RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03875
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20070823

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Medic, medically separated for “tendonitis, right (dominant) hand,” with a disability rating of 0%.

CI CONTENTION:  “Please 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 - 20070725	VARD - 20100201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tendonitis, Right (Dominant) Hand	5099-5024	0%	Dupuytren Contracture, Right Hand	5099-5024	10%	20090911	
Anxiety Disorder	Not Unfitting	PTSD	9411	50%	STR	
		Anxiety Disorder	9413	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  60%	
*Service treatment records

ANALYSIS SUMMARY:

Tendonitis, Right (Dominant) Hand.  Service treatment records (STR) indicate the CI deployed to Iraq from October 2005-November 2006 as a medic.  She developed pain and swelling in the fleshy part of her dominant right hand during her tour.  Pain appeared with lifting and carrying litters.  After her return, the pain continued with the development of a bump in the same area.  Neuroimaging was unremarkable.  Orthopedics diagnosed Dupuytren’s contracture (inflammation of the tendon.)  Surgical intervention was not indicated.  The commander noted her performance ability had decreased due primarily to her physical limitations.

At the Medical Evaluation Board (MEB) narrative summary (NARSUM), dated June 2007, the CI noted the pain was usually 2/10 but could flare to 7-8/10.  If the pain was bad, she took over the counter medication.  MEB physical exam May 2007 was unremarkable.  The orthopedic hand surgeon consultation noted extreme tenderness to palpation over the base of the second finer and the fleshy part of the palm of her right hand.  There was no apparent mass and she was able to oppose her thumb to all the tips of her other fingers.  She was working in her primary MOS but just screening patients.  She could not start intravenous (IV) lines, suture, do any prolonged lifting, or drive a military vehicle.  The examiner noted her condition had not improved significantly with conservative therapy.

At the VA Compensation and Pension (C&P) exam, dated September 2009, performed 25 months after separation, the CI reported she was medically boarded because she could not shoot a gun.  She was last treated in August 2007 and her condition had gotten worse.  She had daily pain, stiffness, and occasional locking.  She was able to do her job and cook with difficulty.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 0%, coded analogously to 5024 (tendonitis), while the VA assigned a 10% rating under the same code.  The NARSUM examiner and the commander noted she was unable to perform several facets of her MOS due to the pain caused by the contracture.  Board members agreed that application of IAW VASRD §4.40 (functional loss) “a part which becomes painful on use must be regarded as seriously disabled” should be applied. 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 tendonitis condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that anxiety disorder was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The DD Form 2807, Report of Medical History, noted the CI reported anxiety, depression and counseling.  The psychiatric intake noted the CI had a past history of inpatient care for an eating disorder, had been treated for depression in 2003, and had posttraumatic stress disorder spectrum anxiety symptoms.  A diagnosis of anxiety disorder NOS [not otherwise specified] was rendered and medication was recommended.  The examiner noted the condition existed prior to service and was exacerbated by military duty.  The CI was assigned a S2 profile and medication was recommended.  A follow up visit a month later noted significant improvement.  Impairment for military duty, social and industrial adaptability was mild.  The anxiety disorder condition was not implicated in the commander’s statement and was not judged to fail retention standards.  It was reviewed and considered by the Board.   There was no performance based evidence from the record that anxiety disorder condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the anxiety disorder contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the tendonitis, right (dominant) hand condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5024 IAW VASRD §4.71a.   In the matter of the contended anxiety disorder conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 her prior medical separation:

CONDITION	VASRD CODE	RATING	
Tendonitis, Right (Dominant) Hand	5099-5024	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140714, 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.

Sincerely,

Enclosure