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AF | PDBR | CY2012 | PD2012 01422
Original file (PD2012 01422.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    BRANCH OF SERVICE: Army
CASE NUMBER: PD1201422   SEPARATION DATE: 20031021
BOARD DATE: 20130426


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard PFC/E-3 (92Y10/Unit Supply Specialist) on a temporary tour of active duty, medically separated for right residual pain, diminished sensation, and finger weakness status post (s/p) insect bite right (dominant hand). The CI sustained a presumed insect bite at a training exercise resulting in persistent pain, swelling, and weakness. The right hand residual pain, diminished sensation at site, and weakness of the index and long fingers s/p insect bite could not be adequately rehabilitated with treatment to meet the physical requirements of the CI’s Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the right hand pain and finger weakness as unfitting, rated 20%, with application of the US Army 40-501, chapter 3, paragraph 3-30j and Veterans Affairs Schedule for Rating Disabilities (VASRD) . The CI made no appeals and was medically separated with a 20% disability rating.
CI CONTENTION: "The course of my injury has remained undetermined, As time has gone on, my hand, elbow, shoulder have gotten worst."


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 conditions “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. 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 Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20030918
 VA (16 Mos Post-Separation) – All Effective Date 20031019**
Condition
 Code Rating Condition Code Rating Exam
S/P Insect Bite Rt (Dom) Hand w/Residual Pain, Diminished Sensation at Site & Weakness Of Fingers 5299-5223 20% Residuals Insect Bite & Cellulitis, Rt Hand w/Sensory Impairment, Hx of Pain Rt Elbow & Shoulder 8513 20%* 20050225
↓No Additional MEB/PEB Entries↓
 Not Service-Connected x 2
Combined: 20%
 Combined: 20%
* Voc rehab also granted .
** Also of note, the separation date per the VARD is 21 Oct 2003 but the compensation date is 19 Oct 2003.


ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-connected condition continues to burden him. It is a fact, however, that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. This role and authority is granted by Congress to the Department of Veterans Affairs (DVA). The DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate 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 utilizes DVA evidence proximate to separation in arriving at its recommendations; DoDI 6040.44 defines a 12 month interval for special consideration to post-separation evidence. The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES rating determinations for the disability existing at the time of separation. Post-separation evidence is probative only to the extent that it reasonably reflects the disability at the time of separation.

Right Hand Condition. The CI presented in January 2003 with complains of right dominant hand pain and swelling. He was presumed to have an insect bite with cellulitis and was treated with medications, occupational, and physical therapy. The CI subsequently developed numbness and decreased range-of-motion (ROM) of the right hand which progressed to pain in the right wrist, elbow, and shoulder. An orthopedic consultant diagnosed reflex sympathetic dystrophy (RSD), (currently called complex regional pain syndrome [CRPS]) however radiographs of the right upper extremity were normal and results of a bone scan and electromyogram (EMG) were not within the service treatment records (STRs). The narrative summary (NARSUM) notes that the CI reported pain and weakness in the right hand, wrist, elbow and shoulder. The CI wore a hand brace which did not relieve his symptoms and he reported persistent swelling of the right hand. The physical examination was significant for brown skin discoloration at the base of the thumb, index and middle fingers. There was decreased grip strength and pinprick sensation in the thumb, index, and little fingers.

The Board weighed three ROM evaluations, with documentation of additional ratable criteria, in arriving at its rating recommendation, as summarized in the chart below.

Right Hand (Dominant) Goniometric ROM
in degrees
 OT ~8 Mo. Pre-Sep
MEB ~3 Mo. Pre-Sep
 VA C&P ~16 Mo. Post-Sep
Index Finger Middle
(Long) Finger		 Finger s Finger s Finger s
MCP 0-90⁰
 0/60 0/60 Unknown Full ROM Full ROM
PIP 0-100⁰
 5/95 5/90 Unknown Full ROM Full ROM
DIP 0-70⁰
 10/65 5/70 Unknown Full ROM Full ROM
Comments
 Swelling, erythema, sensation intact Limited (Good) ROM; swelling, skin discoloration, decreased grip, decreased pinprick sensation, pain minimal and constant Swelling of the hand which increase d with motion, painful motion of the elbow and shoulder, increased elbow and shoulder weakness with repetitive use
§4.71a Rating
 20% 20% 20 %
§4.124a Rating (Nerve)
 Mild Neuralgia of the lower radicular group 8712 20% 8713 20% 2 0%

At the VA Compensation and Pension (C&P) exam 16 months after separation , the CI reported continued pain and swelling of the right hand wit h radiation of pain to the elbow and shoulder. The physical examination revealed minimal swelling of the right hand and wrist. There was increased swelling with motion. There was no tenderness to palpation or painful motion. The elbow and shoulder examination s demonstrated painful motion and increased weakness with repeated motion .

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA both rated the right (dominant) upper extremity condition at 20%. The PEB coded the right hand residual pain s/p insect bite with diminished sensation and weakness analogous to favorable ankylosis of two digits. The VA coded the residual right hand pain with sensory impairment and history of elbow and shoulder pain as mild incomplete paralysis of all the radicular nerve groups of the right upper extremity. The CI did have a diagnosis of RSD; however, there is no VASRD code for rating RSD. This pain syndrome is rated by analogy to neuralgia of the affected peripheral nerve distribution and would result in a disability rating similar to the VA rating. 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 right upper extremity pain 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 right hand residual pain s/p insect bite 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
Right hand residual pain s/p insect bite 5299-5223 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120801, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130010158 (PD201201422)

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 and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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