Author: JOHN J. D'ORAZIO
Last saved by: julie.raveau
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxx	CASE:  PD1201913
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20130523
SEPARATION DATE:  20030601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve BUCN/E-3 (Construction man) medically separated for a left (non-dominant) wrist condition.  He suffered an initially occult scaphoid fracture during physical training while activated in 2001, ultimately requiring surgical intervention; followed by a repeated injuries and a second surgical intervention in 2002.  The condition could not be adequately rehabilitated to meet the requirements of his rating or physical fitness standards.  He was therefore placed on restricted duty and referred for a Medical Evaluation Board (MEB).  The wrist condition was forwarded (as the sole submission) to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The PEB adjudicated “left scaphoid fracture non-union, surgically treated” as unfitting, rated 10%, under criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and he was medically separated.

CI CONTENTION:  The application states simply, “Increased pain.  Only option is to fuse wrist.  Lose of motion.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left wrist condition is addressed below.  Any conditions or contention not requested in this application or otherwise outside the Board’s defined scope of review remain eligible for consideration by the Board for Correction of Naval Records.  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him but must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for later increased severity or complications of conditions for which they were separated.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:  
   
Service PEB – Dated 20030320 | VA (1 Mo. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Surgical Residuals, Left Wrist | 5215 | 10% | Surgical Residuals, Left Wrist | 5299-5215 | 10% | 20030702
No Additional MEB/PEB Entries | Other x 5 | 20030702
Combined:  10% | Combined:  10%
Derived from VA Rating Decision (VARD) dated 20030918.   

ANALYSIS SUMMARY:

Left Wrist Condition.  The CI’s initial injury was in November 2001.  Initial X-ray revealed no fracture.  He suffered continued pain, was treated conservatively over the next 4 months, and computed tomography (CT) then revealed a scaphoid fracture with non-union and deformity.  In March 2002 he underwent surgical reduction and fixation with follow-up hardware removal.  In September 2002 he was re-evaluated for continuing left wrist pain, complicated by another fall.  A repeat CT showed non-healing, and in October 2002 he underwent a second procedure.  This revealed severe degenerative changes and fragmentation of the scaphoid, necessitating excision and partial fusion (four corner fixation).  The final surgery and further attempt at rehabilitation did not restore adequate function for continued performance within the CI’s rating, although CT demonstrated good surgical results.  The final orthopedic addendum to the narrative summary noted continued pain interfering with specified activities and lifting.  The physical exam noted healed incisions, significantly decreased measured grip strength, and the following range-of-motion (ROM) measurements:  extension 15 degrees (normal 70 degrees), flexion 20 degrees (80 degrees), ulnar deviation 15 degrees (45 degrees), radial deviation 20 degrees (normal), and pronation/supination 60 degrees each (80 degrees).  At the VA Compensation and Pension (C&P) evaluation a month after separation, the CI reported pain and stiffness of the left wrist, aggravated by “movement,” pushing, pulling, and lifting.  The VA physical exam noted the surgical scar; and recorded ROM as flexion 25 degrees, extension 25 degrees, ulnar deviation 10 degrees, and radial deviation 5 degrees.  Painful motion was documented.

The Board directs attention to its rating recommendation based on the above evidence.  VASRD §4.71a provides only one code for limited motion at the wrist (5215), which confers only a 10% rating (major or minor, and regardless of the severity of ROM impairment).  Alternate analogous coding and rating under the criteria of 5003 (degenerative arthritis) can be supported but is not advantageous.  The only higher rating available for the wrist requires ankylosis (code 5214), and the evidence makes clear that significant joint excursion was retained in this case.  The ROM threshold for the 10% rating under 5215 is 15 degrees for extension, which was met by the MEB evidence.  The minimum 10% rating can also be justified in this case by either VASRD §4.59 (Painful motion) or §4.40 (Functional loss).  There is no VASRD compliant pathway to a rating higher than 10%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left wrist condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left wrist condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION | VASRD CODE | RATING
Scaphoid Non-Union and Surgical Residuals, Left Wrist | 5215 | 10%
COMBINED | 10%
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120930, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	xx
	President 
	Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW 
                                        BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
          (b) CORB ltr dtd 20 Aug 13

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandum, 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:

- former USN 
- former USMC
- former USMC
- former USMC
- former USMC
- former USN 
- former USMC
- former USN 

						  xx
	     					  Assistant General Counsel
						     (Manpower & Reserve Affairs)

PD1201913