RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-02825
BRANCH OF SERVICE:  Army	BOARD DATE:  20150708
SEPARATION DATE:  20060818

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Cannon Crew Member) medically separated for mild incomplete paralysis of non-dominant radial nerve.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  The profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  Proliferative nerve injury secondary to shrapnel and producing left triceps atrophy (radial nerve) were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded tardy ulnar nerve with elbow pain on the left non-dominant arm and neck pain secondary to shrapnel wounds for PEB adjudication.  The Informal PEB (IPEB) adjudicated the history of left (non-dominant) radial nerve injury as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  An Administrative PEB was conducted and adjudicated mild incomplete paralysis of non-dominant radial nerve as unfitting, rated 20% citing application of the VASRD.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  The applicant makes no specific contention in his application.  He was not evaluated for TBI or PTSD conditions.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any condition outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Administrative IPEB – Dated 20060613	VA* - (~8 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Incomplete Paralysis of Non-Dominant Radial Nerve	8514	20%	Left Arm Triceps Muscle Injury	5306	0%	20070409	
			Residual Scar, Left Arm	7804	10%	20070409	
Other MEB/PEB Conditions x 2 (Not In Scope)	Other x 5	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070626 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Mild Incomplete Paralysis Of Non-Dominant Radial Nerve.  The record showed that the CI sustained a blast injury to the non-dominant left forearm on 5 February 2005.  The wound was treated, some of the shrapnel removed, and rehabilitation begun.  Despite this, left hand weakness and hypersensitivity persisted.  Electrodiagnostic studies (EDX) on 5 April 2005 showed injury to the left radial and ulnar nerves.  He continued rehabilitation with reduced, but persistent symptoms.  He was seen in physical medicine on 15 February 2006 and recommended for MEB.  At the DD Form 2808, Report of Medical Examination, performed non 28 March 2006, the CI reported a subjective inability to move his neck and left arm.  The examiner observed FROM (full range-of-motion) on examination.  The neurological examination was checked “normal.”  The MEB narrative summary (NARSUM) was a month later on 28 April 2006, 4 months prior to separation.  The examiner noted that some of the shrapnel had not been removed.  The CI reported decreased strength and loss of sensation in the left hand and arm [forearm].  His strength was essentially normal in rehabilitation and physical medicine.  However, his continued pain precluded performance of full duty.  On examination, there was essentially FROM of the neck, shoulders, elbows, wrists, and hands.  He reported pain at the elbow with repetitive motion.  The neurological studies of the left arm were recorded as “essentially normal.”  The injury to the radial nerve was thought to be medically unacceptable; the ulnar nerve was medically acceptable.

At the VA Poly-trauma Compensation and Pension (C&P) examination performed on 30 March 2007, 8 months after separation, the CI reported left hand weakness and numbness in the ulnar distribution.  The neurological examination was essentially normal other than some decreased sensation in the ulnar distribution over the left hand.  A week later in the Neurology C&P examination, the CI reported a burning sensation of the left arm down to the fourth and fifth fingers (ulnar distribution).  The examination was normal, other than decreased sensation of the left hand in an ulnar distribution and possible weakness of some of the intrinsic muscles of the hand.  Repeat EDX studies 2 days later showed mild left carpal tunnel syndrome (a compression of the median nerve).

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left radial nerve for mild incomplete paralysis at 20%, coded 8514 (paralysis of the radial nerve).  The VA did not rate the radial nerve condition directly, but did assign a non-compensable 0% rating for left triceps atrophy, coded 5306 (extensor muscles of the elbow).  The evidence supports an impairment of no more than mild for the left radial nerve injury.  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 left radial nerve 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 left radial nerve 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

			
XXXXXXXXXXXXXXX 
President 
DoD Physical Disability Board of Review

AMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20150012801 (PD201302825)

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						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA