DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD DC 20374-5023

IN REPLY REFER TO

1850
CORB:003
9 Jun 20

From: Director, Secretary of the Navy Council of Review Boards To:    

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:   (a) DoDI 6040.44
(b) PDBR ltr of 27 Sep 18

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.

2.	On 4 June 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary’s determination, which represents final action in your case by the Department of the Navy, has been forwarded to the office of the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-00577
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050817

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Automotive Maintenance Technician, medically separated for “status post (s/p) open reduction and internal fixation [ORIF] for right mandibular symphysis fracture and s/p closed reduction for right and left subcondylar fractures of the mandible” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made. 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 - 20050405	VARD - 20060217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P ORIF for Right Mandibular Symphysis Fracture and S/P Closed Reduction for Right and Left Subcondylar Fractures of the Mandible	9905	10%	S/P Mandibular Fractures Times Three	9905	20%	20060201	
S/P Total Restoration of All Teeth Due to Fractured Teeth	Cat II	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

S/P Mandibular Fractures. According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his jaw in May 2002 following a syncopal incident during recruit training.  He had multiple fractured and displaced teeth, and mandibular symphysis  and

bilateral subcondylar fractures, which were surgically repaired in May 2002 with subsequent dental restorations. Conservative therapy including a soft diet, medications, and use of temporomandibular joint (TMJ) splints, did not adequately relieve the mandibular pain and he was not considered a candidate for oral surgery.

On 9 December 2004, a memorandum from the CI’s treating dentist indicated he was not responding to traditional therapy, and in conjunction with an oral surgeon, suggested orthodontics with the possibility of future jaw surgery for a bite correction. Another memorandum from the same provider referred to an 8 March 2005 visit, 5 months prior to separation, that documented inter-incisal ROM (between upper and lower front teeth) of 35mm (normal 45-50) with lateral excursions of 8mm right and 7mm left (normal 10-12).

The 14 December 2004 MEB NARSUM examination, 8 months before separation, noted CI complaints of mandibular pain with talking, chewing, lifting over 30 pounds, or running. The provider documented bilateral mandibular tenderness and numbness over the mid aspect of the lower lip, as well as TMJ tenderness with decreased range of motion (ROM). The CI was able to bite down on a tongue depressor without difficulty and TMJ splints were in place. Panorex imaging showed old bilateral condylar fractures with satisfactory teeth alignment and spacing.

At the 1 February 2006 VA Compensation and Pension (C&P) dental examination, 6 months after separation, the CI reported jaw pain and right temporal headaches associated with cold weather and chewing. History included surgical repair of mandibular and condylar fractures, loss of a tooth, and dental treatment with 12 crowns. Physical examination showed tooth #19 missing, limitation of inter-incisal ROM of 30mm and lateral excursion of 5mm. There was no bone loss of the mandible, maxilla, or hard palate.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the s/p mandibular fractures condition 10%, coded 9905 (temporomandibular articulation, limited motion), and listed “s/p total restoration of all teeth due to fractured teeth” as a related Category II (contributes to the primary unfitting condition but not separately unfitting) condition. The panel deliberated and agreed there was no loss of masticatory surface that could not be restored by suitable prosthesis; and therefore, there was no separately compensable limitation for the dental restorations. The VA rated the s/p mandibular fractures condition 20%, also coded 9905, based on the C&P examination, citing limited inter-incisal movement between 21 and 30mm. Members considered the entirety of the record and probative value of the measurements from the STR and VA examinations. The STR measurements were closer to separation and supported a 10% rating under code 9905, but were not accompanied by an examination report. The CI had ongoing bite difficulties and functional loss, and the panel adjudged that the VA examination was more representative of the disability picture portrayed in the remainder of the record, and thus carried a higher probative value for rating. The panel agreed that a 20% rating was justified for limitation of inter-incisal ROM of between 21 and 30mm. There was no evidence of bony loss, malunion, or severe displacement of the mandible for any higher rating under other VASRD analogous codes. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the mandibular fractures condition, coded 9905.

BOARD FINDINGS: In the matter of the status post mandibular fractures condition, the panel recommends a disability rating of 20%, coded 9905 IAW VASRD §4.150. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:
CONDITION	VASRD CODE	PERMANENT RATING	
S/P Open Reduction and Internal Fixation for Right Mandibular Symphysis Fracture and S/P Closed Reduction for Right and Left Subcondylar Fractures of the Mandible	
9905	
20%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170215, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record