RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01256
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040925

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Network Switching Systems Operator-Maintainer, medically separated for “flexion contracture, left (non-dominant) index finger” with a disability rating of 0%.  

CI CONTENTION:  No specific contention was made.  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(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  The panel 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 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 - 20040721	VARD - 20050209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Flexion Contracture, Left (non-dominant) Index Finger	5229	0%	Ankylosis at the Proximal Interphalangeal Joint, Left Index Finger	5225	10%	20041222	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left (non-dominant) Index Finger Flexion Contracture.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-handed CI sustained a left index finger laceration on 17 April 2003.  He underwent three surgeries: 2 May 2003 for a flexor tendon repair; 25 August 2003 for flexor tendon tenolysis; and 16 September 2003 for a palmaris tendon graft.  

During the May 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported his left index finger was numb at some parts and tingled when touched at others.  Physical examination showed the left index finger was prominently flexed at the proximal interphalangeal (PIP) joint and the CI was unable to extend the finger upon attempts to extend.  There was minimal flexion ability at the distal interphalangeal (DIP) and proximal PIP joints.  The CI was able to minimally flex at the PIP with the other fingers held straight.  Muscle strength was decreased (4/5) and light touch sensation was intact.  

The 22 June 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of the left index finger PIP joint’s progressive loss of extension.  The CI reported no pain at rest, but pain increased to a 6/10 level with gripping, lifting and increased use.  Physical examination showed two-point radial digital nerve discrimination greater than 10 mm and the ulnar nerve less than 5mm.  Grip strength was 50 pounds compared to 130 pounds on the right.  Left pinch strength was noted to be 10 pounds compared to 30 pounds on the right.  Three-point left pinch was 11 pounds versus 28 pounds on the right.  Metacarpophalangeal joint range of motion was limited in flexion and extension, and some motion was only in conjunction with motion of other fingers.  The CI was able to flex the tip of his index finger to the thenar eminence (muscle pad at the base of the thumb).  

At the 22 December 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported he had undergone four surgeries and his joint was totally ankylosed.  Physical examination showed left index finger PIP joint ankylosis (abnormal stiffening and immobility).  Left index finger X-rays revealed the finger was in a 90 degrees flexed position at the level of the PIP joint but was otherwise unremarkable.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left index finger condition 0%, coded 5229 (index or longer finger, limitation of motion), citing an ability to flex the top of the finger to the thenar eminence.  The VA also rated the left index finger condition 10%, coded 5225, (index finger, ankylosis), based on the C&P examination 3 months after separation, citing left index finger ankylosis.  

The panel deliberated if the CI’s limitation of index finger motion more nearly approximated the 10% rating criteria under code 5229.  The 10% criteria specifies a one-inch gap between the fingertip and the proximal transverse crease of the palm; not the thenar eminence.  Given the anatomic difference (distance) between the thenar eminence and the proximal transverse crease of the palm, the MEB NARSUM examination most nearly approximated the 10% rating disability picture.  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 left index finger condition, coded 5225.  

BOARD FINDINGS:  In the matter of the left index 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 the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left (Non-Dominant) Index Finger Flexion Contracture	5229	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160926, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180000480, 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