RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-04987
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040728

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Pavements and Construction Equipment Craftsman, medically separated for “crush injury right hand with persistent pain and swelling” with a disability rating of 10%.  

CI CONTENTION:  “On going issues with hand injury and asthma.”  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 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 - 20040316	VARD - 20050126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crush Injury Right Hand…	5309	10%	Residuals, Crush Injury to Right Hand Muscle Group IX	5309	10%	20041228	
Asthma 	6602	EPTS	Asthma	6602	10%	20041228	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Hand Crush Injury.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered a crush injury in April 2003 when his right hand was caught between a ball joint and a piece of heavy machinery;  X-rays taken at the time were negative for fracture in the wrist, hand and fingers.  The 20 November 2003 MEB NARSUM examination, 8 months prior to separation, noted complaints of chronic right wrist and hand pain with intermittent swelling that had not improved since the injury.  He was unable to carry or move objects in the right hand, although he had good grip strength.  Physical examination showed no skin discoloration or temperature change compared to the left hand.  The CI reported decreased sensation in the radial, median and ulnar nerve in the right hand compared to the left.  Wrist range of motion (ROM) tests recorded, in degrees: flexion to 75 (normal 80), extension to 60 (normal 70), radial deviation to 30 (normal, 20), and ulnar deviation to 50 (normal 45).  There was full active ROM in the fingers, hand, and elbow.
At the 28 December 2004 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported constant pain that radiated up the arm and occasionally went up over the back of his head and triggered migraine headaches.  Physical examination showed grip strength of 3/5, but no muscle atrophy of the hand or temperature/color changes.  There was diffuse soft tissue swelling of the hand, but finger and elbow ROM was full.  Wrist flexion was to 60 degrees and extension to 60 degrees, with pain in both planes.

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 function: the forearm muscles), citing accordance with DoD and VASRD guidelines.  The VA also rated the right hand condition 10%, coded 5309, based on the C&P examination, citing limitation of motion and pain.  A higher 20% rating under code 5309 requires demonstration of impairment to the moderately severe level, however, because both the NARSUM and C&P examinations showed near full hand, finger and elbow ROM, and no muscle atrophy with 3/5 strength, panel members agreed at a 10% rating, and no higher, was justified.  There were no additional applicable codes that would result in a higher rating.  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.  

Contended PEB Condition:  Asthma.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Although the CI was placed on a temporary profile for asthma, the commander stated that he was able to work full shifts with no interruption and satisfy duty requirements.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, panel members concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right hand condition and IAW VASRD §4.73, the panel recommends no change in the PEB adjudication.  In the matter of the contended asthma, the panel agrees it cannot recommend it for additional disability rating.  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.   

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04987.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.

						Sincerely,