RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-04461
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20091120

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “right (dominant) index finger, limitation of motion of” with a disability rating of 10%.

CI CONTENTION: Review requested of right hand injury as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).

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 - 20091105	VARD - 20100412	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Index Finger…	5229	10%	Status Post Right Index Metacarpal Neck Fracture with Multiple Corrective Surgeries	5229	10%	20091118	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right (Dominant) Index Finger. According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained a right index finger metacarpal neck fracture in December 2007 and underwent open reduction and percutaneous pinning in January 2008. He developed a malunion of the fracture and subsequently underwent a corrective osteotomy with plate fixation in June 2008. Following the healing of the osteotomy site, he had a third procedure in February 2009 for hardware removal along with another tendon release.

The 31 August 2009 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of right index finger stiffness and pain. Physical examination showed flexion contractures of 25 degrees at the metacarpophalangeal (MCP) and 20 degrees at the interphalangeal joints of the right index finger. Range of motion measurements showed flexion to 60 degrees at the MCP, 20 degrees at the interphalangeal, and 10 degrees at the distal interphalangeal joints; painful motion was not addressed.

At the 18 November 2009 VA Compensation and Pension (C&P) examination, 1 week before separation, the CI reported not being able to completely extend or flex his right index finger. Physical examination showed limited right index finger motion and a 1 inch gap with grasping of the palmar crease and the inability to touch the thumb. There was moderate stiffness and pain, but no additional ROM loss with repetitive motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the finger condition 10%, coded 5229 (index finger, limitation of motion), citing a 1 inch gap between the fingertip and the palmar crease. The VA also rated the finger condition 10%, coded 5229 (index finger, limitation of motion), based on the C&P examination, citing “limitation of motion of the index or long finger, with a gap of one inch (2.5 cm) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees.” Panel members noted that the highest rating for the index finger under code 5229 is 10%, and there were no other applicable codes for this condition. 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 finger condition.

BOARD FINDINGS: In the matter of the right 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.

The following documentary evidence was considered:

	PD-2017-04461

AR20190012186, XXXXXXXXXXXXXXXXXX

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.