[AR Number], XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

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

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2016-01781
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Armament, Avionics and Electrical Systems Repairer, medically separated for “right (dominant) index finger fracture” with a disability rating of 0%.  

CI CONTENTION:  “My mobility gets in the way of some normal activities.  My finger and hand gets sore with minimal activity.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040108	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominant) Index Finger Fracture	5229	0%	Residuals of Right Index Finger with Status Post ORIF	5299-5229	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Index Finger (RIF) Fracture.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported injuring his RIF when going over a wall during an obstacle course. He underwent an open reduction internal fixation (ORIF) of a proximal interphalangeal joint (PIPJ) fracture on 5 August 2003, but refused surgery for pin removal and opted to move forward with MEB proceedings to return home due to family problems.  In September 2003, an X-ray showed healing in slight radial angulation.  Subsequent occupational therapy (OT) examinations showed a weak grip, and on 12 November 2003, measured range of motion (ROM) was -25-90 degrees (normal 0-100) for metacarpophalangeal joint (MCPJ), 20-35 degrees for the PIPJ and 10-20 degrees for the distal interphalangeal joint (DIPJ).  

The 17 November 2003 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of pain and the inability to perform his military specialty duties.  He continued to refuse removal of the pin, which the provider noted could relieve discomfort and possibly help regain motion and function.  Physical examination showed the RIF PIPJ was swollen and mildly in varus, with tenderness noted especially on the ulnar side.  The ROM was “not assessable” with the joint “held about 5 degrees flexed.”  Residual stiffness was noted, but neurovascular function was intact.  The OT examination on 18 November 2003 noted active ROM of the RIF MCPJ from 0-95 degrees, PIPJ from 15-60 degrees and DIPJ from 0-30 degrees.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the RIF condition 0%, coded 5229 (index or long finger, limitation of motion), citing post-ORIF residual limitation of motion.  The VA rated the index finger condition 10%, analogously coded 5299-5229, based on the STR, citing pain limiting impairment with daily activities, continued tenderness, swelling with mild varus, and ROM as reported on 12 November 2003.  Members noted that based on the MEB NARSUM examination, the CI met criteria for a 10% rating under code 5229 for “a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible.”  There was no RIF ankylosis to support consideration under code 5225, and no paralysis of the radial or median nerves affecting index finger motor function for rating under codes 8514 or 8515.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the RIF condition, coded 5229.  

BOARD FINDINGS:  In the matter of the right index finger fracture, the panel recommends a disability rating of 10%, coded 5229 IAW VASRD §4.71.  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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Index Finger Fracture	5229	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161124, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record