RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03890 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050415

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty, Basic Marine, medically separated for “chronic radial sided left wrist pain” with a disability rating of 10%.

CI CONTENTION:  Review of all conditions requested. 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 - 20050225	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radial-Sided Left Wrist Pain	5099-5003	10%	No VA Examination Proximate to Separation in Evidence	
Healed Scaphoid Waist and Ulnar Styloid Fractures of the Left Wrist	CAT II		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	
	
ANALYSIS SUMMARY:

Left Wrist Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-handed CI’s left wrist condition began in August 2004 after being struck in the wrist during pugil stick training. X-rays revealed a fracture of the base of the ulnar styloid with  no  significant  displacement.  Treatment  consisted  of  a  long  arm  cast.   X-rays  dated  21 September 2004 showed interval healing of the ulnar styloid fracture. He underwent physical therapy with improvement of the pain which was present with flexion and extension. X-rays dated 5 October 2004 indicated a focal area of density in the waist (middle part) of the navicular

bone. He was then placed into a short arm thumb spica cast to treat the undetected scaphoid waist fracture. X-rays on 19 October 2004 showed a fracture at the base of the ulnar styloid without displacement and a fracture at the distal third of the scaphoid.   A bone scan on            28 October 2004 showed increased activity of the left wrist compatible with the history of a scaphoid fracture and hyperemic (increased blood flow) changes throughout the wrist. X-rays on 2 November 2004 showed a fracture of the distal third of the scaphoid; the remaining carpal bones and radiocarpal joint appeared normal. On 5 November 2004 a short arm spica cast was to be continued for another 6 weeks. On 22 November 2004 the CI reported his wrist was pain- free for 3 weeks. On 17 December 2004 X-rays showed interval healing of the left scaphoid fracture. At an orthopedic clinic visit on 14 January 2005, he reported he had been out of the cast for 3 weeks. He had some throbbing in the wrist; pain seemed to be the same; and he could not do pushups. On examination he lacked 5 degrees of flexion and 5 degrees of extension. He was tender along the first DC (dorsal compartment) and had mild pain with Finkelstein’s test (to determine de Quervain’s tendonitis). Fluoroscopic examination showed normal mechanics and the scaphoid was healed and non-mobile.

The 14 January 2005 MEB NARSUM examination, 3 months prior to separation, noted the complaint of chronic radial-sided pain in the wrist. Physical examination revealed flexion of the left wrist to 85 degrees (normal 80) and extension to 85 degrees (normal 70) with mild pain at the extremes of motion as compared with 90 degrees flexion and 90 degrees extension on the left. Ulnar and radial deviation of the wrist were equivalent, but there was mild discomfort at the extreme of ulnar deviation. He had mild tenderness along the first DC with the wrist in ulnar deviation, but not with the wrist in neutral, and he was mildly tender at the proximal pole of the scaphoid, but he was non-tender along the ulnar side of the wrist. There was mild pain with crepitus (grinding) with circumduction of the wrist and with the TFCC (triangular fibrocartilage complex) grind test (pain and clicking with ulnar deviation of the wrist). There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left wrist condition 10%, analogously coded 5099-5003 (degenerative arthritis). The PEB listed healed scaphoid waist and ulnar styloid fractures of the left wrist as related Category II diagnoses, which contribute to or are related to the Category I disability in this case. The panel concluded the Category II diagnoses were not separate conditions that could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).

The panel noted that the CI had neither wrist ankylosis (code 5214) nor wrist limitation of motion (code 5215). Additionally, there was no elbow impairment (code 5209), radius and ulna nonunion with a flail false joint (5210), ulna or radius impairment with nonunion or malunion (codes 5211 or 5212), or supination and pronation impairment (code 5213), and there were no impaired finger movements due to tendon tie-up or muscle or nerve injury. Therefore, a rating higher than the 10% assigned by the PEB using code 5099-5003 cannot be achieved. 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 chronic radial-sided left wrist condition.

BOARD FINDINGS:  In the matter of the chronic radial-sided 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.

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 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 18 Jul 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.