DEPARTMENT  OF THE NAVY
SECRETARY  OF THE NAVY  COUNCIL  OF REVIEW BOARDS
720 KENNON STREET SE STE 309 WASHINGTON  NAVY  YARD  DC 20374-5023

IN REPLY REFER TO

1850
CORB:003
12 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01944

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 19 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy of 15 October 2019 for appropriate action.

2.	On 31 January 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01944 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20070430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Reconnaissance Marine, medically separated for “traumatic amputations to 5th digit on dominant hand, left side,” with a disability rating of 20%.

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 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 - 20070118	VARD - 20070824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Traumatic Amputations to [Fifth] Digit on Dominant Hand, Left Side	5156	20%	Partial Amputation of Ring Finger at Distal Phalanx with Total Amputation, Little Finger at Distal Metacarpal, Left Hand	5151	30%	20070601	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Traumatic Amputations to [Fifth] Digit on Dominant Hand, Left Side. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left fifth digit was traumatically amputated in April 2005 after a grenade explosion. His injuries included complete traumatic amputation of the fifth digit to include the distal metacarpal as well as an open fracture of his distal phalanx on the ring finger of the same hand. The CI subsequently underwent debridement and revision amputation that resulted in a nonunion which was again revised along the fourth finger.

During the 19 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported pain, numbness and tingling in the left hand and “practical amputation” at left fourth finger and amputation of fifth finger. Physical examination noted amputation of the left pinky finger.

The 2 November 2006 MEB NARSUM examination, 5 months prior to separation, showed evidence of the amputation with graft in site. All incisions were healed with no sign of infection. There was decreased sensation to light touch across the distal phalanx around the area of the previous surgery.  Grip strength was decreased.

At the 1 June 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported problems with coordination of the left hand. He had to use both hands for writing. He complained of daily pain caused by typing, and moving simple objects weighing just a few pounds aggravated the left hand. The hand would fatigue easily and he would not be able to use it. The CI reported less strength than normal, and there was numbness on the ulnar border of the hand and tingling on the inside of the fourth finger. The fourth finger was shortened at the tip and closed back. After repairing the nailbed, the nail was deformed and there was bony deformity of the tip of the fourth finger making it very hard to use a keyboard. Physical examination revealed a slightly thinner left arm, but muscle strength was normal. Flexors and extensors of the left hand showed 2/5 ring finger weakness and flexion of the distal phalanx was limited to 80 degrees, compared to 90 degrees at the right ring finger. The examiner also noted the distal phalanx of the left hand was atrophic just prior to the nailbed and the nailbed was dystrophic (wasting away). The ring finger was shortened such that it was 1cm shorter than the right ring finger. The little finger was amputated at the palm. The examiner recorded the left ring finger was amputated surgically, in addition to the little finger.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left hand condition 20%, coded 5156 (little finger, amputation of), citing traumatic amputations of the fifth digit on the left hand as well as injuries to distal phalanx of the fourth digit on the left hand after multiple grafts. The VA rated the left hand condition 30%, coded 5151 (amputation of the ring and little fingers), based on the C&P examination, citing partial amputation of ring finger at distal phalanx with total amputation, little finger at distal metacarpal, left hand (major).

Panel members agreed a 20% rating and no higher was justified for the left fifth digit amputation under code 5156 as recorded in the STR. The panel considered the 5151 code, but noted that rating multiple finger amputations applies only to amputations at the proximal interphalangeal joints or through proximal phalanges. The little finger was amputated at the palm, meeting the criteria; however, the ring finger demonstrated pathology at the distal phalange, not involving the proximal phalange. Therefore, panel members concluded, the 30% rating under code 5151 was not justified. The panel next decoupled the fourth and fifth digits and considered if a higher rating could be achieved by evaluating the fourth finger as a separate condition. A compensable rating under the 5155 code (ring finger, amputation of) requires loss of more than one-half of the bone with metacarpal resection, or that the proximal interphalangeal joint or proximal joint be involved without metacarpal resection. The panel agreed, the fourth finger amputation did not meet this requirement. There were no additional applicable codes to consider that would achieve a higher rating. After due deliberation, considering all 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 amputations to the fourth and fifth digits of the dominant left hand 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.