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AF | PDBR | CY2012 | PD2012 01702
Original file (PD2012 01702.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201702
BRANCH OF SERVICE: navy  BOARD DATE: 20130418
SEPARATION DATE: 20021101


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PO3/E-4 (MM3 4296/Machinist's Mate) medically separated for arthrofibrosis of the proximal interphalangeal and distal interphalangeal joint of the left middle, ring and small fingers. While stationed aboard ship, in July 2001, the CI was closing a battery box when the lid came down on her left hand causing a crush injury and near amputation of three fingers. She was brought emergently to Naval Hospital Bremerton where she underwent surgical reconstruction. Despite continued lengthy post-operative therapy, the condition could not be adequately rehabilitated to meet the physical requirements of her rating or satisfy physical fitness standards. She was placed on limited duty and referred for a Medical Evaluation Board (MEB). The MEB forwarded crushing left hand injury; status post (s/p) surgical treatment of near amputation of left middle, ring and small fingers; arthrofibrosis of the proximal interphalangeal joint of the left middle, ring and small fingers; and decreased left hand grip strength conditions to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB submitted no other conditions. The PEB adjudicated arthrofibrosis of the proximal interphalangeal and distal interphalangeal joint of the left middle, ring and small fingers as unfitting, rated 20%. The remaining conditions were determined to be category II , conditions that contributed to the unfitting condition. The CI made no appeals, and was medically separated with that disability rating.


CI CONTENTION: The CI attached a one page statement to her application which was reviewed by the Board and considered in its recommendations.


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 hand and finger conditions is addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 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 Board for Correction of Naval Records.


RATING COMPARISON :

Service IPEB – Dated 20020905
 VA - (~6 Mos. Pre –Separation)
Condition
 Code Rating Condition Code Rating Exam
Arthrofibrosis . . . . joints of left middle, ring & small fingers 5218 20% S/P Surgical Repair Crush Injury, Left Small, Ring & Middle Fingers 5218 20% 20020424
No Additional MEB/PEB Entries
 Other x 7 20020424
Combined: 20%
 Combined: 60%
Derived from VA Rating Decision (VA RD ) dated 200 21210 (most proximate to date of separation [ DOS ] ).

ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Arthrofibrosis Proximal and Distal Interphalangeal Joints Left Middle, Ring and Small Fingers Condition. The right hand dominant CI sustained a crushing injury in July 2001 when a battery box lid came down on the middle, ring and small fingers of the left hand. She underwent emergency reconstruction surgery and subsequently continued treatment with occupational/hand therapy. Despite 6 month of continued occupational therapy, the CI maintained decreased range-of-motion (ROM) and diffuse stiffness in the affected fingers as well as decreased grip of the left hand. The CI was not able to regain full functionality of her left hand (could not hold tools, dropped things) so MEB was initiated. The MEB narrative summary, orthopedic physical exam from 18 April 2002, almost 7 months prior to separation, noted a ROM for the middle finger at the proximal interphalangeal (PIP) joint of from 0 degrees (neutral) to 75 degrees (flexion), and at the distal interphalangeal (DIP) joint 45 degrees to 55 degrees (i.e. 45 degrees of lost extension with only 10 degrees of motion). For the ring finger, ROM at the PIP joint was from 10 degrees to 30 degrees, DIP was 45 to 45 degrees (no motion, fixed at 45 degrees of flexion). For the small finger, ROM at the PIP joint was 10-30 degrees, and the DIP joint was 20-30 degrees. As indicated there was loss of full extension of these fingers except for the middle finger and nearly no motion at the DIPs. There was decreased sensation of the injured fingers with hypersensitivity over the little and ring finger tips. Grip strength was decreased 50% for the left hand. At the VA Compensation and Pension (C&P) exam performed on 24 April 2002, 6 months prior to separation, the CI reported difficulties performing daily living activities like tying shoelaces, fasten buttons, picking up objects with the left hand. On examination, the CI was not able to make a tight fist. The distance between the tips of the injured fingers and the transverse palmar crease was: long (middle) finger 1.5 inches; ring finger 3 inches; and little finger 3 inches. The C&P examination recorded marked reduced ROM compared to the orthopedic examination the week before. The left middle finger had 34 degrees of extension lag with fixed deformity at the DIP joint and inability to flex the PIP joint and six degrees of flexion at the metacarpal phalangeal (MCP) joint. Prior examinations demonstrated more than 60 degrees of MCP flexion. The ring finger and a fixed deformity at the DIP joint with 15 degrees of extension lag with flexion at the PIP or DIP joints. The little finger had a deformity of the nail and 20 degrees of extension lag at the DIP joint with no flexion; PIP joint flexion was 48 degrees. X-ray exam was normal for both hands.

The Board directs attention to its rating recommendation based on the above evidence. Both the PEB and the VA rated the CI condition 20%, adjudicated under the same code 5218 unfavorable ankylosis of multiple digits citing limitation of motion and strength equivalent to ankylosis of long, ring and small fingers of the non-dominant hand. A higher rating is not possible under the code for favorable ankylosis of multiple digits, ankylosis of individual digits or limitation of motion of individual digits. Higher ratings require involvement of the thumb and index fingers. 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 arthrofibrosis , joints of left middle, ring & small fingers 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 arthrofibrosis of the proximal interphalangeal and distal interphalangeal joints of left middle, ring & small fingers 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
Arthrofibrosis of the Proximal Interphalangeal and Distal Interphalangeal Joints of Left Middle, Ring & Small Fingers 5218 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120714, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record




         xx
         Director of Operations
         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 31 May 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their 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:
- X former USMC
- X former USN
- X former USMC
- X former USN
- X former USN
- X former USN



                                                     
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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