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

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01978

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 13 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 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:  XXXXXXXXXXXXXXX	CASE: PD-2017-01978
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070918

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Auxiliary Equipment Technician, medically separated for “medial sagittal band injury right middle finger” with a disability rating of 10%.

CI CONTENTION: Review of additional conditions (hypertension, hyperlipidemia, insulin resistance, obstructive sleep apnea, circadian rhythm disorder) not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was requested. 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070615	VARD - 20080424	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Medical Sagittal Band Injury Right Middle Finger	
5229	
10%	Residuals, Hyperextension Rupture of Extensor Tendon to Right Third Finger and Sagittal Band Tear between the Right 2nd and 3rd Fingers	
8515-5024	
10%	
20080108	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Medical Sagittal Band Injury Right Middle Finger. According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI’s right middle finger condition began in January 2006 after his hand was accidently knocked into a submarine bulkhead while performing work. Despite extensive specialty consultation and a prolonged period of occupational therapy, the CI’s painful condition and hand weakness continued.

The 15 May 2007 MEB NARSUM examination, 4 months prior to separation, noted that the CI’s chief complaint was “right hand swelling and pain.” The physical examination (PE) revealed edema over the back of the right hand near the third metacarpal-phalangeal joint. Local tenderness was present as well as painful motion upon making a fist. Comparison grip strength was documented as right greater than left. Although digital range of motion (ROM) was documented in this examination, its written verbiage was uninterpretable.

The 8 January 2008 VA Compensation and Pension (C&P) general examination, 4 months after separation, noted no new or additional physical complaints. The PE revealed inconsistent documentation of right hand grip strength noted as “…the grip of the right hand is determined to be reduced by 85%” and “…the grip of the right hand is reduced by 50% at this time.” Edema was diffusely present over the back of the right hand and the same area was tender. Right third digit ROM was documented as normal at the metacarpal-phalangeal joint, 90 degrees at the proximal inter-phalangeal joint (normal 100) and 10 degrees at the distal inter-phalangeal joint (normal 70).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right middle finger condition 10%, coded 5229 (index or long finger, limitation of motion). The VA rated the right middle finger condition 10%, analogously coded 8515-5024 (median nerve, paralysis-tenosynovitis), based on the C&P general examination, citing wrist and finger painful motion. After due deliberation, considering all the evidence and mindful of VASRD
§4.3 (reasonable doubt), panel members first agreed no firm physical evidence of any sort of nerve irregularity existed to support a nerve-related impairment rating. Members then agreed that an impairment rating under limitation of motion of individual digits was most appropriate and the sole and greatest rating of 10%, coded 5229 (PEB’s rating) was supported. As such, members finally concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the right middle finger condition.

BOARD FINDINGS: In the matter of the right middle finger 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.

2	PD-2017-01978