RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	  	CASE:  PD-2014-03435
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20021231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Marine, medically separated for “triangular fibrocartilage complex tear” with a disability rating of 10%.   

CI CONTENTION:  The CI contends for conditions not identified by either the Medical Evaluation Board or Physical Evaluation Board.  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 - 20021104	VARD - 20030630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Triangular Fibrocartilage Complex Tear	5299-5003	10%	Right Wrist Injury …	5271	0%	20030507	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Triangular Fibrocartilage Complex Tear Condition (Right Hand Dominant).  The service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a wrist injury in February 2002 that was reinjured while using crutches for a stress fracture of the foot.  Radiographic imaging in June 2002 documented a tear in the ligaments of the wrist (triangular fibrocartilage complex [TFCC]).  At a sports medicine visit in June 2002, the physical examination showed tenderness of the wrist bilaterally and pain with flexion, extension, and ulnar and radial deviation, and full range of motion.  Grip strength was to 15 pounds on the right, compared to 45 pounds on the left.  At an orthopedic visit in July 2002, the physical examination showed full pronation and supination, 70 degrees each of dorsiflexion (normal 70) and palmar flexion (normal 80).  Despite treatment, the right wrist condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.  The MEB forwarded “sprain and strain of unspecified site of wrist” for PEB adjudication.  

On the MEB DD Form 2808 dated 30 July 2002 (5 months pre-separation), the examiner documented decreased strength and decreased range of motion of flexion, extension, and lateral movements.  The MEB NARSUM examination was performed on 15 August 2002 (4 months pre-separation).  The CI declined the recommended surgery.  The physical examination showed tender to palpation, with dorsiflexion and palmar flexion to 70 degrees each (normal 70 and 80, respectively).  Ulnar and radial deviation was to 45 degrees and 20 degrees respectively (both normal).  Pronation and supination were both normal at 80 degrees each.  An Orthopedic addendum dated 23 August 2002, 4 month before separation, documented dorsiflexion and palmar flexion of 70 degrees each with pain, with full pronation and supination, and tenderness over the TFCC area.  

At the VA Compensation and Pension (C&P) examination dated 7 May 2003 (4 months post-separation), the CI reported pain with repetitive movements and when picking up objects, typing or lifting.  Physical examination showed dorsiflexion of 40 degrees, plantar flexion of 62 degrees, ulnar deviation of 42 degrees, and normal radial deviation.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the condition 10% for the “triangular fibrocartilage complex tear,” analogously coded 5299-5003 (degenerative arthritis).  The VA rated the right wrist condition 0% coded 5215 (wrist, limitation of motion), based on the VA C&P examination 4 months  after separation, citing that dorsiflexion of the wrist was not less than 15 degrees, or for palmar flexion limited in line with the forearm.

There was evidence of painful motion and radiographic evidence of cartilage abnormalities IAW §4.59 in support of a 10% rating (5299-5003) for the residuals of the wrist trauma.  Rating under code 5215 was of no advantage as dorsiflexion and palmar flexion were normal on all preseparation examinations and it only provides a maximum 10% rating.  There was no documentation of ankylosis for a higher rating under 5214.  There was no evidence of nonunion for a higher rating under 5211 or 5212.  There was no evidence of less than normal supination or pronation for a higher rating under 5213.  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:  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.  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 20140706, 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 Aug 16

      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:

		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						XXXXXXXXXXXXXXXXXXXX
	     					Assistant General Counsel
	                                                            (Manpower & Reserve Affairs)