RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03287
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20031114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Electrical Mechanical Equipment Repairman, medically separated for “status post distal phalanx amputation [left, non-dominant]…,” with a disability rating of 10%.  

CI CONTENTION:  The CI requested consideration of all conditions.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based on 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 PEB - 20031015	VARD - 20041008	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Distal Phalanx Amputation…[left, non-dominant]	5153	10%	Residuals, Status Post Left Distal Index Finger Amputation	5153	10%	STR	
Status Post Hook Nail Ablation	Cat II					
Status Post Left Index Finger Flexor Tendon Adhesion Release	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Status Post Distal Phalanx Amputation [Left, Non-Dominant].  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was right-hand dominant.  His left distal index finger condition began in June 2002 with a traumatic amputation of the distal part of his left index finger transiting from one deck to another via a ship ladder.  The amputation was revised at the distal interphalangeal (DIP) joint with subsequent revision surgeries to release tendon adhesions that limited index finger motion and remove a deformed nail (hook nail ablation).  The last surgery, in April 2003, indicated that there was residual DIP joint present.  The MEB forwarded “status post traumatic left index finger, distal phalanx,” “residual hook nail deformity” and “left index finger flexor tendon adhesion” for PEB adjudication.  The NARSUM evaluation dated 22 May 2003, 6 months prior to separation, indicated that the CI was right-handed with the above history of left index finger distal phalanx amputation and surgeries.  Examination showed limited active range of motion (ROM) of the left proximal interphalangeal (PIP) joint of 0-20 degrees (passive 0-90 degrees) and at the metacarpophalangeal (MCP) joint of 0-95 degrees (passive 0-110).  At the MEB examination (recorded on DD Forms 2807 and 2808) dated June 2003, 5 months prior to separation, the CI reported left index finger amputation with numbness and tingling and inability to move the index finger.  The examiner noted left hand index finger distal phalanx amputation with decreased ROM of the proximal and middle joints of the finger to 0 degrees.  At the orthopedic evaluation dated July 2003, 4 months prior to separation, the CI reported frustration with slow progress.  Examination documented limited active PIP ROM of 0-10 degrees and MCP ROM of 0-90 degrees.  

There was no VA Compensation and Pension (C&P) examination proximate to the date of separation as the CI failed to report for the scheduled evaluation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5153 code (amputation of index finger) and also listed “status post left hook nail ablation (and) status post left index finger flexor tendon adhesion release” as related Category II conditions (contribute to the primary unfitting condition but are not separately ratable).  The impairment from the two Category II conditions were subsumed under the overall rating for the left distal index finger condition (IAW §4.14 avoidance of pyramiding, more than one rating based on the same impairment is prohibited).  The VA also assigned a 10% rating using the 5153 code based on the STR, citing amputation of the index finger through the middle phalanx or at the distal joint.  The Board agreed that alternative ratings under codes 5229 (index or long finger, limitation of motion) or 5225 (index finger, ankylosis of) would not provide for any rating higher than the 10% awarded by the PEB.  The PIP joint was still intact (as was the MCP) and there was no indication that there was resulting limitation of motion of other digits or interference with overall function of the hand to warrant any higher rating.  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 index finger condition.  

BOARD FINDINGS:  In the matter of the left index 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.  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 20140703, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 1 Jun 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						  	(Manpower & Reserve Affairs)