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AF | PDBR | CY2013 | PD-2013-01987
Original file (PD-2013-01987.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-01987
BRANCH OF SERVICE: Army  BOARD DATE: 20141008
SEPARATION DATE: 20051220


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (14S/Avenger Crewmember) medically separated for right hand burn scar. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent P3/U3/L3 profile and referred for a Medical Evaluation Board (MEB). The burnt hand condition, characterized as “2% total body surface area flame burn second-degree involving 1% right lower arm and 1% right hand” and “bilateral anterior knee pain,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB forwarded no other conditions to the PEB. The Informal PEB adjudicated “grafted burn scar dorsum right (dominant) hand, 80 square centimeters [sq. cm.]” as unfitting, rated 20%, with likely application of the VA Schedule for Rating Disabilities (VASRD). The remaining (bilateral knee pain) condition was determined to be not unfitting , not rated. The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 burn scar right hand condition is addressed below; 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 Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20051024
 VA – 2 days Post-Separation
Condition
 Code Rating Condition Code Rating Exam
Burn Scar Right Hand 7801 20% Burn Scar Right Hand 7801 20% 20051222
No Other Items in Scope
Rated: 20%
 Combined: 60%
Derived from VA Rating Decision (VA RD ) dated 200 60424 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Burn Scar Right Hand Condition. The narrative summary notes the CI experienced burn injury of his scalp, right forearm/hand and left hand 2 July 2004 secondary to an improvised explosive device blast. On initial evaluation, he was noted to have a small superficial burn on the back of his scalp, 1% partial thickness burn of the right dominant upper extremity involving the back of the hand and index finger and 1% burn of the forearm, and a 2 centimeter (cm) partial thickness burn of the left hand web space. He was treated conservatively with burn wound care and therapy for right hand range-of-motion (ROM). In March 2005, he had excision of a deep scar and placement of an autograft harvested from his right thigh.

At the MEB exam, the CI reported pain of his scars of the right wrist and hand and difficulty using his hand for activities such as writing or opening a lock, as well as heavy work. The MEB physical exam noted right arm, elbow and forearm ROM within normal limits, with hypertrophic scarring and sensitivity. Right wrist ROM noted a mild flexion deficit of 47 degrees (normal 80 degrees), but within functional limits, mild thumb web space deficit bilaterally, but within functional limits, all other ROM of the hand was normal. There was a painful hypertrophic scarring of the back of the hand and wrist. The MEB examiner noted normal sensation and strength “well within functional limits” of the bilateral upper extremities. A memorandum to the PEB 18 October 2005 documented that the right hand scar was approximately 80 sq. cm.

At the VA Compensation and Pension (C&P) examination performed 2 days after separation, the CI reported pain and paresthesia of the scar involving the dominant right hand and forearm. He reported difficulties with use of the right hand for fine and gross motor activities. The VA noted a tender 31.5 cm by 13 cm, total 409.5 sq. cm., (63.5 square inches [sq. in.]) scar of the right forearm and hand. Musculoskeletal examination noted equal strength bilaterally with normal ROM.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA both rated the right hand/forearm scar 20%, coded 7801 (nonlinear, deep burn scars not of the face, head or neck). The Board noted the CI had a residual hypertrophic, tender scar of the right forearm and hand that mildly limited his wrist ROM. That was documented for the PEB as 80 sq. cm. and at the VA C&P examination as 409.5 sq. cm. Although the two measurements differed from each other, the Board agreed that both measurements met the 20% rating coded as 7801 based on the size of the scar (scars exceeding 12 sq. in. (77 sq. cm.) but less than 72 sq in. (465 sq. cm.) and did not meet the next higher evaluation of 30%, which applies to a minimum scar size of 72 sq. in. (465 sq. cm), which is greater than either the service or C&P noted scar size. Additionally, the right wrist did not meet a compensable rating based on limited wrist ROM, which applies to “plantar flexion limited in line with the forearm” and there was no other ratable impairment of the right forearm/hand. 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 burn 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 burn scar condition and IAW VASRD §4.118, 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 re-characterization of the CI’s disability and separation determination.
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






                 
XXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXX, AR20150003243 (PD201301987)

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                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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