RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04098
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070131

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Counterintelligence Special Agent, medically separated for “residuals of gunshot wound to right (dominant) hand” with a disability rating of 10%.  

CI CONTENTION:  “I believe I should be awarded the initial 30% disability rating including full retirement and benefits as promised originally.”  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 - 20061207	VARD - 20070510	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Residuals of Gunshot Wound to Right (Dominant) Hand	5309	10%	Status Post Right Thumb Gun Shot Wound with Residuals	5010-5307	30%	20061116	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Right (Dominant) Hand Gunshot Wound.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained a gunshot wound to the thumb during a live fire exercise in October 2005.  The wound was irrigated and debrided, and he underwent surgery that day with removal of the bullet segment and internal fixation of the thumb.  A second surgery was performed in March 2006 where lysis of adhesions, as well as reconstruction of the extensor mechanism with tendon transfer to the interphalangeal (IP) joint, was performed.  

The 24 July 2006 orthopedic MEB consultation, 6 months prior to separation, noted CI complaints of right thumb pain with difficulty grasping objects in a closed-fist manner.  He also could not lift heavy objects or fire a weapon.  Physical examination showed no wrist or thumb tenderness, but there was a significant decrease in grip strength and range of motion (ROM) of the carpometacarpal  and first metacarpophalangeal (MCP) joints.  Extension of the IP joint was weak with strength of 3+/5.  The thumb and hand had intact neurovascular as well as motor function including radial, medial and ulnar nerves.  Grip strength of the remaining fingers was excellent on resistance.  

During the 25 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported limited hand and wrist mobility.  Physical examination revealed decreased wrist extension, flexion, and radial deviation.  Right thumb ROM was also decreased, as was right hand grip strength, but bilateral upper body strength was normal.  The next day, measurements performed by occupational therapy showed right thumb ROM of the MCP joint from 20-35 degrees and of the IP joint from 20-50 degrees, compared to left thumb MCP and IP joints to 65 degrees and 70 degrees, respectively.  Grip strength was 20 pounds and pinch strength was 4 pounds.  

The 3 August 2006 MEB NARSUM examination noted CI complaints of right hand and thumb weakness with pain that was constant and located at the thumb and index finger MCP joints. The symptoms increased with extended use of the hand, increased writing or gripping, or accidentally bumping the hand, and he was unable to hold, grip and fire a weapon.  Medications, heat, resting the hand, and avoiding certain activities provided some relief.  The examiner cited physical findings from the MEB and occupational therapy examinations. 

At the 16 November 2006 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported right thumb pain, and loss of ROM and strength, in addition to weakness and easy fatigability.  He was unable to keep up with normal work requirements because he could not grip a pen to write or hold a weapon and fire, and he had limited lifting abilities.  Physical examination showed he was able to tie shoelaces, fasten buttons, and pick up a piece of paper and tear it without difficulty.  The right hand fingertips were able to approximate the transverse palmar crease, and right and left thumbs were able to oppose the fingers equally at 0 degrees.  Right hand strength was within normal limits, and right thumb ROM showed radial motion to 30 degrees (normal 70), palmar flexion to 60 degrees (normal 70), MCP flexion to 10 degrees (normal 60), and IP flexion to 60 degrees (normal).  There was full ROM of the index, long, ring and little fingers 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hand condition 10%, coded 5309 (Group IX muscles of the forearm and hand function). The VA rated the right hand condition 30%, dual coded 5010-5307 (arthritis due to trauma-group VII muscles arising from internal condyle of humerus), based on the C&P examination, citing an overall disability picture reflecting a moderately severe muscle disability.  With consideration of VASRD 4.56 (evaluation of muscle disabilities including cardinal signs of loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement) and the “cardinal signs” elaborated therein, panel members deliberated over the appropriate rating recommendation.  A rating of 20% under code 5309 is granted when there is evidence of moderately severe muscle function impairment.  The orthopedic examination documented significant decrease in grip strength as well as ROM of the thumb and first finger MCP joint, but grip strength was excellent in the remaining fingers.  The commander’s statement, dated 5 months prior to separation, noted that the CI was unable to hold and write with a pen for any length of time without taking a break, and that this requirement slowed his performance.  The C&P examination, which was most proximate to separation, showed normal grip strength in both hands, and that the right hand fingertips were able to approximate the transverse palmar crease, and the right and left thumb were able to oppose the fingers equally.  The right hand strength was within normal limits, and there was full ROM of the index, long, ring and little fingers.  The CI was able to tie shoelaces without difficulty, fasten buttons without difficulty and pick up a piece of paper and tear it without difficulty.  Thus, panel members agreed that the evidence did not support a higher rating for a moderately severe impairment.  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 right hand condition.  

BOARD FINDINGS:  In the matter of the right hand condition and IAW VASRD §4.73, 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.  

The following documentary evidence was considered:  

AR20190012036,  

Dear XXXXXXXXXXXXXX:

	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.