RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00433
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E4, Motor Transport Operator, medically separated for “chronic pain, status post fracture at distal phalanx, right middle finger” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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 panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel 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 - 20040726	VARD - 20041211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Status Post Fracture at Distal Phalanx, Right Middle Finger	5099-5003	0%	Degenerative Joint Disease, Right Third Distal Interphalangeal Joint; Status Post Boney Mallet Injury	5229	10%	20041120	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Pain, Status Post Fracture at Distal Phalanx, Right Middle Finger.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI’s right middle (long) finger condition began in November 2003 after he was hit with a football that caused a mallet finger (injury to the extensor tendon of the distal phalanx) on 8 January 2004.  The CI was splinted for the injury.  He sustained a second injury in early January 2004 when the door of a bus slammed on the hand causing a comminuted fracture of the middle finger distal phalanx and underwent an open reduction internal fixation of the finger fracture on 8 January 2004.  
The MEB NARSUM examination on 1 July 2004, 4 months before separation, noted complaints of right hand pain.  Physical examination showed limited flexion of the distal interphalangeal joint (DIPJ) of the right middle finger.  Finger ROM was (extension/flexion) 0/90 degrees at the metacarpophalangeal joint (MPJ), 0/80 degrees proximal interphalangeal joint (PIPJ), and 0/0 degrees DIPJ, as compared to the left middle finger which showed MPJ 0/90 degrees, PIPJ 0/100 degrees, and DIPJ 0/80 degrees.  The MEB examiner noted there was no motor or sensory abnormality of the right hand.  

At the 20 November 2004 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported constant pain with flare-ups due to weather.  Physical examination showed very limited ROM of the DIPJ, estimated to be 5 to 10 degrees total ROM, as well as a 10 degree lack of extension at the PIPJ, with painful motion.  There was instability, lateral deviation or malrotation.  The examiner indicated the joint was “not quite ankylosed.”  The VA examiner stated that the CI had stiffness and painful ROM.  He had normal strength with pushing, pulling and twisting.  The examiner further indicated the CI likely had difficulty grasping a pen and writing, but that additional functional limitation of the hand due to the long finger was difficult to estimate and the CI did not have any obvious functional impairment other than pain with use of the finger.  Right hand radiographic (X-ray) studies showed severe degenerative joint disease of the right long finger DIPJ.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right middle finger condition 0%, analogously coded 5003 (arthritis, degenerative), citing in accordance with the VASRD §4.68 amputation rule.  The VA rated the right middle finger condition 10% coded 5229 (index or long finger, limitation of motion), citing severe limitation of motion and pain.  

VASRD code 5229 assigns a 10% rating for “a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible.”  There was no description in record of long finger limitation of motion in these terms.  However, full flexion of the MPJ and slightly limited flexion of the PIPJ, and no or minimal flexion at the DIPJ can reasonably be anticipated to result in a gap of one inch or more supporting a 10% rating.  The functional disability of the long finger could not be equated to amputation of the long finger (5154) at the MPJ for a higher rating.  No additional functional limitation of the hand or fingers was evidenced by the examinations for consideration of higher or additional ratings under other amputation or limitation of motion codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right middle finger condition, coded 5229.  

BOARD FINDINGS:  In the matter of the chronic pain, right middle finger condition, the panel unanimously recommends a disability rating of 10%, coded 5229 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain, Status Post Fracture at Distal Phalanx, Right Middle Finger	5229	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160709, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015294, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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