Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-01922
Original file (PD-2013-01922.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-01922
BRANCH OF SERVICE: Army  BOARD DATE: 20150224
SEPARATION DATE: 20040920


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Light and Heavy Wheel Repair) medically separated for a left shoulder and right 5th finger conditions. The shoulder and finder conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The “chronic left shoulder pain, s/p BANKART and SLAP repair with degenerative changes” and “chronic right 5th finger pain, s/p traumatic partial amputation,” were the only two conditions forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB combined the two MEB conditions and adjudicated “chronic pain, left shoulder, s/p surgical repair and right 5th finger, s/p partial amputation distal to distal interphanangeal joint” as unfitting, rated 10%, c iting the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: The CI writes: “I disagree with my rating wholeheartedly. For years, I have sought treatment from numerous VA treatment centers without much success for injuries and illnesses sustained during my enlistment that were deemed unworthy for a rating during my medical board. The doctors who have been treating me have had little success and project little hope for future success of improvement for my current medical state. I am suffering from extreme embarrassment due to the hair loss and unattractive scarring sustained to my head during my Army service. It has negatively affected my self esteem significantly. I am always wearing hats in an attempt to hide my head. I have had numerous visits to dermatologists at the VA treatment center and have received several injections, topical solutions, and shampoos to no avail. I am the father of four very skillfully athletic sons; however, my physical acuity has significantly diminished due to my Army service and I am extremely disheartened that I am unable to physically participate in my sons' sports and weight training. I am forced to watch others train them from the sidelines. Despite all of the experience and training that I've acquired during my military career, I am currently unemployed and having difficulty securing employment in my field with my physical limitations in this dismal economy. As I age, all of my conditions worsen. Most mornings, I am in excruciating pain. I experience pain and swelling in cold weather. I experience pain from overuse when performing menial household chores. As a young, hard-charging NCO, mentally I felt like my young adulthood was stolen from me without any regard, concern, or adequate compensation. As a man, I felt like my livelihood was taken as well as causing me to feel like less than a man in regard to making provision for my family at a time when my self-esteem was at an all-time low due to my mistreatment when I was discharged. REF: The Wounded Warrior Act. Because Operation Desert Spring and Operation Iraqi Freedom had just begun when I sustained my final injury, I didn't receive the same adequate information or treatment during my board process that many soldiers have been receiving subsequent to my discharge. They are provided liaisons and counselors to physically walk them through the process. I wasn't afforded the same luxury. My unit had not even returned from downrange when I began my process, they were still actively engaged in the push to Baghdad. I believe that if I had the same resources available to me, I would have secured a much higher rating.”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

IPEB – Dated 20040625
 VA* - (1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
CHRONIC PAIN, L SHOULDER, AND R 5TH FINGER…. 5099-5003 10% S/P OPEN BANKART AND SLAP REPAIR, L SHOULDER 5099-5010 10% 20041028
PARITAL AMPUTATION, TUFT, DISTAL PHALANX, R LITTLE FINGER 5156 10% 20041028
Other x 0 (Not In Scope)
 Other x 6
RATING: 10%
 RATING: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 50216 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY : The PEB combined the left shoulder and right finger conditions as a single unfitting condition rated as 5099-5003 (analogous to arthritis) at 10%. The PEB relied on the USAPDA pain policy for not applying separately compensable VASRD codes. However, the Board must apply separate codes and ratings in its recommendations if compensable ratings for each condition are achieved IAW VASRD rating guidelines. If the Board judges that two or more separate ratings are warranted in such cases it must satisfy the requirement that each “unbundled” condition was unfitting in and of itself. Thus the Board must exercise the prerogative of separate fitness recommendations in this circumstance, with the caveat that its recommendations may not produce a lower combined rating than that of the PEB. The Board first considered whether the evidence supports that left shoulder and right finger conditions each remained reasonably justified as unfitting when separated from the PEB’s combined adjudication. The left shoulder and right hand injuries were both specifically noted in the commander’s statement as limiting the CI’s duty performance due to difficulties with tasks attributed to the decreased use of his dominant hand such as vehicle maintenance and carrying/firing a weapon and also shoulder related activities such as working overhead, climbing into and out of vehicles, and lifting heavy objects. Both conditions were permanently profiled and judged to fall below retention standards. Therefore, the Board concluded that the evidence supports that the left shoulder and right finger conditions were both reasonably justified as unfitting at the time of separation and eligible for individual disability rating.

Left Shoulder Condition. The narrative summary (NARSUM) noted following several left shoulder dislocations, the CI had surgery to stabilize the joint and repair a cartilage tear in 1998. The CI had a good functional outcome from the surgery until he injured his right finger in February 2003. Following the finger injury the CI reported increased use of his left upper extremity, which increased his shoulder pain and stiffness. He was re-evaluated by the orthopedic specialist and referred for physical therapy. Scant notes in the service treatment record (STR) indicated the CI had left shoulder pain with good range-of-motion (ROM). Shoulder X-rays noted the surgical stabilizers and minimal degenerative changes and computed tomography (CT) scan noted a normal shoulder status post the surgical repair. Following the 1998 surgery, there were no further dislocations reported or documented in the STR and no further surgery was recommended. A physical therapy visit on 13 January 2004 noted no improvement change in the shoulder symptoms with treatment. The exam noted full flexion and abduction, with painful ROM and an MEB was recommended.

At the MEB examination on 8 April 2004, 6 months prior to separation, the CI reported shoulder pain, specifically noting “cannot lift anything with my left shoulder.” The MEB physical exam noted tenderness to palpation (TTP) of the anterior shoulder with normal muscle strength. Left shoulder ROM was flexion of 140 degrees (normal 180) and abduction of 112 degrees (normal 180), with painful motion.

At the VA Compensation and Pension (C&P) examination on 28 October 2004 performed a week after separation, the CI reported shoulder pain and stiffness with flare-ups due to activity. The exam noted pain with resisted shoulder abduction and painful ROM. Shoulder ROM was flexion of 150 degrees and abduction 140 degrees, with no change in ROM or additional pain or fatigability with repetition of ROM. There was no muscle atrophy noted.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the shoulder and finger pain condition 10% and cited the USAPDA pain policy as noted above and the VA rated the shoulder condition 10%, coded 5099-5010 (analogous to traumatic arthritis). The Board agreed that the evidence supports that the left shoulder disability met a 10% rating coded as 5010, or as 5201 (limited arm motion) for painful ROM IAW VASRD §4.71a with consideration of §4.59 (Painful motion) or coded analogously to rotator cuff injury with 5299-5203 (impairment of the clavicle or scapula without loose movement). The Board reviewed to see if a higher evaluation was achieved, but found the threshold for a 20% rating for limited arm motion described as “at shoulder level” was not met; Board practice when rating with 5201 has considered 90 degrees of abduction or flexion “shoulder level.” Additionally, there was no evidence of impairment of the humerus, impairment of the clavicle or scapula with loose movement, or shoulder ankylosis to provide a higher rating. The Board agreed to code as 5201 for painful motion. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59, the Board recommends a disability rating of 10% for the left shoulder condition.

Right Finger Condition. The NARSUM noted during deployment in February 2003 the CI sustained a traumatic partial amputation of the tip of the right little finger (distal phalanx) while working on a diesel engine. He underwent surgery with revision of the amputation and wire fixation of the finger at the distal interphalangeal joint (DIP) joint. The fixation wire was removed and the CI had occupational therapy (OT) with improvement in finger ROM, but continued to report pain. Right finger X-rays in November 2003 noted the old amputation of the tuft of the distal phalanx. At OT visits in November and December 2003 the CI reported pain levels of 2/10.

At the MEB examination on 8 April 2004, 6 months prior to separation, the CI reported constant dull, pressure type finger pain. The exam noted the CI was right hand dominant. Little finger ROM was the same on the right and left for metacarpophalangeal with extension-flexion of 0-75 degrees (normal 0-90) and proximal interphalangeal (PIP) joint 0-85 degrees (normal 0-100). The right DIP joint had extension lag of 15 degrees and flexion of 55 degrees (normal 0-70/80), and measured grip strength was within normal range, bilaterally. The fingernail was intact and there was TTP of the PIP and DIP joints and decreased sensation on the palmar aspect of the finger, but 2-point discrimination was intact.

At the VA C&P examination on 28 October 2004 performed a month after separation, the CI reported numbness and pressure like sensation on the tip of his finger and stiffness of his finger joints since the injury, with increased pain with use. The exam noted the same findings as the MEB examination and right little finger ROM noted decreased PIP joint ROM of 0-60 degrees and DIP joint extension lag of 10 degrees.

The Board directed its attention to its rating recommendation based upon the evidence above. The PEB rated the right finger and left shoulder condition 10% and cited the USAPDA pain policy as noted above and the VA rated the right finger 10%, coded 5156 (little finger amputation). According to the VASRD §4.71a “single finger amputation ratings are the only applicable ratings for amputations of whole or part of single fingers.” Thus, the applicable amputation code this case is 5156. The rating criteria of 5156 are specified as “little finger amputation with metacarpal resection (more than one half of the bone lost)” for 20% rating or “without metacarpal resection, at proximal interphalangeal joint or proximal thereto” for 10%. The Board noted the partial distal phalanx amputation did not meet a compensable rating based on the extent of the amputation. The Board next considered rating the DIP joint for limited ROM, but 5230 (limited motion of the ring or little finger) provides a 0% rating for “any limitation of motion.” However, the Board noted that the CI had tender PIP and DIP joints with limited ROM and pain with use of his dominant hand. The Board considered that VASRD §4.45 (The joints) notes “multiple involvements of the interphalangeal joints of the upper extremities…are considered groups of minor joints, ratable on parity with major joints” and §4.59 (Painful motion) states that “it is the intention to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.” Thus, the Board concluded that the evidence supports the CI’s disability due to the distal phalanx partial amputation warrants a 10% rating coded as 5230 IAW §4.45 and §4.59. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), §4.45 and §4.59, the Board recommends a disability rating of 10% for the right finger 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 the left shoulder and right finger conditions was operant in this case and the condition was adjudicated independently of that policy by this Board. In the matter of the left shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the right finger condition, the Board unanimously recommends a disability rating of 10%, coded 5230 IAW VASRD §4.71a. 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:

CONDITION VASRD CODE RATING
Chronic Left Shoulder Pain Condition 5201 10%
Chronic Right Finger Pain Condition 5230 10%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131023, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record







XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXX, AR20150011056 (PD201301922)


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 20% 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                       XXXXXXXXXXXXXXX
                                    Deputy Assistant Secretary of the Army
                                    (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2014 | PD-2014-01010

    Original file (PD-2014-01010.rtf) Auto-classification: Denied

    The left small finger condition, characterized as “chronic left pinkie pain with decreased range of motion secondary to tendon and nerve injury”was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.The MEB also identified and forwarded high frequency hearing loss (HFHL) left ear; adjustment disorder; and right knee pain for PEB adjudication. The Informal PEB adjudicated “left (non-dominant) small finger, limitation of motion of” as unfitting, rated 0%with likely application of...

  • AF | PDBR | CY2012 | PD-2012-00733

    Original file (PD-2012-00733.pdf) Auto-classification: Denied

    Pre‐Sep) – Dated 20010925 VA (1 Week Pre‐Separation) – All Effective Date 20011204 Condition Code Rating Condition Code Rating Exam 5154 10% Residuals, Traumatic Partial amputation, left middle finger Patellofemoral pain syndrome, right knee 5299‐5226 10% 20011126 5024 10% 20011126 0% X 0 / Not Service‐Connected x 0* 20011126 ↓No Addi(cid:415)onal MEB/PEB Entries↓ Combined: 10% Combined: 20% *VARD 20030214 denied four additional conditions as “Not Service Connected, No Diagnosis.” ANALYSIS...

  • AF | PDBR | CY2013 | PD2013 00373

    Original file (PD2013 00373.rtf) Auto-classification: Denied

    The Service ratings for the unfitting left fifth digit amputation, left thumb pain due to scarring and right thumb pain due to scaring conditions is are addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.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 respective Service Board for Correction of Military Records. The CI...

  • AF | PDBR | CY2012 | PD2012 00941

    Original file (PD2012 00941.rtf) Auto-classification: Approved

    The PEB adjudicated “pain left ankle and right wrist” as a single unfitting condition, rated 0% and “fusion of distal interphalangeal joint of the left non-dominant ring finger” as unfitting, rated 0%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Pre-Separation) ConditionCodeRatingConditionCodeRatingExam Pain Left (this should be right)Ankle and Right Wrist5099-50030%Right Ankle Fracture5010-527110%*19990626Right Wrist, Residuals, status post (s/p)...

  • AF | PDBR | CY2012 | PD2012 01702

    Original file (PD2012 01702.rtf) Auto-classification: Denied

    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. Arthrofibrosis Proximal and Distal Interphalangeal Joints Left Middle, Ring and Small FingersCondition . Physical Disability Board of Review

  • AF | PDBR | CY2013 | PD 2013 00068

    Original file (PD 2013 00068.rtf) Auto-classification: Approved

    CI CONTENTION :“PTSD was diagnosed on the narrative summary and listed on the medical board, but I was never evaluated for this condition prior to being medically discharged. At no time was a profile other than S1 assigned and after separation, the CI worked 70 hours per week.After due deliberation, members agreed that the evidence does not support a conclusion that the functional impairment from the PTSD condition was integral to the CI’s inability to perform his AFS requirements and,...

  • AF | PDBR | CY2013 | PD2013 02174

    Original file (PD2013 02174.rtf) Auto-classification: Denied

    The Informal PEB adjudicated “chondromalacia patellae, left knee and little finger/left hand, limitation of motion”as unfitting, rated 10% and 0%, with likely application of the VA Schedule for Rating Disabilities (VASRD). The adjustment disorder, as implied by the PEB, was a condition not constituting a physical disability IAW DoDI 1332.38., and therefore, not ratable.The Board noted the PEB identified that the adjustment disorder was not compensable but could be administratively...

  • AF | PDBR | CY2013 | PD-2013-02144

    Original file (PD-2013-02144.rtf) Auto-classification: Approved

    No other conditions were submitted by the MEB for PEB adjudication.The Informal PEB adjudicated “chronic pain, right small finger; right inguinal pain of neuralgia and chronic thoracolumbar back pain”as unfitting, rated at 0%, 0%and 0% respectively.The CI made no appeals and was medically separated. Additionally, the Board considers VA evidence within 12 months of separation only to the extent that it reasonably reflects the disability at the time of separation. The PEB coded the condition...

  • AF | PDBR | CY2013 | PD-2013-02764

    Original file (PD-2013-02764.rtf) Auto-classification: Approved

    The InformalPEBadjudicated right hand pain secondary to a fracture of the little finger condition as unfitting, rated 0%with cited application of the US Army Physical Disability Agency (USAPDA) pain policy.The CI made no appeals and was medically separated. Despite physical and occupational therapy, his right hand pain continued.The MEB narrative summary completed on22 February 2006 (2 months prior to separation) provided a detailed and chronological history of the CI’s condition with...

  • AF | PDBR | CY2014 | PD-2014-00095

    Original file (PD-2014-00095.rtf) Auto-classification: Approved

    The tip of the left index finger was amputated and the little finger was shortened in comparison. ROM was decreased in the first three fingers; excluding the thumb and little finger. 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...