RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02858
BRANCH OF SERVICE:  MARINE CORPs                                           SEPARATION DATE:  20030331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2, Basic Marine, medically separated for “soft tissue injury to right wrist consistent with a low grade sprain” with a disability rating of 10%.

CI CONTENTION:  “My VA rating is 40% for my shoulder & wrist injury.”  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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:

SERVICE PEB - 20030204	VARD - 20030620	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Soft Tissue Injury to Right Wrist…Low Grade Sprain	5299-5003	10%	S/P Distal Radial Fracture, Right	5215	10%	20030130	
Right Grade II Acromioclavicular Separation	Not Unfitting	AC Joint Separation, Right	5299-5203	10%	20030130	
		Brachial Plexopathy…Associated with AC Joint Separation, Right	8599-8510	30%	20030130	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Soft Tissue Injury to Right Wrist Consistent with a Low Grade Sprain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left-hand dominant CI’s right wrist condition began in November 2002 after he tripped and fell.  A tentative diagnosis of an occult scaphoid fracture was made and he was placed in a long arm cast.  X-rays revealed no evidence of a scaphoid fracture, but there was a healed fracture of the distal radius.  A bone scan on 5 December 2002 demonstrated normal uptake in the scaphoid, but an increased uptake in the right distal radius near the physis (growth plate) location suggestive of a fracture versus a stress fracture.  Despite treatment, the condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “soft tissue injury, r/o scaphoid fracture, right wrist” for PEB adjudication.

At the MEB NARSUM examination dated 16 December 2002, 3 months prior to separation, the CI complained of right wrist pain.  On examination his right wrist demonstrated tenderness to palpation across the dorsal capsule between the scaphoid and the lunate.  The snuffbox was not tender to palpation nor was the pole of the scaphoid on the palmar side.  His wrist range of motion (ROM) was extension (dorsiflexion) of 50 degrees (normal 70) and flexion (palmar flexion) of 60 degrees (normal 80).  He had a mild amount of discomfort with both of the maneuvers dorsally (painful motion).  His finger ROMs were within normal limits bilaterally.  At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated 31 December 2002, 3 months prior to separation, the CI checked yes to the question of a painful shoulder, elbow or wrist and physical examination revealed numbness of the right distal radius area.

At the VA Compensation and Pension (C&P) examination on 30 January 2003, performed 2 months before separation, the CI reported his right wrist was injured while doing pugil sticks.  His right hand could go numb with some regularity and was painful at night.  The possible scaphoid fracture was found to be a tiny chip fracture of the distal right radius.  Physical examination of the right wrist revealed dorsiflexion of 80 degrees and palmar flexion of 85 degrees.  He was able to radially deviate 10 degrees (normal 20) and ulnar deviate 40 degrees (normal 45).  There was some tenderness of the distal radius to deep palpation.  Grip strength of his right hand was 2/5 versus a 5/5 on the left.  His grip strength increased to 4/5 when he brought his arms forward and locked the elbows in front of the chest.  X-rays of the right forearm on 30 January 2003 showed no significant radiographic residual from the prior fracture and the radius and ulna appeared intact. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right wrist condition 10%, analogously coded 5299-5003 (degenerative arthritis).  The VA also rated the right wrist condition 10%, coded 5215 (wrist, limitation of motion) based on the VA C&P examination 2 months before separation, citing grip strength 2/5 with slight painful limitation of motion.

Board members noted there was no report or evidence of wrist ankylosis to warrant a rating higher than the PEB’s 10% rating, nor was there nonunion of the radius with a flail false joint (code 5210) or radius impairment (code 5212) with nonunion in the lower half with false movement.  Additionally, there was no impairment or limitation of supination and pronation (code 5213) reported to justify a higher rating.  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 soft tissue injury to right wrist consistent with a low grade sprain condition.

Contended Conditions:  Right Grade II Acromioclavicular Separation.  The PEB listed the right grade II acromioclavicular separation condition as a category II condition, a condition that is related to the primary unfitting condition and contributes to the primary unfitting condition.  The Board’s first charge for this Navy PEB Category II condition is to assess whether it can be reasonably justified as separately unfitting for rating consideration.  Shortly after being placed in a right wrist cast, the CI was pushed from behind by a fellow recruit on 7 November 2002 and hit the floor with his cast, which aggravated an existing grade II AC separation that occurred as a result of a dislocated right shoulder 3 years earlier.  Treatment consisted of Tylenol #3 (a combination of Codeine (narcotic) and Acetaminophen (pain reliever)) and physical therapy.  On 13 November 2002 flexion of the right shoulder was 10 degrees (normal 180) and abduction was 45 degrees with reported pain of 8/10 (10 being the worst pain).  However, by 27 November 2002, abduction was 130 degrees and flexion was 160 degrees, while on 7 December 2002 abduction was 175 degrees and flexion was 170 degrees.  Shoulder muscle strength was 4/5.  The sports medicine examiner assessed the CI’s condition as a grade II AC separation with a rotator cuff tear (infraspinatus versus supraspinatus) and the CI reported 25% improvement on 11 December 2002.  Despite treatment, the right shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “right grade II acromioclavicular separation” for PEB adjudication.

At the MEB NARSUM examination dated 16 December 2002, 3 months prior to separation, the CI complained of right shoulder pain and used non-steroidal anti-inflammatory drugs as needed and underwent physical therapy.  On examination his right shoulder demonstrated no atrophy and he had 5/5 power bilaterally.  The ROM measurements were flexion to 95 degrees, abduction to 90 degrees, and internal rotation to T10.  He was tender to palpation only over his AC joint.

At the VA C&P examination dated 30 January 2003, 2 months prior to separation, the CI reported intermittent weakness of the right arm, ongoing pain in the right shoulder, and a variety of strength capabilities at different times of the day and night.  The examiner noted that the CI was “not being specifically treated for a brachial plexus palsy, but strengthening exercises have been worked on” and he did have a right AC grade II joint separation that was felt to be somewhat unstable.  Examination of the right shoulder showed forward flexion 0-180 degrees and abduction 0-180 degrees with significant discomfort between 110 and 160 degrees.  External rotation was painful past 40 degrees.  Palpation of the right shoulder, brachial plexus, and the neck area revealed marked spasm over the trapezius muscle, marked tenderness over the right brachial plexus, and tenderness of the right AC joint.  With any military brace type activity of his right shoulder, his right arm went numb and became weak.  However, nerve conduction studies were not requested.  X-rays showed productive change at the inferior right acromial margin.  The examiner opined that the brachial plexopathy, which is not in the scope of review, should improve within a year.

There was performance-based evidence from the record that the right grade II acromioclavicular separation significantly interfered with satisfactory duty performance at separation.  Members agreed that the Category II right grade II acromioclavicular condition was reasonably justified as separately unfitting based on the findings noted above.  After due deliberation, conceding reasonable doubt it is appropriately coded 5203 (clavicle or scapula impairment-nonunion without loose movement) and meets the VASRD §4.71a criteria for a 10% rating.  There was no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula impairment).

BOARD FINDINGS:  In the matter of the soft tissue injury to the right wrist consistent with a low grade sprain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5003 IAW VASRD §4.71a.  In the matter of the Category II right grade II acromioclavicular separation condition, the Board unanimously agrees that it was separately unfitting and unanimously recommends a disability rating of 10%, coded 5203 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Soft Tissue Injury to the Right Wrist Consistent with a Low Grade Sprain	5299-5003	10%	
Right Grade II Acromioclavicular Separation	5203	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND 
 		  DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:   (a) DoDI 6040.44
       (b) PDBR ltr dtd 24 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX    
       (c) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
       (d) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
       (e) PDBR ltr dtd 27 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
       (f) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
       (g) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a.  XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     b.  XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c.  XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d.  XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10 percent) effective date of discharge.

     e.  XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge.

     f.  XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.