RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03835
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040924	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Cavalry Scout, medically separated for “contracture right middle finger at proximal interphalangeal joint,” with a disability rating of 0%.

CI CONTENTION:  The CI requests the Board consider 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 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 PEB - Dated 20040812	VARD - 20041022	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Contracture R Middle Finger at PIP Joint	5229	0%	GSW to the R Middle Finger	5229	10%	20041022	
			R Arm Neuritis…R Middle Finger	8515	10%	20041022	
RATING:  0%	COMBINED RATING:  30%	

ANALYSIS SUMMARY:  

Contracture Right Middle Finger at Proximal Interphalangeal (PIP) Joint.  The record showed that on 9 June 2003, the right hand dominant CI was accidentally shot in the right middle finger by a fellow Soldier while deployed.  He underwent debridement of the wound with repair of the tendon, nerves and bone with subsequent revision on 23 October 2003 with a bone graft.  Despite surgical intervention and rehabilitation, he had a residual contracture of the first finger joint (PIP) which precluded full function and impaired duty.  The narrative summary (NARSUM) was dated 27 April 2004, 5 months prior to separation.  The above history was noted.  On examination, the CI had diminished sensation over the top (away from the palm) of the right middle finger, diminished right grip strength, and decreased range of motion (ROM) as charted below.  At the MEB examination the same day, the examiner noted that the sensation was slightly diminished over the distal right middle finger and the ROM diminished.  No comment was made on motor function.  An orthopedic appointment on 11 August 2004 noted that the CI had right cubital tunnel syndrome (a part of the elbow through which the ulnar nerve passes).  Sensory changes were present and confirmed with electrodiagnostic testing, but motor function was normal.  

At the VA Compensation and Pension (C&P) examination performed on 22 October 2004, less than a month after separation, the CI reported decreased mobility of the hand and pain with “heavy” activity.  He also reported a tightness of the right elbow with an “electric sensation.”  Motion of the right middle finger was reduced and painful with the fingertip reaching only 3 cm from the median (should be proximal) transverse fold of the palm.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Hand
(Dominant)	OT ~3 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
MCP	0/70	0-20 Dorsiflexion/0-40 Palmer	
PIP	20/40	-10 Extension 10 to 30 Flexion	
DIP	-15/25	0-50	
Comments	Meets retention standards; painful motion 	Flexion to 3 cm from transverse crease	
§4.71a Rating	10% (4.59)	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the contracture of the right middle finger at 0%, coded 5229 (limitation of motion), noting that the limitation in motion supported a 0% rating.  The VA rated the finger condition at 10% also using the 5229 code.  The Board considered the evidence.  Painful motion was documented on the ROM values obtained proximate to separation for the PEB.  The limitation on the VA C&P was more than 2 cm from the transverse crease of the palm.  Both support a 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right middle finger condition coded 5229.  

The Board noted that the VA also rated the CI for a right arm neuritis associated with the gunshot wound.  The orthopedist determined that this was actually secondary to a cubital tunnel syndrome which is outside the Scope of the Board.  Regardless, the record does not support the presence of an unfitting neuropathy at separation.  Accordingly, no additional rating for a neuropathy can be recommended.  

BOARD FINDINGS:  In the matter of the right middle finger contracture condition, the Board unanimously recommends a disability rating of 10%, coded 5229 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Contracture Right Middle Finger	5229	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140804, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Dear 
 
The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical
Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, 

Sincerely,

Enclosure