RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-04318
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20030430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Field Radio Operator) medically separated for a left wrist condition.  The left wrist condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  “Left scaphoid nonunion status-post surgical treatment” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  “Proximal phalanx fracture right middle finger, healed” was also submitted by the MEB.  The Informal PEB adjudicated “left scaphoid fracture with nonunion and avascular necrosis of the proximal pole” as unfitting, rated 20%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  “Proximal phalanx fracture of the right middle finger” was determined to be Category III (not separately unfitting and does not contribute to the unfitting condition).  The CI made no appeals and was medically separated.  

CI CONTENTION:  His conditions continue to worsen and negatively impact his daily activities.  He was not evaluated for neck and feet conditions.  His complete submission is at Exhibit A.  

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 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:  

IPEB - Dated 20030306	VA* - (~1 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Scaphoid Fracture with Nonunion and Avascular Necrosis of the Proximal Pole	5299-5212	20%	Residuals, Post-Operative Left Scaphoid Fracture	5299-5215	10%	20030414	
			Scar, Left Wrist	7805	0%	20030414	
Proximal Phalanx Fracture of the Right Middle Finger	Cat III	Residuals, Fracture Right Third Finger	5299-5229	0%	20030414	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7	
RATING:  20%	COMBINED RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20030529 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Left Scaphoid Fracture.  The CI was right hand dominant.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s left wrist condition began in November 2001 after a traumatic fracture of the left wrist scaphoid bone.  The fracture did not heal following conservative therapy and surgery was performed on 22 April 2002 (open reduction internal fixation with a bone graft from the hip).  The CI had continued pain on motion of his wrist.  At the MEB NARSUM exam on 29 January 2003, 3 months prior to separation, the CI reported continued left wrist pain with certain motions.  Radiographs documented a persistent nonunion of the scaphoid bone.  The MEB physical exam showed painful wrist motion less than the opposite side and weakened grip strength of approximately 50% of the dominate right side.  

At the VA Compensation and Pension (C&P) examination on 14 April 2003, performed less than 1 month before separation, the CI reported decreased and painful wrist motion with a 50% diminished grip.  Physical exam showed full painless wrist motion with a grip about 60% of the other (dominant) side.  The surgical scar was well healed.  

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Left Wrist ROM
(Degrees)	PCC ~3 Mo. Pre-Sep	MEB ~3 Mo. Pre-Sep	VA C&P ~1 Mo. Pre-Sep	
Dorsiflexion (70 Normal)	0-70	70	0-70	
Palmar Flexion (80)	0-45	75	0-80	
Ulnar Deviation (45)	0-15	35	0-45	
Radial Deviation (20)	0-10	15	0-20	
Comment	Painful motion; tender	Discomfort; decreased grip strength	No pain; decreased grip strength; DeLuca negative	
§4.71a Rating	10% (PEB 20%)	10% (PEB 20%)	0%-10% (VA 10%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 20%, analogously coded 5212 (impairment of radius-non-union in upper half).  The VA rated the left wrist condition 10%, analogously coded 5215 (limitation of wrist motion), citing full ROM with decreased grip strength and non or malunion of the navicular fracture.  The VA also rated the wrist scar 0%, coded 7805 (other scars).  Any contribution from the non-tender wrist scar was considered in rating the unfitting left wrist condition.  The weakened grip strength (beyond that expected of a non-dominant hand) and painful limited motion were considered by the Board.  There was not sufficient evidence of ankylosis of the wrist (frozen joint) or limitation of use of the hand to warrant any rating higher than that awarded by the PEB.  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.  

Contended PEB Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that the right middle finger fracture was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The right middle finger was not profiled or implicated in the NMA/commander’s statement and was not listed on any LIMDU or duty restriction.  The CI fractured his right middle finger proximate phalanx and had a closed reduction and pin fixation in November 2002 (pins removed December 2002).  He had occupational therapy and per the NARSUM had no functional complaints at the time of the MEB.  The pre-separation VA exam documented slight swelling at the prior fracture area with full finger ROM and normal right hand grip strength.  There was no performance based evidence from the record that the right middle finger significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended right finger fracture and so no additional disability rating is recommended.  

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.  In the matter of the contended right finger condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 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 21 Jan 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:

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