RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01481
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141107
SEPARATION DATE:  20040930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-1 (9900/Basic Marine) medically separated for a wrist condition.  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The MEB forwarded midcarpal instability right wrist and right inguinal hernia to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated midcarpal instability right wrist as unfitting, rated at 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I should receive a 20% because I received injuries to both wrists while in Service.  Because of the injury to the right I was discharged.  I’m currently unable to work at my current place of employment due to my injury and awaiting further evaluations.  Asked to be put on light duty to be able to go to work so I can have a source of income.  Because of the nature of job there is no light duty work, so I can’t return unless I’m full duty, that’s if they keep my position.  And instructed not to do physical activities.  It makes it hard to find employment suiting those criteria.  In service I sustained both right wrist scapho-lunate dissociation with instability. Light wrist laxity. All x-rays taken of right wrist was compared to left wrist (left wrist has injury).”

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.  The Category III right inguinal hernia was not contended thus is not within the DoDI 6040.44 defined purview of the Board.  This, and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Naval Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him.  The Board also acknowledges the CI’s contention that suggests a higher rating should have been granted on the unfitting medical condition documented at the time of separation.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20040810	VA* - (8 yrs Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Midcarpal Instability Right Wrist	5299-5003	10%	Right Wrist Midcarpal Instability	5215	10%*	20130305	
Other x 1 (Not in Scope)	Other x 3	
Combined:  10%	Combined: 10%	
*Derived from VA Rating Decision (VARD) dated 20130319 (most proximate to date of separation (DOS)

ANALYSIS SUMMARY:

Midcarpal Instability Right Wrist.  During a medical consultation dated 12 May 2004, the CI reported “on and off” right wrist pain with audible “clicks” with motion.  Range-of-motion (ROM) of the right wrist was fully intact with only slight pain noted.  Right hand strength was normal; the right wrist bone was without tenderness or reports of instability.  Initial X-rays images of the wrist were reported as “normal” (radiological reports are omitted from STRs but are referenced) however, subsequent X-rays images revealed scaphoid-lunate dislocation (partial ligaments tear between wrist bones, permitting movement).  During an orthopedic hand evaluation dated 8 June 2004, the right wrist ROM, the examiner recorded a dorsal flexion of 50 degrees with pain and plantar flexion of 75 degrees (normal 70 degrees and 80 degrees respectively).  Audible clicking of the wrist on ulnar deviation (rotation of wrist toward the little finger) was also recorded.  The CI was diagnosis with “instability” of right wrist but the condition was not recommended for surgery.

The MEB’s report of medical history (DD Form 2807) dated 16 June 2004 did not indicate that the right wrist condition impaired the use of the CI’s right arm and hand.  On the MEB NARSUM evaluation dated 12 July 2004 (performed 3 months prior to separation); the examiner noted the CI’s right wrist ROM as “full” with painful motion.  The Watson’s Test (determines wrist dislocation) was negative and an audible “clunk” was noted on ulnar deviation to bilateral wrist.  Tenderness to palpation of the right wrist bone was present 

At the remote VA Compensation and Pension (C&P) evaluation dated 5 March 2013 (performed 9 years post separation), the CI made contradicting remarks in regards to the right wrist condition impacting his current occupation as a land surveyor.  On examination there were no reports of tenderness, edema (swelling), deformity or tissues/muscle atrophy (waste away, become emaciated) nor audible “popping” with motion.  The right wrist ROM was recorded as plantar flexion 65 degrees and dorsiflexion 60 degrees; both with pain.  While motor strength was normal.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the wrist condition at 10%, though utilizing different VASRD codes.  While the PEB used code 5099-5003, (analogous to arthritis,), citing painful motion, IAW §4.59 and the VA used code 5215, (wrist, limitation of motion), IAW §4.71a, the Board determined that no higher rating could be achieved under either code.  The Board unanimously agreed that the evidence in the record supported a rating of 10%, but no higher, for painful motion IAW §4.40 and §4.59.  The Board considered a rating under code 5215 (wrist, limitation of motion), however a 10% rating under this code requires a dorsiflexion of less than 15 degrees or a plantar flexion limited in-line with the forearm, thus, the Board agreed that the evidence in the record did not support any rating under this code.  The Board further considered a rating under code 5214 (wrist, ankylosis), but it was not supported by the evidence in record.  The Board agreed that the wrist condition had an element of intermittent, not fixed, positional instability and further noted there’s no applicable VASRD code for rating instability of the wrist.  
The Board unanimously agreed that the wrist instability was mild, intermittent and had little impact on wrist function when separated from painful motion.  The Board concluded that no rating higher than 10%, slight, could be recommended under this analogous code.  The Board found no other appropriate codes for rating consideration and was unable to recommend a rating higher than 10% for the right wrist condition.  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 right 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130920, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

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 8 Apr 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN