RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02511
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141204
SEPARATION DATE:  20071217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty AB/E-1 (9T000/Basic Enlisted Airman) medically separated for a left middle finger condition.  This condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The finger condition, characterized as “intra articular fracture left middle finger MCP,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated healing communited fracture of left middle finger as unfitting, rated 0%, with application of VA Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB, but waived his appeal and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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:

Service IPEB – Dated 20070926	VA* - (3.9 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Healing Communited Fracture, Left Middle Finger	5229	0%	Fractured Middle Finger, Left Hand	5229	0%	20080718	
Other x 0 (Not in Scope)	Other x 2	
Combined:  0%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20080718 (most proximate to date of separation)

ANALYSIS SUMMARY:

Healing Comminuted Fracture of Left Middle Finger.  The right hand dominant CI incurred a fracture of the middle finger (the proximal phalanx) of the left hand in June 2007.  X-rays demonstrated the fracture was non-displaced (the bones remained in proper alignment) and the CI was treated with splinting and casting of the finger.  Follow up X-rays demonstrated new bone formation at the fracture site (callous) indicating healing.  Orthopedic examination performed on 13 August 2007, noted the finger to be non-tender but stiff.  The middle finger flexed reaching the fingertip to within less than one centimeter of the palm.  Occupational therapy examination on 29 August 2007 recorded normal range-of-motion (ROM) of the joints of the middle finger except for 7 degrees of decreased extension at the middle joint of the middle finger.  The MEB narrative summary examination on 14 September 2007 recorded normal middle finger ROM.  Grip strength was decreased.  

The VA Compensation and Pension (C&P) examination dated 11 April 2008 (4 months after separation), was not in the file, however results of the examination were reported in the Veterans Affairs Rating Decision (VARD) dated 18 July 2008.  The VARD stated,

“You reported you are able to do everything you want and there are no limitations to your activities. The examiner noted your grip strength was 5/5 and you were able to oppose all fingers freely to the thumb. The distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints and interosseous were all intact. There was no limitation in range of motion or joint function following repetition due to pain, weakness, lack of endurance, or incoordination. X-rays revealed no significant joint or bony abnormalities. The examiner diagnosed fractured left middle finger.”

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the residuals of the left middle finger fracture at 0% coded 5299 (limitation of motion of the index or long finger).  A gap of 2.5 centimeters or more between the fingertip and proximal crease of the palm or limitation of extension by more than 30 degrees supports a 10% rating.  The examinations proximate to separation did not demonstrate limitation of motion that supported a minimum rating under the code for limitation of motion.  The VA C&P examination (4 months after separation), confirmed the anticipated normal functional outcome.  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 healing comminuted fracture of left middle 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.  In the matter of the healing comminuted fracture of left middle finger 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140506, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-02511.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings