RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02924
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060313

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Motor Transport Operator, medically separated for “amputation of left (non-dominant) long and ring fingers” with a disability rating of 20%.   

CI CONTENTION:  “Issues with left hand and functionality.  PTSD was not looked in to.  Bi-lateral hearing loss.”  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 - 20060112	VARD - 20070323	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Amputation of Left (Non-Dominant) Long and Ring Fingers	5149	20%	Amputations, Left Middle and Ring Fingers	5149	20%	STR	
Injury to the Left Small Finger 	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Amputation of Left (Non-Dominant) Long and Ring Fingers.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left long and ring fingers were traumatically amputated in November 2004 after sustaining wounds from an IED explosion while deployed.  X-rays showed absence of the ring finger distal to the proximal interphalangeal joint and absence of the long finger through the proximal phalanx.  There was also a healed fracture of the small finger.   The 21 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, revealed partial amputation of the left third and fourth fingers with decreased range of motion (ROM) of the left fifth finger.  

The 27 July 2005 MEB NARSUM examination, 8 months prior to separation, noted complaints of difficulty with bimanual tasks, particularly handling heavy materials or small objects.  Grip with the left finger was impaired due to absence of the long and ring fingers and small finger limitation of motion and strength.  He was unable to carry a pail or suitcase with his left hand.  Physical examination showed the long and ring finger amputation sites with well-healed scars without unusual tenderness.  Motion of the metacarpophalangeal joints (MTPJs) of the ring and long fingers was from full extension to 70 degrees flexion (normal 90).  The ROM of the small finger MTPJ was from full extension to 60 degrees flexion.  Strength in the small finger joints was near normal and strength in the MTPJ joint extension was normal while strength in the interphalangeal joint extension was markedly diminished. 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 amputation of the left long and ring fingers 20%, coded 5149 (two finger amputations (long and ring)), citing amputation through proximal phalanx of long finger and at PIP joint of ring finger.  The VA also rated the amputation of the left long and ring fingers 20%, coded 5149, based on the STR, citing amputation of the long and ring fingers.  Panel members agreed there was no possible higher rating than the 20% assigned by the PEB.  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 amputation of the left long and ring fingers.  

Contended PEB Condition:  Injury to the Left Small Finger.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was permanently profiled and failed retention standards but was not implicated in the commander’s statement.  The NARSUM examination of the small finger revealed healed surgical and wound scars predominantly on the ulnar side of the finger and palm with no infection.  There was a rotational deformity of the small finger of about 30 degrees.  The NARSUM noted the CI had a total of 6 surgical procedures, most recently on 25 April 2005, with a nerve graft from a sensory branch of the ulnar nerve at the elbow to the small finger.  He could bring the tip of the small finger to within 3.3 cm of the palm and could bring the tip of the thumb to the tip of the small finger.  Sensation on the radial side of the small finger was normal while sensation on the ulnar side of the finger was decreased.  He could feel light touch to the level of the base of the nail but was without feeling over the ulnar side of the tip of the small finger.  Orthopedics noted that limitation of motion and strength of the small finger helped impair grip strength of the left finger.  However, the panel noted the fracture had healed and there was no evidence of ankyloses.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.   After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the amputation of the left (non-dominant) long and ring fingers and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended injury to the left small finger, the panel recommends no change from the PEB determination as not unfitting.  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 20170321, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190008792, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX
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,