RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03545
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20020813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Wheeled Vehicle Mechanic, medically separated for “hypersensitivity of the right thumb” rated at 10%.

CI CONTENTION:   The CI indicates he still suffers from the effects of the lacerations to his thumbs, a spinal injury, memory loss, mental health concerns, injury to his right arm, and nerve damage in his cervical spine.  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 upon a 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 - 20020507	VARD - 20071106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hypersensitivity…Right Thumb…	8516	10%	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Hypersensitivity of the Right Thumb.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI’s right thumb condition began in August 2001 after he lacerated both thumbs opening a respirator mask canister.  After the right thumb laceration was sutured, the CI reported continued numbness of the ulnar side of the palmar aspect of the thumb.  He was diagnosed with digital nerve injury of the ulnar side of the thumb and underwent nerve repair by a hand specialist on 4 October 2001.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “hypersensitivity right thumb status post ulnar digital nerve laceration” for PEB adjudication.
During the MEB examination (recorded on DD Forms 2807 and 2808) dated 25 March 2002, 5 months prior to separation, the CI checked “No” next to the question “have you ever or do you now have impaired use of the arms, legs, hands, or feet?”

The MEB NARSUM examination on 4 April 2002 (4 months before separation) noted complaints of hypersensitivity of the right thumb.  The examiner noted limitations including inability to grasp or lift with his dominant right hand.  Physical examination performed by the orthopedic clinic showed well-healed scars of the thumb.  Thumb range of motion was “lacking 15 degrees” full extension, and 20 degrees flexion, compared with the left thumb motion of 0 degrees extension to 75 degrees flexion and right thumb MP joint full extension and 50 degrees of flexion, compared to 75 degrees flexion on the left.  Two point discrimination was “mildly deceased” on the right thumb compared to the left.  The CI was able to make a full fist and was able to oppose the thumb to all fingers.  Occupational therapy measured grip strength (three repetitions) – right side was 90, 60, and 80 pounds, compared to 140, 130, and 120 pounds on the left.  Pinch strength was reported as right tip, 5 pounds, lateral, 7 pounds; and pad, 7 pounds and left side was 21, 26, and 25 pounds respectively.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the hypersensitivity of the right thumb condition 10% coded 8616 (ulnar nerve neuritis) citing full motion of the thumb with decreased grip strength and decreased sensation.  There is no evidence in record that the CI ever filed a VA claim for his right hand or thumb conditions.

There was evidence of thumb pain, decreased grip and pinch strength, and non-ratable limitation of motion that supports a 10% rating and no higher coded IAW VASRD §4.124a (neurological conditions) as adjudicated by the PEB.  Although the mechanism of injury was a nerve laceration, an alternative rating of the hand disability IAW VASRD §4.73 (muscle injuries) could be considered under 5307 (group VII muscle function: flexion of wrist and fingers).  However, the Board agreed there is no higher rating than 10% that could be supported for “moderate” muscle injury.  As demonstrated at the occupational therapy evaluation the CI was able to grip and pinch grasp significant weight with the right hand, though less the non-dominant left hand and there was no mention of functional problems with dropping objects, etc.  All Board members agreed that the objectively measured weakness did not approach the threshold of “moderately severe.”  There was no limitation of thumb motion or ankylosis of the thumb that supports a rating under the respective codes (5228, 5224) IAW VASRD §4.71a (musculoskeletal conditions).  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 hypersensitivity of the right thumb condition.

BOARD FINDINGS:  In the matter of the hypersensitivity of the right thumb condition and IAW VASRD §4.124a, 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 20140614, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

21 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017510 (PD201403545)

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.

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA