RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	BRANCH OF SERVICE:  Army
CASE NUMBER:  PD1201577	SEPARATION DATE:  20020212
BOARD DATE:  20130430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Specialist/E-4 (44E10/Machinist), medically separated for benign idiopathic tremor (essential tremor), rated as mild, involving only the hands.  The CI complained of an insidious onset of a bilateral hand tremor which interfered with his ability to do work-related tasks beginning in June of 2001.  The CI was diagnosed with an essential tremor.  Despite multiple medication adjustments, his bilateral hand tremor persisted.  The CI’s condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent P3/L2 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication.  The PEB adjudicated the essential tremor/benign familial tremor as unfitting, but determined it existed prior to service (EPTS) and was not permanently service aggravated (PSA), and therefore, not ratable or compensable.  The case was suspended after new evidence was received and returned for a review of the diagnosis.  The diagnosis was changed to benign idiopathic tremor (essential tremor), and the PEB processing resumed.  Upon Informal Reconsideration, the PEB rated the condition 10%, with cited application of the US Army Physical Disability Agency (USAPDA) Policy/Guidance Memorandum #12, dated 8 April 2002, Subject: Table of Analogous Codes, and the Veterans Administration Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “May disability has caused me many problems in the work place. Have already changed my profession because of it.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The ratings for unfitting conditions will be reviewed in all cases.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:  

Informal Reconsideration – Dated 20021009	VA (~3.5 Mos. Post-Separation) – All Effective Date 20021203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Benign Idiopathic Tremor (Essential Tremor)	8199-8105	10%	Benign Essential Tremor	8199-8106	10%	20020414	
↓No Additional MEB/PEB Entries↓	0% X 2 / Not Service-Connected x 2	20020414	
Combined:  10%	Combined:  10%	

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impact that his service-incurred condition has had on his current earning ability and quality of life.  However, the Disability Evaluation System does not have the role or authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  This role and authority is granted by Congress to the Department of Veterans' Affairs.

Benign Idiopathic Tremor (Essential Tremor) Condition.  In 2001, the CI presented with constant, mild shaking of both hands that worsened with movement.  Laboratory studies, magnetic resonance imaging (MRI), and electromyogram (EMG) were all normal.  He was diagnosed with essential tremors and started on medications for control.  The narrative summary (NARSUM) notes that despite multiple medication trials and dosage adjustments, the CI was unable to perform his duties as a machinist.  The CI also reported an inability to perform household tasks and repairs.  Waiting room observation and physical examination demonstrated evidence of a constant bilateral hand tremor; his neurologic examination was otherwise normal.  At the VA Compensation and Pension (C&P) exam about 3 months after separation, the examiner noted four to five-cycles per second bilateral hand tremors at rest and with intention.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the benign idiopathic tremor condition at 10%, coded 8105, analogous to Sydenham’s chorea, mild.  The VA also rated the tremor condition at 10%, analogous to mild, Huntington’s chorea, 8106.  Huntington’s chorea has the same rating criteria as Sydenham’s chorea.  There was no evidence of weakness, abnormal EMG, or other neurologic findings for a higher rating of 30% or moderate.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the benign idiopathic tremor condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the benign idiopathic tremor condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Benign Idiopathic Tremor	8100-8105	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120817, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130010792 (PD201201577)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA