RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXX	CASE: PD-2017-05618
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20020430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Finance Technician, medically separated for “status post (S/P) left four corner fusion and scaphoidectomy” with a disability rating of 20%.

CI CONTENTION: He was rated for his non-dominant hand, it also affects his dominant hand, the wrong operation was performed, subsequent operations were performed, and nerve damage was not factored into the rating. 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 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 - 20011220	VARD - 20020522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Left Four Corner Fusion and Scaphoidectomy	5299-
5214	20%	Residuals, Fracture, Left Wrist, With
Surgical Fusion, and Scaffold Lunate Disassociation	5299-
5214	20%	20020329	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

S/P Left Four Corner Fusion and Scaphoidectomy. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-handed CI’s left wrist condition began in October 2000 after he sustained a scapholunate disassociation with a DISI (dorsal intercalated segment instability) deformity injury while playing football as part of physical training. He underwent a left wrist four corner fusion (capitolunate-triquetral-hamate) with a scaphoid excision in June 2001 and underwent occupational therapy thereafter.

The 20 August 2001 MEB Limited Duty Board NARSUM examination, 8 months prior to separation, showed a roughly 0-30 degrees arch from neutral with 30 degrees of palmar flexion and no extension. At a clinic visit on 6 September 2001, the CI reported pain at the extremes of motion. Left wrist range of motion (ROM) was approximately dorsiflexion 8 degrees (normal 70), palmar flexion 60 degrees (normal 80), ulnar deviation 15 degrees (normal 45), and radial

deviation 8 degrees (normal 20). Pronation and supination were essentially equal to the right wrist, and he could make a composite fist with the left hand.

The 28 September 2001 MEB NARSUM examination, 7 months prior to separation, noted the complaint of severe decrease in left wrist ROM. Physical examination showed a well-healed left wrist scar with ROM measured in degrees as dorsiflexion 8, palmar flexion 6 [may have been a typo], ulnar deviation 14, and radial deviation 8). The left wrist had a 39 percent ROM compared with the contralateral wrist, which had ROM within normal limits. X-rays showed a well-matured wrist fusion with a plate in place. During the 26 October 2001 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported a history of left wrist dislocation and a four corner fusion 26 June 2001. Physical examination documentation showed “lacks ulnar/radial deviation and lacks extension of left wrist and decreased strength.” At an orthopedic clinic visit on 13 December 2001, ROM was from 5-10 degrees of dorsiflexion down to 60 or 70 degrees of palmar flexion. The CI was diffusely tender across the dorsum of the wrist without focal localization.

At the 29 March 2002 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported pain, weakness, stiffness, recurrent subluxation, swelling, inflammation, dislocation, locking, and lack of endurance of the left wrist. Physical examination showed no evidence of erythema, swelling, effusion, or increased warmth. There was tenderness and greatly reduced motion with dorsiflexion 0 degrees with pain on attempting to move. Palmar flexion was 0-30 degrees, radial deviation 0-5 degrees, and ulnar deviation 0-5 degrees, all with pain at the end of the motions. Left wrist ROM was limited by pain, but not by weakness, fatigue, lack of endurance, or incoordination. X-rays showed S/P-surgical changes with resection of the scaphoid along with a dorsal plate and multiple screws immobilizing the central and medial carpal bone structures without evidence of post procedural complications.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the status post left four corner fusion and scaphoidectomy condition 20%, analogously coded 5299-5214 (ankylosis of wrist). The VA based the rating on the STR and C&P examination, citing treatment in service, and evidence of painful and limited left wrist motion.

The panel noted both the PEB and the VA assigned a 20% rating for the non-dominant left wrist using code 5299-5214 for wrist ankylosis favorable in 20-30 degrees dorsiflexion. Examination in August 2001 showed a roughly 0-30 degrees arch from neutral with 30 degrees of palmar flexion and no extension, which is consistent with a 20% rating, but no higher, using code 5214 in the “absence of any other position, except favorable” or “unfavorable, in any degree of palmar flexion, or with ulnar or radial deviation.” Furthermore, pronation and supination were essentially equal to the right wrist, and the CI could make a composite fist with his left hand. Although dorsiflexion was less than 15 degrees, using code 5215 (wrist, limitation of motion) offers a 10% rating, thereby offering no benefit to the CI. 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 S/P left four corner fusion and scaphoidectomy condition.

BOARD FINDINGS: In the matter of the status post left four corner fusion and scaphoidectomy 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 TIIB NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB: 003
10 Sep 20

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

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 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.