RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00028
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “gunshot wound left (non-dominant) hand with deformity of middle, ring, and little fingers” with a disability rating of 20%.  

CI CONTENTION:  The CI had a problem displaying weakness at time of discharge but has since matured.  His gunshot wound only got worse over time until 2014 when a bunch of bone and scar tissue was removed.  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 - 20041005	VARD - 20051129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Gunshot Wound Left (Non-Dominant) Hand With Deformity of Middle, Ring, and Little Fingers	5222	20%	Deep Loss of Sensation, Middle, Ring, Small Fingers, S/P Left Hand Gunshot Wound	8514	20%	20050510	
			Post Traumatic Changes and Deformity of the Fourth and Fifth Metacarpophalangeal Joints, Residuals of Gunshot Wound, Left Hand	5299-5223	10%	20050510	
			Scar and Deformity, Left Hand	7800	10%	20050510	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Gunshot Wound Left (Non-Dominant) Hand With Deformity of Middle, Ring, and Little Fingers.  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his left hand in February 2003 as the result of an accidental gunshot wound during training, for which he had almost complete amputations of the small finger and ring finger.  He also had open fractures of the metacarpals of his index and middle fingers as well as soft tissue injury.  The CI underwent replantation of the small and ring fingers and K wire fixation on 12 February 2003.  

The 27 August 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of inability to a make a fist and his grip strength was significantly decreased so that he could not hold on to heavy or even small objects.  Physical examination of his hands revealed four dorsal scars and one over the first web space approximately a centimeter and a half, one between the second and third metacarpal proximally 8 centimeters in length, one approximately 5 centimeters in length oblique over the ring finger metacarpal, and another oblique scar over the small finger and ring finger metacarpophalangeal (MCP) joint.  Volarly he had four scars approximately 2 to 3 centimeters in length.  He had a puncture type of wound in between the small finger and ring finger metacarpals.  He had some scars also noted times two in the palmar distal and proximal flexor creases that were well healed.  Examination of his function and motion showed that he could oppose his index finger, middle finger, and ring finger to his thumb.  He was unable to make a composite fist secondary to contractures at the MCP joints of the ring finger and the small finger.  He hyperextended his ring finger and small finger MCP joints approximately 20 to 30 degrees and only got the neutral flexion with passive and in active motion.  He had flexion contractures of the proximal interphalangeal joints (PIPJ).  He only flexed approximately 40 to 45 degrees of these joints and digits.  The range of motion (ROM) of his distal interphalangeal joints (DIPJ) were unaffected.  The ROM of his index finger was unaffected but his middle finger only flexed at the MCP joint approximately 70 degrees and he had full active motion at his PIPJ and his DIPJ of that finger.  He had decreased sensation over the radial and ulnar aspect of his middle finger so that he did not feel deep sensation or light touch.  In the volar aspect of his little finger he had decreased light sensation to his middle finger, small finger, and ring finger to light touch versus the opposite side.  He had no deformities of his nails or his nail bed.  There were no changes in the coloration of the fingers.  He had capillary refill that was less than 2 seconds (normal).  He had 2+ radial and ulnar pulses.  He did not complain of any pain.  

At the 10 May 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported he was unable to make a fist and his grip strength was significantly decreased.  Physical examination was identical to the NARSUM examination.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hand condition 20%, coded 5222 (favorable ankylosis, long, ring, and little fingers).  The VA rated the left hand condition 20%, coded 8514 (paralysis of the musculospiral (radial) nerve), based on the C&P examination, citing incomplete paralysis of hand movements which was mild.  The VA also rated the left hand condition 10%, coded 5299-5223 (analogous to limitation of motion, two digits of one hand), citing favorable ankylosis of two fingers other than the thumb and index finger.  

The panel concluded there was no available code warranting a rating higher than the 20% utilizing codes for limitation of motion, favorable ankylosis, or unfavorable ankylosis of the non-dominant hand since the thumb and index finger were not involved.  The panel found no evidence in the record of a “moderately severe disability of muscles” for higher rating IAW §4.73, typically characterized as requiring prolonged hospitalization and involving infection, soft tissue sloughing or muscle scarring, and muscle tissue loss.  The CI clearly had some neurologic impairment with a significant loss of sensation to the middle finger and some decreased sensation of his ring and little fingers and had decreased grip strength of his left hand.  However there was not a rating of more benefit to the CI.  Therefore the panel concluded there was not sufficient evidence to support a rating higher than the 20% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left hand condition.  

BOARD FINDINGS:  In the matter of the left hand condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006288, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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 been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX

Sincerely,					      
Enclosure