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AF | PDBR | CY2012 | PD2012 01761
Original file (PD2012 01761.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201761
BRANCH OF SERVICE: Army  BOARD DATE: 20130417
SEPARATION DATE: 20010930


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (63B/Wheel Vehicle Mechanic) medically separated for right hand pain. This pain started in 1997 when she injured her right hand in a fall during a recreational football game. The hand condition could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty (MOS) or physical fitness standards so the CI was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The hand condition, characterized as “Complex regional pain syndrome not sympathetically maintained”, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated the hand condition as unfitting and rated 20%. The CI made no appeals and was medically separated.


CI CONTENTION: “Disability (RSD) to Right hand (dominate hand) led to me being rendered as no longer fit for the military. I feel that my initial rating was unfairly determined from someone poor write up and/or inaccurate reported information. I arrived at this conclusion because after later going to an appeal hearing I was able to produce examination document(S) that contradict what the doctor was saying in her write up are weren't viewed during the decision process. At that point my rating was raised from 20 to 40 which mean that I should have been medically retired when I exited the military which I do believe would have entitle me to certain benefits that I didn't receive and still don't have. Proof of claim is enclosed which should also be in file. Certain disabilities such as mines can hinders a person from obtaining certain jobs and doing certain activities more than a person will realize. No other disabilities was considered at the time of my exit from the military.”


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 right hand condition is addressed below. No additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions not requested in this application or outside the Board’s defined scope of review remain eligible for consideration by the Board of Correction of Military Records.


 RATING COMPARISON :

Service PEB – Dated 20010529
 VA - (~2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Complex Regional Pain Syndrome Right Hand Not Sympathetically Maintained…. 8799-8713 20% Reflex Sympathetic Dystrophy, Right Hand 8599-8512 20%* 20010811
No Additional MEB/PEB Entries
 Other x 3 20010811
Combined: 20%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 20011011 .
ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continues to burden her. 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 Board utilizes DVA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. The Board’s authority as defined in DoDI 6040.44, however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation. Post-separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation.

Right Hand Condition. The service treatment records (STRs) indicate that this right hand dominant CI injured the right hand during a recreational football game in 1997, with two additional documented injuries, 1998, 1999. The right hand was not fractured during these injuries. Her hand did not improve significantly despite multidisciplinary treatment intervention. The CI described intermittent shooting pain through her fingers and severe hand pain triggered by cold temperatures. Multiple examinations prior to the narrative summary (NARSUM) documented that the CI had pain, swelling, decreased muscle strength (tests results varied), and decreased sensation in the digits of the right hand. However, range-of-motion (ROM) was consistently reported as within normal limits, and there was no evidence of atrophy. Anesthesia pain clinic treatment entry 9 February 2001 reported bone scan result consistent with mild degenerative joint disease (DJD). A normal magnetic resonance imaging (MRI) of the right hand was noted in the NARSUM. The commander statement indicated the CI’s duties involved instructing and writing at the mechanical school, and her profile limited her ability to perform the duties of her MOS. The CI’s profile limited her ability to be exposed to temperatures less than 65 degrees, no climbing, crawling, or repetitive use of right hand and no gripping with right hand. At the narrative summary (NARSUM) evaluation, 26 March 2001, 6 months prior to separation, the CI reported touching cold objects and exposure to cold temperatures causes hand pain. She could sustain a right hand grip for only seconds; she had pain 50-60 percent of the time at work because of the cooler ambient temperatures. The CI reported she was able to perform activities of daily living such as cooking, light housework and daily grooming, although some of these activities exacerbated her pain. At work her typing speed fell from 65 words per minute to 20. On physical examination, swelling was noted in dorsum of hand; there was decrease in hand grip, mild, 4/5, no paresthesia or hyperesthesia and normal sensation. Reflexes and ROM were normal. The examiner diagnosed complex regional pain syndrome (CRPS) not sympathetically maintained. The Compensation and Pension (C&P) examination, 11 August 2001, approximately a month prior to separation, recorded slightly swollen right hand around digits 3 and 4 with extreme tenderness but with full ROM, normal tests of reflex, sensory and strength in the right hand. The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA chose different coding options for the condition. The PEB adjudicated the condition as CRPS not sympathetically maintained, coded 8799-8713 (analogous for all radicular groups; incomplete paralysis), with a 20% rating for mild incomplete paralysis. The VA adjudicated the condition as reflex sympathetic dystrophy coded 8599-8512 (analogous for paralysis of lower radicular group); and initially assigned a 20% rating, the CI appealed and a 40% rating was assigned. Of note both the coding option of the VA and PEB requires meeting the same criteria for the higher rating of 40%; demonstrating incomplete paralysis of hand movements consistent with moderate degree of impairment. Both the NARSUM and C&P examination noted full ROM, no evidence of muscle atrophy and essentially normal hand grip and strength. Although pain was present during each examination, reflexes were normal, no paresthesia or hyperesthesia noted that would suggest moderate level of impairment. Therefore, a higher rating under either code is not supported by the records. Applications of VASRD §4.40 (functional impairment), §4.45 and §4.59 (painful motion) were considered but would achieve only a minimal compensatory rating of 10% given absence in the record of objective evidence of significant increased functional loss due to pain on use, weakened movement, excess fatigability, in- coordination, or flare-ups. The Board, after due diligence, found no additional route to any higher disability 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 hand 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 CRPS 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
Complex Regional Pain Syndrome Right Hand Not Sympathetically Maintained 8799-8713 20%
Combined 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120927, 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 AR20130009097 (PD201201761)


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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