RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xx	CASE:  PD1300005
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20130717
SEPARATION DATE:  20020916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty DK2/E-5 (Disbursing Clerk) medically separated for bilateral carpal tunnel syndrome (CTS).  In 2000, the CI had onset of pain and numbness in his right hand.  The symptoms worsened and soon he also complained of similar symptoms in his left hand.  He was diagnosed with bilateral CTS, with the right wrist being worse than the left.  In 2001 the CI had surgery performed on both wrists.  Despite surgical intervention his CTS condition did not improve adequately to meet the physical requirements of his Rating or satisfy physical fitness standards.  After two periods of limited duty (LIMDU) the case sent to a Medical Evaluation Board (MEB) that found the bilateral CTS to be medically unacceptable and as forwarded it to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also forwarded a right shoulder condition for PEB adjudication.  The PEB found the bilateral CTS unfitting and rated each wrist at 10% for a 20% combined rating.  The right shoulder condition was found to be Category III (not separately unfitting and not contributing to the unfitting condition).  The CI made no appeals and was medically separated.

CI CONTENTION:  “As per the Wounded Warrior Act of 2008, I wish to have my DoD disability rating reviewed to ensure its accuracy and fairness.”

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 the unfitting CTS conditions are addressed below.  No other conditions are within the defined purview of the Board.  Any conditions outside the Board’s defined scope of review remain eligible for consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service PEB – Dated 20020802	VA - (3 mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Carpal Tunnel Syndrome	5299-8715	10%	Right Carpal Tunnel	8515	10%	20020628	
			Scar on Right Wrist	7804	10%		
Left Carpal Tunnel Syndrome	5299-8715	10%	Left Carpal Tunnel	8515	10%		
			Scar on Left Wrist	7804	10%		
Right Shoulder Impingement	Category III	Right Shoulder Impingement 	5201	30%		
No Additional MEB/PEB Entries	Other x 15		
Combined:  20%	Combined:  80%	
Derived from VA Rating Decision (VARD) dated 20021107

ANALYSIS SUMMARY: 

Carpal Tunnel Syndrome (CTS).  The CI developed symptoms of bilateral CTS on a gradual basis.  In March 2001 he was placed on 8 months of LIMDU.  In September 2001 his case was re-evaluated and the LIMDU was extended for another 8 months.  The CI had bilateral carpal tunnel surgery with the right wrist surgery in May 2001, followed by left wrist surgery in October of that year.  In spite of his surgery and other treatment the CTS symptoms persisted and another MEB was initiated.  This MEB narrative summary was dated 24 April 2002.  Physical examination (PE) on the left revealed positive Tinel’s and positive Phalen’s.  Two-point discrimination (TPD) was around 7-8 mm.  On the right, he had positive Tinel’s, positive Phalen’s, and TPD was 5-7 mm.  There was no thenar atrophy of either hand.

On 28 June 2002 (11 weeks prior to separation) the CI had a VA Compensation and Pension (C&P) exam.  The CI reported that he did not get dressed himself and that he required help with everything.  In the exam room, however, he undressed without assistance.  PE revealed positive Tinel’s and positive Phalen’s bilaterally.  Neurological exam was normal.  There was no muscle weakness or wasting.  Peripheral exam showed no peripheral neuropathy, and he had normal grip.  Wrist exam showed no weakness, incoordination, lack of endurance, or fatigue.  Wrist range-of-motion was measured and is summarized below.

 Wrist ROM	VA C&P ~ 2½ mos. Pre-Sep
(20020628)	
		Right	Left	
Dorsiflexion (70⁰ is normal)		40⁰	70⁰	
Palmar Flexion (80⁰ is normal)		40⁰	70⁰	
Ulnar Deviation (45⁰ is normal)		45⁰	45⁰	
Radial Deviation (20⁰ is normal)		20⁰	20⁰	
Comment		(with pain)	(with pain)	
§4.71a Rating		10%*	10%*	
	*10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion) 

The Board carefully examined all evidentiary information available, and directs attention to its rating recommendation based on the above evidence.  The Navy PEB and the VA chose different coding options for the CTS condition, but both assigned a disability rating of 10% to each side, for a combined CTS rating of 20%.  After a thorough review of the treatment record, the Board determined that the CI’s left and right wrist conditions were essentially non-compensable based solely on the Veterans Affairs Schedule for Rating Disabilities (VASRD) §4.71a codes for loss of wrist motion (5214 & 5215).  In accordance with VASRD §4.40, §4.45, and §4.59, however, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  The Board tried to find a path to a rating higher than 10% using other codes applicable to the bilateral CTS condition.  The other VASRD codes that were considered did not result in a higher rating, though, since the record did not show evidence of a significantly disabling abnormality justifying a higher rating.

The Board also considered the matter of peripheral neuropathy.  At the June 2002 C&P exam, neurological exam was normal.  There was no muscle weakness or wasting.  Peripheral exam showed no peripheral neuropathy and the CI had a normal grip.  After reviewing all the information in the treatment record, there was insufficient evidence of a clinically disabling neuropathy that interfered with satisfactory performance of military duties.  Specifically, the CI’s neurological symptoms did not constitute a separately unfitting nerve condition at the time of separation from service.  The Board therefore does not recommend a separate disability rating for peripheral neuropathy.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the bilateral CTS of the left and right wrists.

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 CTS and IAW VASRD §4.40, §4.45, §4.59, and §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left CTS and IAW VASRD §4.40, §4.45, §4.59, and §4.71a, the Board unanimously recommends no change in the PEB adjudication.

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	
Right Carpal Tunnel Syndrome	5299-8715	10%	
Left Carpal Tunnel Syndrome	5299-8715	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20121226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW 
                                        BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
          (b) CORB ltr dtd 5 Nov 13

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- former USMC
- former USN
- former USN
- former USN