Flexion (80)
 “approximately 10 degrees” 20
Ulnar Deviation (45)
 5- 10 15
Radial Deviation (20)
 5- 10 15
Forearm Pronation (0-80)
 30 90
Forearm Supination (0-85)
 40 90
Comment
 Lift < 5 pounds w/wrist +Tenderness
§4.71a Rating
 20% 20% (VA 30% )

The MEB physical exam in November 2002 (5 months after final surgery and 6 months prior to separation) noted that the left wrist was not improved after the multiple procedures. The CI was unable to lift more than five pounds with the left wrist. Examination revealed no neurologic or vascular deficits. Despite the ROM documented by this examiner and reflected in the table above, he stated that the CI “continues to have fairly significant pain without measurable functional ROM in the left wrist at this time.” The examiner stated that X-rays showed the radial non-union appeared to be healing, and also speculated that the CI could require a wrist fusion. At the VA Compensation and Pension (C&P) exam on 15 January 2004 (9 months after separation) the CI reported that pain was aggravated by cold and wet weather. He complained of decreased ROM and was limited to lifting 50 pounds. He took a narcotic medication for episodes of pain. Physical exam noted tenderness to palpation of the left wrist “snuff box” (radial dorsal aspect of the hand over the scaphoid carpal bone) and to brushstrokes over the web space of the thumb and index finger.

The Board directs attention to its rating recommendation based on the above evidence. The PEB’s 20% rating was based on code 5212 (radius, impairment of), while the VA assigned a 30% rating under the 5211 code (ulna, impairment of). Under either code, a 30% rating requires “loss of bone substance (1 inch or more) and marked deformity.” Furthermore, the 30% rating under the 5211 requires impairment of “upper half” of the ulna, but the small portion of the ulna excised in this case was the “lower half.” Board members agreed that examination findings were not consistent with the 30% descriptor under either code. In deliberating higher ratings under alternate wrist coding pathways, the Board noted that wrist ankylosis was absent. Although the service exam noted some limitation of pronation and supination, the severity did not approach “fixed” limitation; moreover, ROM in those planes normalized by the time of the VA exam. Finally, the highest rating for “wrist, limitation of motion of” is 10%. The Board therefore concluded that the 5214 (wrist ankylosis), 5213 (impairment of supination and pronation) and 5215 (limitation of wrist motion) codes offered no benefit to the CI. 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 left 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 left wrist 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.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Posttraumatic Degenerative Changes, Left Wrist
5212 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120816, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         XX
         Director of Operations
         Physical Disability Board of Review
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 31 May 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- X former USMC
- X former USN
- X former USMC
- X former USN
- X former USN
- X former USN



                                                     
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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