Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02270
Original file (PD-2013-02270.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02270
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20140702
SEPARATION DATE: 20080825


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (2T3/Vehicle and Vehicular Equipment Maintenance Craftsman) medically separated for bilateral arm numbness and status post carpal tunnel release (CTR) / ulnar nerve release (UNR) transposition. The conditions could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty Code or satisfy physical fitness standards. He was issued a U4 profile and referred for a Medical Evaluation Board (MEB). The MEB documented that the “numbness in left arm condition” did “not meet standards” and was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated “bilateral arm numbness s/p carpal tunnel release and ulnar nerve release” as unfitting, rated 20% combined, including the bilateral factor, citing criteria of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 rating for unfitting bilateral arm numbness and CTR/UNR transposition are addressed below; and no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 :

Service IPEB – Dated 20080520
 VA - (At Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Arm Numbness s/p Carpal Tunnel Release (CTR) and Ulnar Nerve Release (UNR) 8516 10% Residual Scar, Right Wrist, s/p Right CTR 7805 0% 20080818
Residual Scar, Right Elbow, s/p Ulnar Nerve Entrapment Release 7805 0% 20080818
s/p Right CTR and Right Ulnar Nerve Entrapment Release 8515 0% 20080818
Left Arm Numbness s/p Carpal Tunnel Release (CTR) and Ulnar Nerve Release (UNR) 8516 10% Residual Scar, Left Wrist, s/p
Left CTR		 7805 0% 20080818
Residual Scar, Left Elbow, s/p Ulnar Nerve Entrapment Release 7805 0% 20080818
s/p Left CTR and Left Ulnar Nerve Entrapment Release 8515 0% 20080818
Other Items Not In Scope x 0
 Other x 13 (Not in Scope) 20080818
Combined: 20%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 81112 ( most proximate to date of separation .


ANALYSIS SUMMARY:

Bilateral Arm Numbness s/p Carpal Tunnel Release and Ulnar Nerve Release Condition. The CI is right-hand dominant. The history of the CI’s CTS as recorded in the narrative summary (NARSUM) indicated progressive symptoms of bilateral hand and arm numbness associated with pain and weakness over multiple years. In 2006 and early 2007, the CI underwent two procedures by orthopedics for bilateral CTS and right ulnar neuropathy. Initially post-operatively, the CI did very well in regards to less pain and normal sensation. However, his symptoms of bilateral numbness and tingling in his upper extremities re-appeared in mid-2007 and a repeat of electro-diagnostic testing to his left arm revealed ulnar neuropathy that required surgery in December 2007. Despite aggressive physical therapy (PT), orthotics, anesthetic injections, and multiple surgical interventions, his symptoms interfered with his military occupation and therefore he was referred to the MEB. The MEB examination dated 20 March 2008 (5 months prior to separation), the CI reported “intermittent numbness and hands/wrists pain” the CI also noted the ability to perform his duties for “…short timeframes secondary to pain.” His physical exam revealed upper extremities as normal; specifically noting strength, grasp and neurological tests. The final diagnosis was simply a review listing of his previous surgeries. There was no motor impairment identified. His prognosis was “poor” noting minimal symptom improvement despite long-term aggressive treatment modalities and multiple surgical interventions.

At the VA compensation and pension examination (a week prior to separation), the CI reported constant tingling, numbness, weakness in both arms/hands and stated “surgery did not reduce any of the symptoms.” His degree of functional impairment (weakness) was exampled by difficulty in opening jars. Yet, his examination revealed only “slight” reduction in hand strength bilaterally. The VA’s final diagnosis was the same as the NARSUM with the addition of residual paraesthesias (altered sensation) and weakness in both hands. There was no objective assessment of functional ability.

The Board directs attention to its rating recommendation based on the above evidence. The PEB separately rated each upper extremity for CTR and UNR at 10%, using the VASRD code 8516 (ulnar nerve; incomplete paralysis). The VA also separately rated the CTR and UNR using the median nerve code 8515, rated 0% each citing the absence of objective evidence of “mild” incomplete paralysis of the hand. Board members agreed that peripheral nerve codes for either the median nerve or ulnar nerve were appropriate, given the specific pathology in this case. Such VASRD rating levels are mild, moderate, and severe. Members reviewed and considered the application of §4.124a definition of “incomplete paralysis” which includes, “when the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree” and clearly, an absent motor involvement (sensory abnormality) was such the case in this condition. Both nerve ratings (median and ulna) under incomplete paralysis are equivalent for the “mild” (10%; independent of hand-dominance) and “moderate” (20% non-dominant and 30% dominant hand) severity levels. The Board considered if another VASRD-compliant bilateral code was applicable, or if the unfitting left arm and unfitting right arm conditions rated separately would better depicted the CI’s disability condition IAW VASRD §4.7 (higher of two evaluations). All evidence considered there is no reasonable doubt in the CI’s favor supporting a change from the PEB’s current rating decision for the bilateral CTS, surgical intervention condition. The Board agreed that separate conditions of each upper extremity were independently unfitting and ratable to at least the “mild” (10%) severity level. There are no available separate alternative joint, nerve, or other analogous bilateral coding options which are applicable and or advantageous to the CI’s current separate arm rating of 10% each for a combined 20% rating.


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 bilateral arm numbness; s/p CTR/UNR, 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 20131109, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





                 
XXXXXXXXXXXXXX
President
Physical Disabity Board of Review


 SAF/MRB
Dear XXXXXXXXXXXXXX:

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-02270

         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 re-characterization or modification 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 re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.



                                                               Sincerely,





                                                              
XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

Similar Decisions

  • AF | PDBR | CY2014 | PD-2014-00492

    Original file (PD-2014-00492.rtf) Auto-classification: Approved

    The pain rating was mild with occasional moderate pain.At the MEB examination dated 12 April 2004, the CI reported numbness of the left hand and elbow with pins and a staple in the left wrist, while the MEB medical exam (DD Form 2808) on 20 April 2004 noted a scar on the left elbow.A permanent U3 profile was issued on 15 April 2004 for the ulnar nerve transposition with limitations of no push-ups, carrying more than 30 pounds, or constructing an individual fighting position.At the VA...

  • AF | PDBR | CY2013 | PD2013 01060

    Original file (PD2013 01060.rtf) Auto-classification: Approved

    The MEB narrative summary (NARSUM) accomplished 2 months prior to separation documented continued numbness in the ring and small fingers of his left hand as well as the posterior aspect of his forearm along with left elbow pain and stiffness. Physical Disability Board of Review SUBJECT: Department of Defense Physical Disability Board of Review Recommendation

  • AF | PDBR | CY2013 | PD-2013-01362

    Original file (PD-2013-01362.rtf) Auto-classification: Denied

    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. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. Accordingly, the Board recommended no re-characterization or modification of your separation.I have carefully reviewed the...

  • AF | PDBR | CY2010 | PD2010-00374

    Original file (PD2010-00374.docx) Auto-classification: Denied

    The PEB adjudicated the right and left wrist carpal tunnel syndrome condition as unfitting, rated 10% each, with a combined disability rating of 20%. In the matter of ulnar neuropathy or any other medical conditions eligible for Board consideration, the Board unanimously agrees that it cannot recommend any findings of unfit for additional rating at separation. I have carefully reviewed the evidence of record and the recommendation of the Board.

  • AF | PDBR | CY2014 | PD-2014-00641

    Original file (PD-2014-00641.rtf) Auto-classification: Denied

    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. She had what was diagnosed as right CTSmarked by pain and paresthesias with decreased manual dexterity along with problems of lifting and carrying, lack of stamina,and decreased strength.At the time of the VA examination, she was not employed.Temporally remote (more...

  • AF | PDBR | CY2012 | PD2012 01213

    Original file (PD2012 01213.rtf) Auto-classification: Approved

    No other conditions were submitted by the MEB.ThePEBadjudicated left elbow pain with a history of left CTS and ulnar nerve decompression in March 2003 as unfitting, rated 10%citing criteria of the US Army Physical Disability Agency (USAPDA) pain policyand Veterans Affairs Schedule for Rating Disabilities (VASRD).The remaining condition was determined to be not unfitting.The CI made no appeals and was medically separatedwith thatdisability rating. Other x 720040304 Combined: 10% Derived from...

  • AF | PDBR | CY2012 | PD-2012-00025

    Original file (PD-2012-00025.rtf) Auto-classification: Approved

    Right Wrist Condition . The CI was evaluated by multiple orthopedic specialists and after the MEB examination underwent repeat surgery for the OCD on 3 February 2005.A PT note on 15 August 2005 noted the CI reported doing “pretty well,” with improved ability to walk and decreased pain.At the MEB examinationthe CI reported right ankle pain. At a VA outpatient physical medicine evaluation on 9 November 2005, 2 months after separation, the CI reported right ankle pain despite two surgeries...

  • AF | PDBR | CY2013 | PD-2013-02479

    Original file (PD-2013-02479.rtf) Auto-classification: Denied

    No other conditionwas submitted by the MEB.The Informal PEB (IPEB)adjudicated “bilateral carpal tunnel syndrome”as unfitting, rated 10% and 10% for a combined 20% rating, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Bilateral CTS .The first note in the service treatment record was an electrodiagnostic study dated 29 August 2003, which was performed for the CI’s history of bilateral hand pain, tingling and numbness without neck pain. At an orthopedic...

  • AF | PDBR | CY2013 | PD-2013-01377

    Original file (PD-2013-01377.rtf) Auto-classification: Denied

    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. Knee501010%20041102Other x2 (Not In Scope)Other x10 RATING: 20%RATING: 30% *Derived from VA Rating Decision (VARD) dated 20060106 (most proximate to date of separation (DOS)) Carpal Tunnel Syndrome Condition . RECOMMENDATION : The Board, therefore, recommends that...

  • AF | PDBR | CY2012 | PD2012 00323

    Original file (PD2012 00323.rtf) Auto-classification: Approved

    The PEB adjudicated the right CTS, and the chronic pain, neck and right kneeconditions as two unfitting conditions, rated 10% and 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD),and the US Army Physical Disability Agency (USAPDA) pain policy.The remaining conditions were determined to be not unfitting.The CI made no appeals and was medically separated with a 20% disability rating. Results of this EMG recorded mild bilateral CTS, chronic on left and...