RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04658
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O2, Infantryman, medically separated for “unfavorable ankylosis of left (non-dominant) middle finger” and “right (dominant) ring finger limited range of motion,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  “It has been over a decade since my injury.  Since then I have experienced more pain in each hand, particularly in the left one.  My ability to grip things with the left has also decreased.”  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 - 20041108	VARD - 20050315	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Unfavorable Ankylosis of Left Non-Dominant) Middle Finger	5226	10%	Proximal Interphalangeal [PIP] Joint Arthritis with Ankylosis, Left Long Finger, Status Post [S/P] Fracture and Surgical Repair	5010-5226	10%	20041112	
			Left Hand Grip Strength Weakness, S/P Long Finger Surgery 	5226-5308	10%		
Right (Dominant) Ring Finger Limited Range of Motion	5230	0%	Limitation of Motion, Right Ring Finger w/ PIP Joint Arthritis	5010-5230	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Unfavorable Left Middle Finger Ankylosis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained a closed digit injury in April 2003 when his left middle finger got caught in his parachute risers during Airborne School.  He underwent an open reduction internal fixation of the proximal phalanx, with minimal post-operative occupational therapy results, and subsequently underwent a PIP joint capsulectomy (removal of tissue around the joint), with hardware removal in March 2004.  An occupational therapy evaluation on 2 June 2004 documented left hand grip strength of 42 pounds on the left and 68 pounds on the right, with decreased functioning range of motion (ROM). 

The 27 September 2004 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of persistent left middle finger flexion contracture with PIP joint ankylosis.  The examiner documented that the CI was not able to perform pushups, pullups, swim, and had gripping difficulty, but could lift approximately 25 pounds; these limitations were more prevalent on the left hand than the right.  Physical examination showed left middle finger joint ROM from -10-95 degrees (normal 90) for the metacarpal phalangeal (MCP) joint, and  -10 to 30 degrees (normal 90) for the distal interphalangeal (DIP) joint with the ability to only flex the joint. The PIP joint ROM was -55-65 degrees with an angular and rotational deformity of supination of approximately 5 degrees.  He had well-healed surgical incisions on the finger and decreased sensation to light touch of the left finger pad.  The 15 October 2005 commander’s statement indicated that the CI was unable to meet required physical standards or perform field duties to include carrying a heavy load or firing a weapon due to the “permanent injuries sustained to his left middle finger and right ring finger.”  

At the 12 November 2004 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported the left middle finger pain after fracture and surgical repair.  Physical examination showed that he could tie his shoelaces, fasten buttons, and pick up a piece of paper and tear it without difficulty.  Left hand strength was slightly reduced.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated left finger ankylosis 10%, coded 5226 (long finger, ankylosis), citing unfavorable flexion contracture and PIP joint ankylosis.  The VA rated the left finger ankylosis 10%, analogously coded 5010-5226 (arthritis due to trauma-long finger, ankylosis), as well as left hand grip strength weakness 10%, analogously coded 5226-5308 (long finger, ankylosis-Group VIII), based on the C&P examination, citing moderate weakness and muscle disability secondary to tendon surgery and long finger ankylosis affecting the overall hand function.  Members noted that a 10% rating was the highest rating possible under code 5226.  The panel also considered an additional rating for left hand weakness under code 5308, and agreed that the preponderance of STR evidence documented decreased functioning ROM and left hand grip strength, and warranted an additional “moderate” 10% rating for the left hand muscle disability, noting there was no violation of VASRD §4.14 (pyramiding) or 4.68 (amputation rule).  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 left middle finger ankylosis, coded 5226, and an additional 10% for the associated left hand muscle disability, dual coded 5226-5308.

Right Ring Finger Limited ROM.  According to the STR and MEB NARSUM, the CI’s right finger condition resulted from the aforementioned airborne accident, and he also underwent a right ring finger open reduction internal fixation of the proximal phalanx in April 2004.  Occupational therapy results were minimal.  The MEB NARSUM examination noted complaints of malunion of right ring finger proximal phalanx.  Physical examination showed measured ROM as:  Physical examination showed right ring finger joint ROMs as: MCP from -10-95 degrees, PIP from 28-92 degrees, and DIP from 0-30 degrees; painful motion was not addressed.  The examiner noted well-healed surgical scars, tenderness over the ulnar aspect of the proximal phalanx, and a significant angular deformity with scissoring over the longer finger, but no rotational deformity. 

At the C&P examination, the CI reported right ring finger pain but was able to tie his shoelaces, fasten buttons, and picked up and tear a piece of paper without difficulty.  Right hand dexterity evaluation showed a 1-cm gap between the proximal transverse crease of the palm to ring fingertip.  Right hand strength was slightly reduced and finger joint ROM showed:  MCP to 90 degrees, PIP to 100 degrees, and DIP to 40 degrees; painful motion was not addressed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right finger condition 0%, coded 5230 (ring finger, limitation of motion), citing limited ROM.  The VA also rated the right finger condition 0%, dual coded 5010-5230 (arthritis due to trauma-right finger, limitation of motion), based on the C&P general examination, citing a noncompensable examination.  Members noted that the highest ring finger limitation of motion rating is 0%, and that painful motion or ROM limited by pain was not addressed in the STR or VA evidence.  As with the aforementioned left hand analysis, the panel considered a right hand weakness rating under code 5308, and agreed that the preponderance of STR evidence documented decreased functioning ROM and right hand grip strength, and warranted an additional “slight” 0% rating for the right hand muscle weakness.  However, this additional rating offers the CI no benefit.  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 finger condition.

BOARD FINDINGS:  In the matter of the left finger condition, the panel recommends a disability rating of 10%, coded 5226 IAW VASRD §4.71a, and an additional 10% rating for left hand weakness coded 5226-5308 IAW VASRD §4.73.  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.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Unfavorable Ankylosis of Left (Non-Dominant) Middle Finger	5226	10%	
Left (Non-Dominant) Hand Muscle Weakness	5226-5308	10%	
Right (Dominant) Ring Finger Limited Range of Motion	5230	0%	
COMBINED	20%	

The following documentary evidence was considered:

[AR NUMBER], XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

					      
Enclosure