RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01185
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150521
Separation Date:  20081129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Loadmaster/Aerial Refueling Observer) medically separated for a fracture of his right scaphoid.  The wrist condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for an Medical Evaluation Board (MEB).  The wrist condition was listed by the MEB; however, seven other conditions were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The Informal PEB adjudicated fracture, right scaphoid, with nonunion as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category III conditions (conditions that are not separately unfitting and do not contribute to the unfitting condition).  The CI appealed to the Formal PEB, but withdrew his appeal and was medically separated.

CI CONTENTION:  “The long term effects of my disability still cause pain and have cost me employment.”

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 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:

Service IPEB – Dated 20080623	VA* - (4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fracture, Right Scaphoid, with Nonunion	5215	10%	Residuals, Right Carpal Navicular Fracture	5299-5215	10%	20090318	
Other MEB/PEB Conditions x 6 (Not In Scope)	Other x 8	20090318	
RATING:  10%	Combined:  60%	
*Derived from VA Rating Decision (VARD) dated 20100309 (most proximate to date of separation)

ANALYSIS SUMMARY:

Fracture, Right Scaphoid, with Nonunion Condition.  The CI is right hand dominant.  He was in a motor vehicle accident on 3 April 2007 and sustained numerous orthopedic injuries which required emergent care.  Due to the complexity of his orthopedic injuries, the right wrist pain was not realized until 29 October 2007.  The CI complained of pain in his right wrist associated with use during a neuropsychological evaluation.  The CI again noted daily right wrist at moderate pain level 4/10 at a mental health exam  The MEB narrative summary (NARSUM) exam 8 months prior to separation documented stiffness and pain in the right wrist.  The NARSUM physical exam findings are summarized in the chart below.  The medical provider noted that the pain in the right wrist was a navicular bone fracture.  The VA Compensation and Pension exam 4 months after separation documented that the CI had pain with activities that required dorsiflexion of the wrist such as throwing a ball or doing push-ups.  A right wrist X-ray showed an old fracture of the navicular bone and a knot on the lateral distal aspect of the navicular bone.

There were 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 Wrist ROM (Degrees)	MEB
~8 Mo. Pre-Sep	PT
~4 1/2 Mo. Pre-Sep	VA C&P 
~4 1/2 Mo. Post-Sep	
Dorsiflexion (70 Normal)	15	40	45	
Palmar Flexion (80)	25	90	70	
Ulnar Deviation (45)	--	30	45	
Radial Deviation (20)	--	10	20	
Comment:  Right Hand Dominant	Pos. tenderness to palpation	Pos. painful motion	Pos. tenderness to palpation & painful motion	
§4.71a Rating	10% (PEB 10%)	10%	10% (VA 10%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the fracture, right scaphoid, with nonunion condition as 5215 (limitation of wrist motion) and rated at 10%, palmar flexion limited in line with forearm.  The VA coded the residuals, right carpal navicular fracture with analogous code 5299-5215 also rated at 10%.  Both the MEB and VA examiners documented limited right wrist dorsiflexion and palmar flexion ROM that are non-compensable.  The MEB ROM value of 15 degrees dorsiflexion was right at the 10% level of compensability IAW VASRD code 5215.  There was also adequate evidence of painful motion which is also compensable under code 5003 (degenerative arthritis).  The Board considered application of VASRD code 5213 (impairment of supination and pronation); however, the decrease in ROM did not reach compensable levels.  There is no appropriate coding/rating scheme that would be greater 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 fracture, right scaphoid, with nonunion 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 scaphoid fracture with nonunion 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 20140304, 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 20 Aug 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:

- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN