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

From:	Director, Secretary of the Navy Council of Review Boards
To:	PD-2017-03137

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 27 Jun 19

IN REPLY REFER TO

1850
CORB:003
27 Feb 20

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

2.	On 21 February-2020, the Assistant General Counsel of the Navy (Manpower &
Reserve Affairs) took action in your case by  accepting the   recommendation of
the PDBR.	Accordingly,  your  records  will  be corrected  to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (FEB) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents  final action in  your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion,

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-03137
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20081201

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aviation Structure Mechanic, medically separated for “right [major-hand] fourth and fifth carpometacarpal joint posttraumatic arthritis” with a disability rating of 10%.

CI CONTENTION: “My right hand-wrist has gotten worse. I had to cut off my pinky finger and have had numerous surgeries.”  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 - 18 September 2008	VARD - 20091006	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Right Fourth and Fifth Carpometacarpal Joint Posttraumatic Arthritis	
“5299-5232”	
10%	Right Hand Hardware and Bone Graft Metacarpal Arthrodesis of Ring and Little Finger due to Pseudoarthrosis	
5299-5223	
10%	
20090723	
			Right Wrist Closed Hamate Bone Fracture	5215-5024	10%	20090723	
Multiple Extensor Tendon Ruptures	Category II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Right [Major] Fourth and Fifth Carpometacarpal Joint Posttraumatic Arthritis. According to the service treatment record and MEB narrative summary (NARSUM), the right-handed CI had a fifth finger dislocation and then sustained a right hamate (carpal bone) fracture in February 2005 that

developed posttraumatic fourth and fifth carpometacarpal arthritis. The CI underwent four right hand surgeries: a fourth and fifth carpometacarpal joint fusion (11 August 2006); a revision arthrodesis of the fourth and fifth carpometacarpal joint (8 August 2007); a ring and small finger extensor tendon reconstruction (17 December 2007); and a right hand debridement and irrigation (28 March 2008).

The 12 May 2008 MEB NARSUM examination, 7 months prior to separation, noted complaints of right hand pain. Physical examination showed well-healed dorsal ulnar wrist and hand incision with minimal swelling. There was mild-to-moderate tenderness at the surgical site and over the base of the fourth and fifth carpometacarpal joint. The CI could not complete a full grip with his ring and small fingers, with very slight scissoring of the small finger noted. All grip produced ulnar hand pain. Range of motion (ROM) of the little finger was 0-50 degrees at the knuckle (MPJ), 0- 90 degrees at the proximal interphalangeal (PIP) joint and full at the distal (DIP) joint. Diagnostic imaging revealed retained hardware. The examiner stated the CI’s injury and surgeries “[have] left him with a stiff and painful hand with limited function and work capacity.”

At the occupational therapy (OT) evaluation on 19 May 2008 the CI had a right little finger -10 degree contracture, and fourth and fifth fingers with painful motion and decreased extension/flexion and strength. Right grip was 30 pounds (left 120) and pinch was 10 pounds (left 25). There was 8/10 pain with pressure or massage at the scar incision. The orthopedic follow-up on 27 May 2008 noted continued considerable pain to the right hand with limited flexion and intermittent hand numbness. Physical examination showed a thick incision scar with re-scarring of the extensor tendon and a positive Tinel’s and Phalen’s test (neurologic irritation). The assessment was right carpal tunnel syndrome and re-scarring of the tendon, with treatment of a carpal tunnel steroid injection.

At the 30 May 2008 VA Compensation and Pension (C&P) general examination, 6 months before separation, the CI reported right wrist pain up to 10/10 with radiation up to the elbow and weakness, stiffness, swelling, redness, giving way, lack of endurance, locking, fatigability, and dislocation. The CI also complained of carpal tunnel syndrome, osteoarthritis, and an inability to make a fist, pick up anything heavy, or straighten his fourth and fifth fingers. Physical examination showed right wrist tenderness and guarding with dorsiflexion of 50 degrees (normal
70) and palmar flexion of 60 degrees (normal 80). The CI had difficulty tying shoelaces, fastening buttons, and picking up a piece of paper and tearing it with the right hand. On examination of hand dexterity, the gap between the proximal transverse crease of the palm to the right hand little fingertip was 1.5 cm (normal 0). The right little finger lacked 20 degrees of PIP flexion, 60 degrees of MP flexion, and 35 degrees of DIP flexion.

At the 23 July 2009 C&P wrist and finger examination, 8 months after separation, the CI reported decreased function of the right hand with right wrist weakness, stiffness, swelling, giving way, lack of endurance, locking, deformity, tenderness, and pain with flare-ups as often as 10 times per day with lost joint motion. There was constant fourth and fifth finger pain of 8/10 which traveled to the arm; surgery was planned. Physical examination showed a painful deep right wrist and hand scar with underlying tissue damage. There was abnormal right wrist movement with tenderness, deformity, guarding of movement, and malalignment. The CI could tie shoelaces, fasten buttons, and pick up a piece of paper and tear it without difficulty. Right wrist ROM lacked 10 degrees of dorsiflexion and palmar flexion. The right hand fingertips could approximate the transverse crease and there was no gap in opposition to the thumb and fingers. VA documents revealed the CI underwent amputation of the right little finger in August 2009.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right [major] fourth and fifth carpometacarpal joint condition 10%, analogously coded “5299-5232” (likely a typographical error intended to be 5223 - two digits of one hand, favorable ankylosis).       The VA rated the right fourth and fifth finger hardware and bone graph

metacarpal arthrodesis condition 10%, analogously coded 5299-5223, based on the C&P general examination, citing functional limitations. The VA also rated the closed hamate bone fracture, right wrist condition 10%, dual coded 5215-5024 (wrist, limitation of motion–tenosynovitis), citing wrist limited motion, guarding, tenderness, and DeLuca.

The 10% rating by both the PEB and VA is the highest available for ankylosis of the major ring and little fingers, and therefore no higher rating is warranted for the fingers condition. However, the PEB also listed multiple extensor tendon ruptures status post reconstruction as a related diagnosis (Category II) contributing to the disability in this case. The CI’s disability from the tendons and hamate (carpal versus metacarpal) condition was intrinsic to the CI’s inability to perform duties and is separately unfitting and ratable analogous to the wrist. The panel noted the VA changed carpal bone indication from hamate to scaphoid.

There was documented functional loss and limited motion of the wrist to support a 10% rating. There was no ankylosis of the wrist, and 10% was the highest VASRD rating available under any code. The panel adjudged that at separation the CI’s disability did not more nearly approximate loss of use of the hand or amputation of the fifth finger. The CI’s fifth finger amputation occurred after separation, and was a post-separation worsening of the CI’s condition, and not ratable at separation. 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 right fourth and fifth metacarpal condition, coded 5299-5232, and a disability rating of 10% for the right extensor tendon and carpal condition, coded 5215-5024.

BOARD FINDINGS: In the matter of the right fourth and fifth carpometacarpal joint posttraumatic arthritis with multiple extensor tendon ruptures condition, the panel recommends a disability rating of 10% for the right fourth and fifth metacarpal condition, coded 5299-5232, and a disability rating of 10% for the right extensor tendon and carpal condition, coded 5215-5024, both IAW VASRD §4.71a. 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 Fourth and Fifth Carpometacarpal Joint Posttraumatic Arthritis	5299-5223	10%	
Multiple Extensor Tendon Ruptures and Carpal Joint Posttraumatic Arthritis	5215-5024	10%	
	COMBINED	20%	

The following documentary evidence was considered: