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AF | PDBR | CY2013 | PD-2013-02764
Original file (PD-2013-02764.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02764
BRANCH OF SERVICE: Army  BOARD DATE: 20141010
SEPARATION DATE: 20060426


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (19D20/Cavalry Scout) medically separated for a right hand condition. This 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 right hand condition, characterized as “right ulnar hand pain secondary to base of smaller finger MC fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated right hand pain secondary to a fracture of the little finger condition as unfitting, rated 0% with cited applic ation of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “Mild TBI & PTSD – Medical Exam did not account for these.”


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. The contended TBI and PTSD conditions were not identified by the MEB or PEB; and, thus are not within the DoDI 6040.44 defined purview of the Board. These, and any other condition or contention not requested in this application, remain eligible for consideration by the Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20060404
 VA* - (4.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Hand Pain… 5099-5003 0% Right Ulnar Hand Pain… 8516 10% 20060909
Other x 0 (Not in Scope)
 Other x 9 (Not in Scope) 20060909
Combined: 0%
 Combined: 60%
*Derived from VA Rating Decision (VARD) dated 20061106 (most proxima te to date of separation (DOS))


ANALYSIS SUMMARY: The Board acknowledges the CI’s contention that suggests service ratings should have been conferred for other conditions documented at the time of separation. The Board wishes to clarify that it is subject to the same laws for service disability entitlements as those under which the Disability Evaluation System (DES) operates. While the DES considers all of the service member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. However the Department of Veterans Affairs, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically reevaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time.

Right Hand Pain Secondary to a Fracture of the Little Finger. The CI is right-hand dominate. In July 2005, he fractured the base of his little finger on his right hand while moving furniture. The fracture was displaced and required surgical repair. An open reduction internal fixation with instrumentation was performed in July 2005 which resulted in a mal-union and required a second revision surgery in October 2005. Despite physical and occupational therapy, his right hand pain continued. The MEB narrative summary completed on 22 February 2006 (2 months prior to separation) provided a detailed and chronological history of the CI’s condition with current complaints of right hand pain with loss of motion and decreased grip strength. The physical examination revealed a range-of-motion (ROM) of his metacarpal-phalangeal (MCP) joint to approximately 80 degrees (90 normal) compared to 90 degrees on his left hand. Both his proximal inter-phalangeal and distal inter-phalangeal ROMs were 90 degrees (100 and 70 normal respectfully); equal to that of the left hand. There was decreased light touch sensation throughout the little finger side of his right hand. Tenderness along the 5th metacarpal (hand) was additionally present. The patient's condition prohibited him from performing grip-related activities, as well as, push-up and hyperextension activities with load bearing on his right hand.

At the VA Compensation & Pension examination of 9 June 2006, (6 weeks after separation), the CI endorsed a constant 5 of 10 scale right hand pain with associated decreased grip strength. The PE was brief and revealed minimal decreased ROM and subjectively assessed decreased grip strength. Although painful wrist motion was documented, there was no 5th finger or the MCP joint painful motion noted. The CI reported he was a commercial pilot and was able to perform his job satisfactorily.

The Board directs attention to its rating recommendation based on the above evidence. The PEB assigned a 0% rating under an analogous 5003 code (degenerative arthritis) citing pain as intermittent and slight. Using a nerve code 8516 (ulnar nerve; paralysis), the VA assigned a 10% rating. Board members first acknowledged that conditions of the little finger (excluding amputation) frequently rate at 0%; including limited motion (code 5230) as well as joint ankylosis (code 5227). Additionally, absent painful motion, VASRD §4.59 is not applicable in this case. However, due to evidence of subjective weakness and objective sensory impairment, Board members considered rating under a peripheral nerve code. The correct anatomic nerve impairment in this case was indeed the ulnar nerve as identified in the VA’s rating, but it was not consistent with their code of 8516 indicating a “complete paralysis” of the nerve. The Board agreed that a more accurate description in this case was an “incomplete” nerve impairment; specifically described as a neuritis (inflammation causing abnormal sensation). The overwhelming and most consistent objective finding throughout the treatment record was decreased sensation along the distal ulnar nerve distribution. IAW §4.124a, neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis; up to 40% in this case. Mild and moderate impairment under 8616 (neuritis of the ulnar nerve) are 10% and 30% respectively. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of (mild) 10% coded 8616 for the right hand nerve 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 DoDI 1332.39 for rating the right hand was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the right hand condition, the Board unanimously recommends a disability rating of 10%, coded 8616 IAW VASRD §4.124a. 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:

UNFITTING CONDITION VASRD CODE RATING
Right Hand Neuritis 8616 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131218, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






                           XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150006489 (PD201302764)


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 10% 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

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