Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02314
Original file (PD-2013-02314.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02314
BRANCH OF SERVICE: Army          BOARD DATE: 20141105
SEPARATION DATE: 20050420


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a drilling National Guard SPC/E-4 (11B/Infantryman) medically separated for a left hand condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The left hand condition characterized as pain in the hand and weakness in the left upper extremity” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated chronic pain with diminished grip strength, left (non-dominant) hand as unfitting rated at 10% with application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: Required physical therapy was not considered when decision was rendered.


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 condition is 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 Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veteran Affairs, operating under a different set of laws. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.


RATING COMPARISON :

Service IPEB – Dated 20050903
VA - (2 Mos. Post-Separation)
Condition
Code Rating Condition Code Rating Exam
Chronic Pain w/ Diminished Grip Strength, Left (Non-Dominant) Hand 5099-5003 10% Shrapnel Wound w/ Retained Foreign Bodies, Left Hand (Non-Dominant) 5307 10% 20040610
Other x 0 (Not in Scope)
Other x 6 20040610
Combined: 10%
Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 40820 (most proximate to date of separation )


ANALYSIS SUMMARY:

Left Hand Condition. The narrative summary (NARSUM) dated 19 November 2003, notes the CI’s left hand injury was caused by shrapnel. Majority of the shrapnel was surgically removed however, there was a remaining fragment that was unable to be extracted. Notes in the service treatment record indicated the CI was right hand dominant. An occupational therapy evaluation dated 4 November 2004, that the CI’s “hand still hurts when I make a fist”. The examiner noted a flat hard scar under the fifth metacarpophalangeal (MCP) joint was painful with tight fisting of the hand in addition to mildly decreased left hand grip as well as finger pinch strength when compared to the right. Despite therapy, the CI’s hand pain with weakness, continued, which impaired his performance of the duties and responsibility MOS, therefore he was referred for a medical evaluation board.

At the MEB examination 23 December 2004 (approximately 4 months before separation), the CI reported chronic left hand pain and weakness. The MEB physical exam noted full range-of-motion (ROM) of the hand and wrist with tenderness along the fourth and fifth metacarpals, without swelling or crepitus. The MEB examiner indicated a pain rating of slight/constant.

The VA Compensation and Pension (C&P) examination (performed 10 months prior to separation) was not in the available records. However, the original VA Rating Decision dated 20 August 2004 cited this examination. During this appointment the CI reported pain and a tingling sensation. On physical examination there was a hard lump and swelling in the palm at the fifth MCP joint, with normal sensation and ROM of all fingers.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the left hand condition at 10%, coded 5099-5003 (analogous to degenerative arthritis) and cited the USAPSDA pain policy. Also the VA rated the left hand condition at 10%, coded 5307 (for muscle injury, Group VII). The Board agreed that the evidence in the record supports a 10% rating with consideration of functional loss due to hand pain IAW VASRD §4.40, coded either IAW VASRD §4.71a (musculoskeletal system) or §4.73 (muscle injuries) and there was no evidence to support rating for nerve impairment. The Board reviewed the record to see if a higher rating of 20% was achieved with either code utilized by the PEB or VA. The Board found no evidence in record of “occasional incapacitating exacerbations” due to arthritis for higher rating IAW §4.71a, or sufficient evidence of a “moderately severe disability of muscles for higher rating IAW §4.73, that’s characterized as requiring prolonged hospitalization and involving infection, soft tissue sloughing, or muscle scarring and muscle tissue loss. 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 left 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. As discussed above, PEB reliance on the USAPDA pain policy for rating the left hand condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic left hand 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.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131105, w/atchs
Exhib
it B. Service Treatment Record
Exhibit C. Department of Veterans
’ Affairs Treatment Record


        
                 
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

invalid font number 31502



invalid font number 31502
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, AR20150002649 (PD201302314)


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 invalid font number 31502

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-02218

    Original file (PD-2013-02218.rtf) Auto-classification: Denied

    The upper extremity condition, characterized as “right shoulder stiffness, bilateral upper extremity pain and residual disability” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.No other conditions were submitted by the MEB.The Informal PEB adjudicated “left non-dominant forearm and hand injury, with reduced grip strength and chronic left upper extremity pain,”as unfitting rated 10% and 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD)and the...

  • AF | PDBR | CY2013 | PD-2013-01362

    Original file (PD-2013-01362.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. Accordingly, the Board recommended no re-characterization or modification of your separation.I have carefully reviewed the...

  • AF | PDBR | CY2014 | PD-2014-01693

    Original file (PD-2014-01693.rtf) Auto-classification: Denied

    invalid font number 31502 Service IPEB – Dated 20060316VA - (3 Mos. Chronic Upper Back Pain Condition . The CI was seen in pain managementprior to deploying for pain medications due to the chronic clavicle and shoulder pain.

  • AF | PDBR | CY2013 | PD-2013-02596

    Original file (PD-2013-02596.rtf) Auto-classification: Approved

    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. Right Thumb and Right Hand Condition . After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a TDRL placement disability rating of 30% and a TDRL...

  • AF | PDBR | CY2011 | PD2011-01051

    Original file (PD2011-01051.docx) Auto-classification: Approved

    The MEB examiner noted that the right hand dominant CI had reduced ROM and strength of the forearm, wrist and fingers. After the second C&P, the VA raised the rating to 30% still using the 5307 code for severe muscle injury, retroactive to separation. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior...

  • AF | PDBR | CY2013 | PD-2013-01377

    Original file (PD-2013-01377.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. Knee501010%20041102Other x2 (Not In Scope)Other x10 RATING: 20%RATING: 30% *Derived from VA Rating Decision (VARD) dated 20060106 (most proximate to date of separation (DOS)) Carpal Tunnel Syndrome Condition . RECOMMENDATION : The Board, therefore, recommends that...

  • AF | PDBR | CY2013 | PD-2013-01972

    Original file (PD-2013-01972.rtf) Auto-classification: Denied

    The Informal PEB adjudicated “median nerve injury, left (dominant) upper extremity consisting primarily of sensory deficit,” and “chronic pain, left arm, s/p humerus fracture”as unfitting, rated 10% and 10% respectively,citing the US Army Physical Disability Agency (USAPDA) pain for the arm, and the VA Schedule of Rating Disabilities (VASRD) for the nerve.The CI made no appeals and was medically separated. She was described as an “invaluable asset to any team.” The permanent profile listed...

  • AF | PDBR | CY2014 | PD-2014-00909

    Original file (PD-2014-00909.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board next considered if there was evidence of a functionally impairing radiculopathy due to the low back condition to provide additional rating. The Board considered the evidence in record supports thatthe CI’s...

  • AF | PDBR | CY2013 | PD 2013 01186

    Original file (PD 2013 01186.rtf) Auto-classification: Approved

    Additionally, members agreed that the chronic low back pain and left shoulder pain conditions, as isolated conditions, would have rendered the CI incapable of continued service within his MOS and therefore each is separately unfitting and merits a separate rating. Physical Disability Board of Review Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical...

  • AF | PDBR | CY2013 | PD-2013-01366

    Original file (PD-2013-01366.rtf) Auto-classification: Denied

    Post-Separation) ConditionCodeRatingConditionCodeRatingExam Chronic Left Shoulder Pain5099-500310%Residuals of Remote Left Shoulder Injury; S/P Reconstruction520120%20100420Other x 0 (Not in Scope)Other x 520100420 Combined: 10%Combined: 20%Derived from VA Rating Decision (VARD) dated 20100614 (most proximate to date of separation [DOS]) ANALYSIS SUMMARY :The Board notes the earliest VA evaluation was over 5 years after the date of separation. DoDI 6040.44 provides for consideration of...