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AF | PDBR | CY2013 | PD-2013-02783
Original file (PD-2013-02783.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-02783
BRANCH OF SERVICE: Army  BOARD DATE: 20150423
SEPARATION DATE: 20080214


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Military Police) medically separated for a left (non-dominant) wrist pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The “ left wrist pain, S/P ORIF [open reduction with internal fixation] left distal radius” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded three other conditions ( chronic low back pain, adjustment disorder, and condyloma accuminata ) for PEB adjudication. The Informal PEB (IPEB) adjudicated the left wrist condition as unfitting, rated 10%, citing application of the US Army Physical Disability Agency pain policy. The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated. Slightly over a month after the CI’s separation, t he Service conducted a Revised PEB to administratively correct the DA Form 199 pertaining to the CIs IPEB, affirming its findings and rating under criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).


CI CONTENTION: The CI elaborated no specific contention in his 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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

Revised PEB – Dated 20090326
 VA* - (~1 Mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Wrist Pain ... 5099-5003 10% Surgical Residuals, Left Radius / Ulna 5213 10% 20080116
Other x 3 (Not in Scope)
 Other x 16
RATING: 10%
 RATING: 60%
*Derived from VA Rating Decision (VARD) dated 20080812 (most proximate to date of separation ( DOS )

ANALYSIS SUMMARY:

Left Wrist Condition. The service treatment record (STR) documents a left wrist/distal forearm fracture (intrarticular, distal radius and ulnar styloid) sustained in a motor cycle accident in April 2006 (22 months prior to separation). After surgical fixation the CI continued to suffer significant pain and limitations despite a protracted effort at rehabilitation; and, was referred for a MEB in an orthopedic entry of June 2007 (8 months prior to separation). At that exam grip strength was recorded as 4/5, and range-of-motion (ROM) measurements were dorsiflexion (DF) to 65 degrees (normal 70) and palmar flexion (PF) to 40 degrees (normal 80). An occupational therapy entry of October 2007 (4 months prior to separation) documented, “Full functional strength in both upper extremities throughout ... normal bulk and tone without atrophy ... full functional ROM ....” There are no subsequent STR entries reflecting significant ROM limitation; and, no entries noting instability, misalignment or other ratable findings. Post-operative X-rays confirmed normal joint alignment and healing fractures. There was no STR documentation of incapacitating episodes after surgical recovery.

The narrative summary (NARSUM) conducted on 22 October 2007 (4 months prior to separation), and documented “constant” wrist pain rated 5/10 with exacerbations by “pushing, pulling, or lifting any object [specifying 15 pound carrying limit].” The NARSUM physical exam recorded tenderness over the surgical site and grip strength of 4/5. The examiner referenced the occupational therapy ROM (above) performed a few days earlier.

A VA Compensation and Pension (C&P) examination was conducted on 15 January 2008 (a month prior to separation), and documented “constant, occurring three times a day” pain rated 7/10 with exacerbations “elicited by physical activity.” The VA physical exam specified the absence of tenderness, instability, or weakness at the wrist. A normal motor (strength) and sensory exam was recorded. The VA measured ROM was DF 70 degrees and PF 80 degrees (both normal). The VA examiner made note of decreased ROM at the left elbow (not addressed in Service evidence), with supination 30 degrees (normal 85) and pronation 80 degrees (normal).

The Board directed attention to its rating recommendation based on the above evidence. The PEB’s 10% rating analogous to 5003 (degenerative arthritis) was consistent with VASRD §4.71a criteria for the MEB ratable findings and ROM evidence (corroborated by the STR). The VA’s 10% wrist rating, citing the above C&P evidence, was under code 5213 (elbow/forearm code which confers 10% for supination ≤ 30 degrees). Members agreed that 5213 based rating was not appropriate (or advantageous in this case) for wrist rating; and, it is noted that an elbow injury or separate condition is not corroborated by service evidence, nor would it be within Board scope if it were. Given the absence of ankylosis (frozen joint), the only code available under VASRD §4.71a (other than analogous 5003 as employed by the PEB) which is applicable to this case is 5215 (wrist limitation of motion). The latter confers a maximum 10% rating and stipulates compensable thresholds for DF (15 degrees) and PF (0 degrees) not supported by the evidence. Even if painful motion (VASRD §4.59, not specifically in evidence) or functional loss (VASRD §4.40, equivocally supported by the evidence) were conceded to achieve a 10% rating under 5215, it offers no advantage over the PEB’s coding choice. 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131217, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record




XXXXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX , AR20150012443 (PD201302783)

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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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