RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02361
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20051031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantry Assaultman and Security Force Guard, medically separated  for “right fifth carpometacarpal fracture dislocation,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The 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 - 20050822	VARD - 20060424	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right 5th Carpometacarpal Fracture Dislocation	5299-5003	10%	Status Post Right 5th Carpometacarpal Fracture Dislocation	5230	0%	20060301	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Right Fifth Carpometacarpal (CMC) Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right hand (dominant) fracture occurred in February 2004 during training which resulted in surgical fixation on 03 March 2004.  Following that he underwent uneventful hardware removal after the fracture had healed.  The CI continued to have tenderness over the base of the fifth metacarpal which worsened with heavy grip and squeezing activities.  Despite a long period of occupational therapy and pain medications the CI’s right hand pain condition could not be resolved.  

The 26 July 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of tenderness over the base of the 5th metacarpal (MC) that was made worse with heavy gripping activities and with squeezing.  Physical examination showed full range of motion (ROM) of all fingers.  There was tenderness to palpation at the base of the 5th metacarpal.  Grip strength using the Jamar handgrip dynamometer in positions 1 through 5 of the device were recorded as right: 35, 45, 45, 55 and 45.  On the left they were recorded as 55, 90, 75, 65 and 50.  A fluoroscopic evaluation of the right 5th CMC joint demonstrated a 1 mm step-off of the base of the 5th MC at the articular surface.  

At the 01 March 2006 VA Compensation and Pension (C&P) General evaluation, 4 months after separation, the CI reported that he had constant pain, pain with palpation of his hand and had difficulty picking up heavy objects.  Physical examination showed normal range of motion of the right wrist.  With repeat range of motion of his right wrist the CI complained of pain and fatigue at his 5th MC side.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right fifth CMC condition 10%, coded 5299-5003 (analogous to degenerative arthritis).  The VA rated the right fifth CMC condition 0%, coded 5230 (ring or little finger, limitation of motion), citing normal range of motion of the finger.  The panel noted that the CMC joint is at the wrist and not the finger and so focused its analysis on that region.  There was no ankylosing of the wrist or limitation of motion to justify rating under the respective codes (5214, 5212).  There was evidence of painful or limited motion with functional loss supporting a minimal rating (based on §4.59, §4.40 and §4.45).  Panel members agreed there were no other applicable codes.  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 right fifth carpometacarpal fracture dislocation condition.  

BOARD FINDINGS:  In the matter of the right fifth carpometacarpal fracture dislocation condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150707, 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

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

		
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