DEPARTMENT   OF  THE  NAVY
SECRETARY  or THE  NAVY  COUNCIL  OF  REVIEW BOARDS
120    f(ENNON  STPEET  SE  STE  309
WASHINGTON  NAVY YARD,  DC 20374

IN  REPLY  PEITR  TO:
1850
CORB:003
27 Feb 20

From:
To:

Subj: Ref:

Director, Secretary of the Navy Council of Review  Boards
PD-2017--03516

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr of 29 May 19

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 (PEB) from 0% to 10% 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-2017-03516
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20090210

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Engineman, medically separated for “tendon adhesions with joint contractures at the PIP [proximal interphalangeal] and DIP [distal interphalangeal)] joints” with a disability rating of 0%.

CI CONTENTION: “The military messed up their surgery, I lost my finger for it. Now I have arthritis, limited motion in hand. I can barely use my right hand.” 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 - 20081209	VARD - 20090306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tendon Adhesions w/ Joint Contractures…	5239	0%	Right Little Finger Flexor Digitorum Profundus Tendon Tear Status Post- Surgical Grafting Repair	
5199-5156	
10%	
20060122	
Status Post Staged Reconstruction of the Right Small Flexor Digitorum Profundus	Cat II					
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Tendon Adhesions with PIP and DIP Joint Contractures. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent the first phase of a right

(dominant) little finger reconstructive surgery in January 2008 after a hyperextension injury ruptured previous flexor tendon scarring from a remote, poorly healed laceration (which had caused PIP and DIP joint contractures). A rod was placed within the flexor sheath of the small finger and removed in May 2008, when the palmaris longus was harvested and used as a graft. The CI immediately began occupational therapy, but developed significant tendon adhesions with contracture of the PIP joint; he declined further surgery.

During the 29 August 2008 MEB NARSUM examination, 5 months prior to separation, the CI reported the inability to perform any heavy lifting/manual labor or fine motor tasks required for his military specialty. Physical examination showed normal right hand motor strength and intact sensation, but grip strength was significantly decreased compared to the left hand. Range of motion (ROM) measurements showed metacarpophalangeal (MCP) joint flexion to 90 degrees (normal), PIP joint fixed at 90 degrees flexion contracture, and DIP joint flexion from 40-50 degrees (normal 80-90).

At the 22 January 2009 VA Compensation and Pension (C&P) examination, 1 month prior to separation, the CI stated that he was not currently employed, but that activities of daily living had not been affected by his finger disability. Physical examination showed MCP joint flexion to 90 degrees, but that the PIP and DIP joints were fixed in flexion at 90 and 40 degrees, respectively.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated right finger condition 0%, coded 5230 (limitation of motion ring or little finger). The PEB also listed “status post staged reconstruction of the right small finger flexor digitorum profundus” as a related Category II condition (contributes to the primary unfitting condition but not separately ratable), and panel members agreed that this was an aspect of the same disability and not separately unfitting or separately ratable IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated the right finger condition 10%, analogously coded 5199-5156 (little finger, amputation of), based on the C&P examination, citing rating based on ankyloses due to PIP joint fixed at 90 degrees and DIP joint fixed in flexion. The panel noted that code 5230 for limitation of motion of the ring or little finger is a non- compensable code, thus a compensable rating under code 5156 was considered for amputation at PIP joint or proximal thereto. Panel members agreed that a 10% rating, but no higher, was justified based on ankyloses of the right little finger as demonstrated during the NARSUM and C&P examinations, which documented the absence of right PIP and DIP joint motion. 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 finger condition, coded 5199-5156.

BOARD FINDINGS: In the matter of the right finger condition, the panel recommends a disability rating of 10%, coded 5199-5156 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	
Tendon Adhesions With PIP and DIP Joint Contractures…	5199-5156	10%