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AF | PDBR | CY2013 | PD-2013-02122
Original file (PD-2013-02122.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02122
BRANCH OF SERVICE: Army  BOARD DATE: 20140617
SEPARATION DATE: 20060623


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (44C/Financial Management) medically separated for a right (dominant) wrist condition. The CI’s could not be rehabilitated and he was issued a U3 profile and was referred to the Medical Evaluation Board (MEB). The right wrist condition, characterized as “right wrist stiffness” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated the right wrist condition as unfitting, rated 0%. The CI made no appeals and was medically separated.


CI CONTENTION: “ Since separation my % changed. I agree with the % I receive. Would like retirement status for PX and tricare.”


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 right wrist condition is addressed below; and, 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 Military Records. The Board acknowledges the CI’s information regarding the significant impairment with which his 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.


 RATING COMPARISON :

Service IPEB – Dated 20060404
 VA - (~1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right (Dominant) Wrist Stiffness 5215 0% Status Post Right Wrist Fusion Due To Fracture 5215 10% 20060802
Surgical Scar, Status Post Right Wrist Surgeries 7804 0% 20060802
Right Wrist Arthritis NSC 20060802
Other x 0 (Not in Scope)
 Other x 5 20060802
Combined: 0%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 60928 ( most proximate to date of separation [ DOS ] ).
*20120311 Supplemental Statement of the Case (SSOC) denied increases to DC 5215; 7804.
ANALYSIS SUMMARY:

Right Wrist Condition. The narrative summary (NARSUM) notes the CI fractured his right dominant upper extremity wrist in a recreational vehicle accident on 5 May 2005. He underwent open reduction and internal fixation of the fracture immediately. At the time of the initial surgery hand ligaments were noted to be torn and there was loss of the articulating cartilage surface of the radius at the wrist. The CI had limited range-of-motion (ROM) of the wrist post-operatively and continued with significant pain and was thought to have developed post-traumatic wrist arthritis. A second surgery was performed on 14 September 2005 with realignment of the hand bones and partial fusion of the wrist (radius-lunate-scaphoid). After the second surgery the CI’s pain was “less and he was functionally improved” with good ROM of the thumb and fingers noted, but he continued with limitation of wrist ROM which made him unable to perform basic duties of a soldier.

At the MEB examination on 17 February 2006, 4 months prior to separation, the CI reported right wrist stiffness with no pain at rest, but pain with activities such as lifting, grabbing, or carrying a load. He reported not taking any pain medication. The MEB physical exam noted limited wrist ROM of 15 degrees dorsiflexion (DF) (normal 70 degrees) and 35 degrees palmar flexion (normal 80 degrees), as well as decreased side to side wrist motion. The right hand examination was “otherwise unremarkable.” Right wrist X-rays showed post-surgical changes with a successful solid partial fusion of the wrist noted. The MEB examiner indicated a pain rating of “no pain during activities of daily living.”

At the VA Compensation and Pension exam on 2 August 2006, 6 weeks after separation, the CI reported a reduced pain level of 3-4/10 with flare-ups once per week to 7/10. The VA right wrist ROM was documented as DF “0-45%” and palmar flexion “0-45%.” Muscle strength was noted to be reduced with wrist extension graded 4/5 and wrist flexion graded 3/5, with no indication of muscle atrophy and normal sensation/vascular function noted. Wrist X-rays showed the intact wrist partial fusion, without evidence of migration. It could not be discerned from the single examination whether the VA examiner was indicating wrist extension/flexion of 45 degrees or 45% of normal ROM, since the latter was more consistent with the post-operative findings at the MEB NARSUM. VA records indicated a later wrist ROM measurement on 28 January 2008 of extension-30 degrees/flexion-35 degrees with a more remote VA examination on 9 August 2011 indicating similar wrist ROM with normal muscle strength.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the unfitting right wrist stiffness at 0%, coded as 5215 (limitation wrist motion) and noted, “rated as mild.” The VA rated the “status post right wrist fusion” condition 10%, also coded 5215 based upon subjective complaints and functional impairment IAW §4.7 (higher of two evaluations). The Board deliberated the rating of the right wrist condition. Following the second surgery the CI had limited ROM that did not meet the threshold for a compensable rating under the 5215 criteria. There was no evidence of wrist ankylosis, the only other VASRD code specific for rating wrist impairment. The Board agreed that the wrist condition met a 10% rating with 5215 IAW VASRD §4.59 (painful motion) which states “It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.” The Board reviewed to see if there was any path to a higher evaluation. The second orthopedic specialist indicated that the CI had probably developed post-traumatic arthritis, though arthritis was not noted on X-rays. The Board noted that even if it was conceded that there was likely post-traumatic arthritis of the wrist (which medically is likely) this would result in a 10% rating coded as 5099-5010 (analogous to traumatic arthritis). There was no evidence of any ratable muscle or nerve impairment of the right hand. The Board agreed that the wrist condition was appropriately coded as 5010-5215 (analogous to traumatic arthritis with limited wrist motion). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right wrist condition, coded 5010-5215.


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 PEB may have relied upon the USAPDA pain policy for rating the right wrist condition in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the right wrist condition, the Board unanimously recommends a disability rating of 10%, coded 5010-5215 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, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Right Wrist Stiffness 5010-5215 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131101, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                          
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXX, AR20150002599 (PD201302122)
1. 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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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