RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2016-01035
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20040413

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cryogenics Equipment Operator, medically separated for “S/P (status post) wrist injury with healing of the scaphoid but persistent scapholunate gap without frank dorsal intercalated instability” with a disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20031229	VARD - 20050216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Severe Wrist Injury…	5299-5212	20%	Residuals of Left Wrist Fracture, S/P Open Reduction Internal Fixation (ORIF)	5215	10%	20040823	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

S/P Severe Wrist Injury...  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s non-dominant left wrist condition began in April 2002 with a left perilunate (carpal bone in hand) wrist dislocation.  Radiographs showed a fracture/dislocation of the scaphoid and lunate carpal bones, with comminuted fragments.  The CI underwent surgery for open reduction, internal fixation and scapholunate reconstruction on 27 April 2002 with the surgical pins being removed on 28 June 2002.  The CI was referred to occupational hand therapy with improvement but continued to report wrist pain.  The wrist healed with a scapholunate gap without gross instability.  Another surgical procedure for limited fusion was discussed, but the CI declined.  

The 29 June 2003 MEB NARSUM examination, 9 months prior to separation, noted complaints of persistent wrist stiffness and discomfort.  The CI reported he was unable to perform duties required of him due to persistent pain with grip and grasp.  Push-ups, pull-ups, and field duties caused significant pain.  Physical examination showed tenderness to the scapholunate interval and pain with motion.  Wrist range of motion (ROM) showed dorsiflexion (DF) at 40 degrees (normal 70) and palmar flexion (PF) at 35 degrees (normal 80).  There was no evidence of scapholunate instability.  Grip strength (Jaymar grip strength dynamometer) was significantly decreased on the left compared to the right.  

At the 23 August 2004 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported occasional wrist and hand pain and loss of motion, aggravated by repetitive motion or lifting more than 25 pounds.  The CI was noted to be right-hand dominant.  Physical examination showed no deformity, swelling, or redness of the wrist.  There was no tenderness.  Wrist ROM showed DF at 31 degrees and PF at 54 degrees.  Motion was limited by pain and repetitive use by 25 percent.  Wrist X-rays showed widening of the scapholunate distance with post-surgical changes and a suture anchor present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist (non-dominant) condition 20%, analogously coded 5299-5212 (radius, impairment).  The VA rated the left wrist condition 10%, coded 5215 (wrist, limitation of motion), based on the C&P examination, citing limitation of motion and functional loss.  

There was no limitation of wrist DF “less than 15 degrees” or PF “limited in line with the forearm” which supported a rating under the diagnostic code for limitation of wrist motion (5215).   However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45).  The panel also considered rating the wrist injury analogous to a muscle injury due to the significant weakness of the left hand as a result of the wrist pain and limited motion documented in occupational therapy visits in the STR and at the MEB NARSUM examination.  Under 5307 (Group VII-which includes flexion of wrist and fingers as needed for grip strength) the panel agreed that the CI’s residual disability was not appropriately characterized as “moderately severe” for the next higher 20% rating.  

The panel considered other VASRD wrist and analogous codes but all were less applicable and/or not advantageous for rating.  There was therefore no higher rating than 10% supported with any applicable VASRD code.  However, the panel may not recommend a lower combined rating than that of the PEB and therefore no change to the PEB adjudication is recommended.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded 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 recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

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: