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AF | PDBR | CY2013 | PD-2013-02226
Original file (PD-2013-02226.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICA8L DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02226
BRANCH OF SERVICE: Army  BOARD DATE: 20150212
SEPARATION DATE: 20041216


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Motor Transport Operator) medically separated for right index finger pain. The condition 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 “decreased flexion and strength in the right index finger following radio-collateral ligament reconstruction” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded four other conditions (left sided hearing loss, GERD, acne, and parasomnia) for PEB adjudication. The Informal PEB adjudicated his finger pain as unfitting and rated it at 10%. The remaining conditions were determined to be not unfitting . The CI made no appeals and was medically separated.


CI CONTENTION: His conditions continue to burden him. His complete submission, with attachments, is at Exhibit A.


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 20041105
 VA* - (~7 Months Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Pain and Weakness of Right Index Finger… 5099-5003 10% Right Index Finger Pain… 5229 10% 20050707
Parasomnia Not unfitting PTSD 9411 50% VA Records**
Other x 4 (Not In Scope)
 Other x 11
RATING: 10%
 RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 200 50909. **Effective 20091006 .

ANALYSIS SUMMARY:

Right Index Finger Condition. The records show that the CI “jammed” his right index finger in July 2003 while playing volleyball. He was referred to occupational therapy (OT) for rehabilitation. This proved insufficient and he had surgical repair on 8 April 2004. He was again seen in OT for rehabilitation. His level of function gradually improved, but at the 19 July 2004 orthopedic follow-up, it was determined that even though he had improved, he could not fulfill duty requirements and that it was unlikely that he would significantly improve. On examination, the finger was stable with normal sensation. However, the pinch grip was reduced at 4/5 and flexion at the knuckle joint proximal inter-phalangeal joint (PIPJ) was reduced to 60 degrees vice the left side 10 degree motion. The other index finger joints were normal compared to the left side (90/95 for the middle joint and 30/30 for the last [distal] joint). At the MEB examination on 21 July 2004, 5 months prior to separation, the CI reported that his knuckle remained swollen since the surgery. The examiner noted only that flexion at the PIPJ was reduced. The narrative summary was dated 5 October 2004, 2 months prior to separation. The CI reported that the initial injury was from a fist fight with a local civilian while deployed and that he reinjured it playing volleyball. The examiner cited the orthopedic examination completed in July. At the VA Compensation and Pension (C&P) examination performed 8 months after separation and 15 months after surgery, the CI reported pain in his right index finger with all activities. The PIPJ motion was limited to 90 degrees (up from 60 a year earlier) and the middle finger joint (MCPJ) was reduced to 80 degrees (previously 90). He was noted to have decreased strength with flexion and extension as well as painful motion. He could flex his index finger to 1/2-inch of the palm. He did retain fine motor skills though and could write as well as disassemble and reassemble a pen. Grip strength was reduced. No comment was made on stability.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the finger at 10% using an analogous code for degenerative arthritis, 5099-5003. The VA also rated the finger at 10%, but used the code 5229 (limitation of motion of the index finger). The VA rater noted that the motion was limited to 1 inch from the palm, but the C&P actually stated 1/2-inch, which corresponds to a 0% rating vice the 10% awarded. The Board considered the other voting options, but found no route to a rating higher than the 10% adjudicated by the PEB. It noted that the 5229 code provides a better clinical description, but provides no rating advantage to the CI. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the right index finger condition.

Contended PEB Conditions. The CI contended for PTSD. The Board noted that CI was evaluated for PTSD during the MEB process and found not to meet the criteria for PTSD. The diagnosis of parasomnia was made and found to be not unfitting. No other records were found in the service treatment records addressing a mental health condition. The Board’s main charge is to assess the fairness of the PEB’s determination that parasomnia was not unfitting. The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. No mental health condition profiled or implicated in the commander’s statement. The parasomnia was judged to not fail retention standards. It was reviewed and considered by the Board. There was no performance based evidence from the record that any mental health condition significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the parasomnia conditions and so no additional disability rating is recommended.


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 index finger condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended parasomnia condition, the Board unanimously recommends no change from the PEB determination as not unfitting. 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 20131104, 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, AR20150010419 (PD201302226)


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

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