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AF | PDBR | CY2013 | PD-2013-02449
Original file (PD-2013-02449.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02449
BRANCH OF SERVICE: Army          BOARD DATE: 20150806
SEPARATION DATE: 20051223


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-5 (M1 Armor Crewman) medically separated for a right ulnar nerve injury. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent P3U3 profile and referred for a Medical Evaluation Board (MEB). The “diabetes type II” and “right arm pain with finger numbness,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (hypertension) for PEB adjudication. No other conditions were submitted by the MEB. The Informal PEB adjudicated “right (dominant) ulnar nerve injury with persistent loss of sensation and painful numbness and tingling in ulnar distribution” as unfitting, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The PEB determined that the remaining condition s were not unfit, with likely application of DoDI 1332.38 with specific regard to the not unfit diabetes type II condition. The CI made no appeals and was medically separated.


CI CONTENTION: CI noted paralysis has worsened over the years.


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 conditions 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/Naval 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 :

IPEB - Dated 20051107
 VA* - Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Right (Dominant) Ulnar Nerve Injury with Persistent Loss of Sensation and Painful Numbness and Tingling in Ulnar Distribution 8699-8616 10% Right Ulnar Nerve Injury with Loss of Sensation and Painful Numbness and Tingling in Ulnar Distribution (Claimed as Right Arm, Idiopathic Peripheral Neuropathy) 8516 10% STR
Conditions x 2 (Not In Scope)
 Other x 5
RATING: 10%
 RATING: 50%
* Derived from VA Rating Decision (VA RD ) dated 20 060606 (most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Right Ulnar Nerve. During combat in March 2005, the right-handed CI experienced bruising and pain after striking his right elbow on the ground. At a neurologic evaluation on 26 July 2005 (5 months prior to separation), he reported right hand weakness. Exam showed reduced grip strength. However, electrodiagnostic studies of the right ulnar nerve were normal. At a clinic visit on 4 August 2005, the CI indicated that he was pain free, and that “except for the numbness in the right hand affecting mainly the 4th and 5th fingers, he has no other symptoms.” On the MEB examination DD Form 2807 on 23 August 2005 (4 months prior to separation) the CI wrote “numbness in #4-5 fingers (right) hand” since March 2005. He checked “No” for “Impaired use of arms, legs, hands, or feet.” Physical examination showed mild decreased strength of the right 4th and 5th fingers. An occupational therapy (OT) evaluation on 25 August 2005 reported numbness and tingling of the 4th and 5th fingers, and difficulties with fine motor coordination. Evaluation showed the ability to form a full fist. Grip strength was reduced in the right hand and left hand, but pinch strength was normal. There was diminished sensation of all fingers and the thumb.

The narrative summary (NARSUM) on 31 August 2005 reported that the CI’s arm symptoms did not improve with OT. Pain between the wrist and elbow was not present at rest, but occurred with twisting motions. Numbness of the 4th and 5th fingers was also reported. Examination showed normal muscle strength of the right arm, and there was no muscle atrophy.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating under an analogous 8616 peripheral nerve code (neuritis of ulnar nerve), while the VA used the 8516 code (paralysis of ulnar nerve) to justify the same rating. The ulnar nerve coding pathway stipulates that “moderate” incomplete paralysis justifies a 30% rating for the dominant upper extremity, while “mild” warrants 10%. Board members agreed the evidence at hand was most accurately depicted by the “mild” descriptor, and therefore a 10% rating was supported. 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 right ulnar nerve injury 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 right ulnar nerve injury 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 20131108, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review


SAMR-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 XXXXXXXXXXXXXXX, AR20150014178 (PD201302449)


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










                 

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