RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01189
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20040515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Administrative Clerk, medically separated for “status post left wrist trans-scaphoid perilunate fractures/dislocation,” with a disability rating of 10%.  

CI CONTENTION:  “To this day I have not recovered full mobility of hand/wrist, strength, and have pain from time to time similar to arthritis.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20040325	VARD - 20151020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Left Wrist Transscaphoid Perilunate Fracture/Dislocation	5215	10%	Residuals, Left Wrist Fracture and Residual Scar	5215	10%	20150831	
Status Post Pin Removal, Left Wrist	Category 2	Arthritis Due to Trauma	5010	NSC	20150831	
Status Post Open Reduction Internal Fixation, Left Wrist Transscaphoid Perilunate Fracture/Dislocation	Category 2	Left Hand and Fingers	5228	Deferred	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Status Post Left Wrist Transscaphoid Perilunate Fracture/Dislocation (With Category 2 Conditions).  The CI was right-handed.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left wrist condition began in July 2003 after he fell approximately 6 feet off of a ladder.  The CI underwent open reduction and internal fixation surgery in July 2003 to repair the complex left wrist fracture/dislocation, including an open carpal tunnel release to relieve a median nerve neuropathy.  The CI developed stiffness around his wrist and had slow progress to regain strength and mobility thru Occupational Therapy.  He was unable to return to duty and the MEB forwarded “status post left wrist transscaphoid perilunate fracture/dislocation,” “status post open reduction internal fixation, left wrist transscaphoid perilunate fracture/dislocation,” and “status post pin removal, left wrist” for PEB adjudication.  

The MEB NARSUM examination on 30 December 2003, 5 months prior to separation, noted complaints of marked loss of range of motion (ROM) of the wrist and grip strength weakness.  He was using intermittent splinting and taking no medications.  Physical exam showed minimal edema about the wrist with no signs of reflex sympathetic dystrophy.  There was no tenderness to palpation of the wrist and there was 5/5 strength in all digits, thumb flexors and extensors, as well as wrist flexors and extensors; however, measured grip strength on the left (non-dominant) was 8/14/11 kg compared to 25/28/22 kg on the right.  Wrist ROM was flexion of 45 degrees (normal 80), extension of 45 degrees (normal 70) with no ulnar or radial deviation.  He was able to oppose his thumb to the base of the small finger and was able to approximate this fingertips within a half centimeter of the distal palmar crease.  Light touch sensation was intact.  X-rays documented hardware in place, the scaphoid predominately healed, and other post-surgical findings, with no signs of infection.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 6 February 2004, 3 months prior to separation, the CI reported left wrist pain and weakness with inability to type or do “push/pulls.”  Physical examination showed left wrist significantly decreased ROM.  

At the 31 August 2015 VA Compensation and Pension (C&P) evaluation, performed 11 years after separation, the CI reported dysesthesias / hypoesthesia involving the left hand fingers, weakness of the digits with decreased ability to flex and extend at the wrist as well as the digits.  He had intermittent hand pain and decreased mobility, with inability to type.  Physical exam showed painful ROM of the wrist with flexion of 45 degrees (normal 80), extension of 55 degrees (normal 70) with ulnar deviation of 25 degrees (normal 45) and radial deviation of 5 degrees (normal 20).  There was 4/5 muscle weakness on left wrist flexion and extension without muscle atrophy.  Surgical scars were well healed and non-tender.  X-rays showed scaphoid hardware in place without complication, disuse osteoporosis with sparing of the proximal pole of the scaphoid, which was consistent with avascular necrosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the status post left wrist transscaphoid perilunate fracture/dislocation condition 10%, coded 5215 (wrist, limitation of motion).  The Navy PEB also listed “status post pin removal, left wrist” and “status post open reduction internal fixation, left wrist transscaphoid perilunate fracture/dislocation” as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from these conditions were properly subsumed under the overall rating for the “status post left wrist transscaphoid perilunate fracture/dislocation” IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the left wrist condition 10% coded 5215 (wrist, limitation of motion), based on the VA C&P examination 11 years after separation, citing painful motion of the wrist.  The VARD deferred a rating on the left hand and fingers with no subsequent rating in evidence.  

The 10% awarded by the PEB and the VA is the highest rating available under code 5215 for wrist limitation of motion.  There was no ankylosis of the wrist (immobile/frozen wrist) for any higher rating under code 5214 (wrist ankylosis), and no ratable limitations of the digits or thumb was documented.  There was no documented peripheral nerve disability or muscle injury for any pathway to any rating higher than a 10% rating.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left wrist condition.  

BOARD FINDINGS:  In the matter of the left wrist condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150611, w/attachments
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

      In accordance with reference (a), I have reviewed the cases listed below and 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN