RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1301078
BRANCH OF SERVICE:  Army	BOARD DATE:  20140212
SEPARATION DATE:  20060421

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SGT/E-5 (92A/Automated Logistical Specialist) medically separated for a left forearm condition.  The CI was mobilized and deployed to Iraq in 2004 where he experienced recurrent tingling in his left arm.  Further testing confirmed carpal tunnel syndrome (CTS), which was initially treated conservatively and then by surgery.  He was found to also suffer from left cubital tunnel syndrome (CUTS) and left shoulder impingement.  Despite treatment, the CTS condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards, so he was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The left arm condition, characterized as “carpal tunnel syndrome,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (see rating chart below) for PEB adjudication.  The PEB adjudicated “left hand numbness…,” rated 10%, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.   The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no 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 the unfitting left arm condition is addressed below; 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 20060421	VA - (2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hand Numbness…	8799-8715	10%	Neuropathy, L. Upper Extremity	8799-8715	10%	20080813	
Left Shoulder Impingement…	Not Unfitting	Degenerative Changes, Left AC Joint…	5201	10%		
Hypercholesterolemia		No VA Rating		
No Additional MEB/PEB Entries	Other x 15		
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20080813.

ANALYSIS SUMMARY:

Left Hand Numbness Condition.  The right dominant CI presented for a 3-day history of left arm pain and tingling on 26 April 2004, 2 months after deployment to Iraq.  He denied trauma or overuse and stated that it had come on suddenly while typing.  He noted that he had been seen a week earlier for left shoulder pain, but this record is not in the available evidence.  He was seen several more times in theater and then evacuated back to his home station, via Landstuhl Army Medical Center, for further evaluation and treatment.  On 16 June 2004, electrodiagnostic testing showed mild left CTS and moderately severe left CUTS.  A magnetic resonance imaging of the cervical spine was normal on 15 July 2004 and further electrodiagnostic testing on 27 July 2004 excluded nerve root impairment or involvement of the brachial plexus (a nerve complex in the shoulder region) as sources of the left arm findings.  Conservative management failed to relieve his symptoms and on 19 October 2004 he underwent release of the carpal tunnel (at the wrist) as well as decompression and transposition of the ulnar nerve in the cubital tunnel at the elbow.  Despite post-operative rehabilitation, he had persistent tingling and could not return to full function.  He was then referred for an MEB.  During the rehabilitative period, he also had left shoulder surgery on 23 August 2005 with excision of the distal left clavicle (collar bone) and sub-acromial decompression to relieve bursitis.  He was returned to full activity for his shoulder on 3 January 2006.  The narrative summary was dated 24 January 2006, 3 months prior to separation, and noted that the CI had persistent left elbow pain and numbness in the left 5th and 4th fingers.  The examiner referred to the MEB examination performed on 5 December 2005 for the objective findings.  These included full range-of-motion of the left shoulder and elbow with normal grip strength.  Point tenderness of the left (elbow) was noted.  It was determined that the persistent pain and tingling prevented the CI from performing his duties.  Follow-up electrodiagnostic studies on 6 February 2006 were normal.  The CI did not file a claim with the VA until 31 October 2007, 18 months after separation.  At the initial VA Compensation and Pension examination performed over 2 years after separation, the CI denied any neurological complaints related to his neck.  He reported that his symptoms had started in April 2004 while deployed and that he woke up to find his left arm and left leg were numb.  He went back to bed and the left leg numbness resolved when he awoke, but the left arm symptoms persisted.  He stated that he had recurrent left side symptoms three times a week for 10-30 minutes and left grip weakness.  On examination, his neurological examination was normal.  Motion was essentially normal and pain free.  Grip strength was equal bilaterally.  It was noted that he had subjective complaints of left sided numbness without objective findings.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated a 10% rating for incomplete (mild) paralysis using and analogous code for neuralgia of the median nerve, 8799-8715.  The VA, examining the condition 2 years later, assigned the same rating and code.  The Board noted that while the CI had surgery, the residual effects were subjective and objective findings absent other than left elbow tenderness.  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 hand numbness 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 hand numbness 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, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Left Hand Numbness, Status Post Carpal Tunnel Release…	8799-8715	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130731, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			

SFMR-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 XXXXXXXXXXXXXXXXXX, AR20140012275 (PD201301078)

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						     

CF: 
(  ) DoD PDBR
(  ) DVA