RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201760 SEPARATION DATE: 20020918 BOARD DATE: 20130123 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B/Infantry), medically separated for chronic painful right thumb joint. The CI injured his right thumb in hand-to-hand combat training in September 2001. After 4 months of occupational therapy, the CI did not improve and the right thumb joint condition could not be adequately rehabilitated for him to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). Healing (left) ankle fracture and benign electrocardiogram (EKG) findings of (right) ventricular conduction delay, identified in the rating chart below, were also identified and forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated the chronic painful right thumb joint condition as unfitting, rated 0% with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with a 0% disability rating. CI CONTENTION: “Continued chronic discomfort in right knee after performed surgery. Also continued chronic discomfort in right thumb. Surgery was performed on my right knee for a torn meniscus that had been previously misdiagnosed, after surgery I had chronic discomfort and @ 14cc of fluid was drained from the back of my knee, I still experience chronic discomfort when running or walking long distances and swelling still occurs in the back of my knee. It is very painful to touch the swollen area or even put ice on it. My right thumb gets stiff and hard to hold items in my right hand. Always aches, sometimes painful to move.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The chronic painful right thumb condition as requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below. The not unfitting healing left ankle fracture and EKG findings are not requested and will thus not be discussed. The right knee condition requested for consideration and the remaining conditions rated by the VA at separation and listed on the DD Form 294 are not within the Board’s purview. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for the Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20020805 VA (At Separation) – All Effective Date 20020919 Condition Code Rating Condition Code Rating Exam Chronic Painful Right Thumb Joint 5099-5003 0% Right Thumb, Posttraumatic Ulnar Collateral Ligament Surgical Repair 5228 0% 20020910 Healing (Left) Ankle Fracture Not Unfitting Left Ankle Distal Tibia Linear Fracture… 5271 10% 20020910 Benign Electrocardiogram Findings of (Right) Ventricular Conduction Delay Not Unfitting Asymptomatic Right Bundle Branch Block, Right Ventricular Conduction Delay… 7005 NSC 20020910 .No Additional MEB/PEB Entries. Right Knee Retropatellar Pain Syndrome 5099-5024 10% 20020910 Not Service-Connected x 1 20020910 Combined: 0% Combined: 20% ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However, the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation. Chronic Painful Right Thumb Joint Condition. The CI suffered a dislocation of his right (dominant) thumb with rupture of the ulnar-collateral ligament in 2001 (the so called gamekeeper’s thumb). This was successfully repaired in October 2001 with a resultant stable hand and thumb condition. Despite rehabilitation, intermittent, persistent pain developed at the surgical site. At the MEB narrative summary (NARSUM) exam, 18 July 2002, 2 months before separation, the CI reported reduced grip strength secondary to pain without instability, numbness, tingling or radicular pain in the hand. On physical exam, minimal tenderness was present at the base on the right thumb. The thumb joint was stable and the surgical repair intact. Range-of-motion (ROM) at the thumb joint was normal with full opposition of the thumb to the base of the fifth digit. Pinch and grip strength were decreased in the right hand compared to the left secondary to pain. At the VA Compensation and Pension (C&P) exam, 19 September 2002, a month before separation, CI noted pain with gripping. On examination, ROM at the thumb was normal, the surgical repair intact, and the thumb joint stable. Motor strength at the thumb was slightly reduced to 4/5. The Board directs attention to its rating recommendation based on the above evidence. The Board noted the CI to be right hand dominant. The PEB and VA both rated the condition 0% using different codes. The PEB rated using the Army pain policy noting the pain to be moderate and occasional. The VA rated under code 5228, thumb, limitation of motion, citing normal ROM. A rating of 10% would require a gap of one to two inches on opposition, not supported by the record in evidence. The Board unanimously agreed that the thumb after repair was stable with no motor, sensory or joint dysfunction. The Board agreed that the thumb was non compensable under motion codes 5224 and 5228. The Board noted the decreased grip and pinch secondary to pain and agreed that §4.59 was applicable and supported a disability rating of 10%. The Board found no pathway to higher rating under any applicable VASRD code. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the thumb 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. As discussed above, PEB reliance on the USAPDA pain policy for rating thumb was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the thumb condition, the Board unanimously recommends a disability rating of 10%, coded 5010-5003 IAW VASRD §4.59. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation: UNFITTING CONDITION VASRD CODE RATING Painful Right Thumb Joint 5010-5003 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120929, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXXXXX, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXX, AR20130006091 (PD201201760) 1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl XXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)