RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-00692
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080311

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-6 (Automated Logistics Specialist) medically separated for a right (dominant) carpal tunnel syndrome condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent P3U3 profile and referred for a Medical Evaluation Board (MEB).  The “bilateral carpal tunnel” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other conditions (right knee pain, hypertension, chronic tension headaches, depressive disorder and acute chondromalacia) for PEB adjudication.  The Informal PEB (IPEB) adjudicated “carpal tunnel syndrome, right dominant hand” as unfitting, rated 10%.  The IPEB determined that the carpal tunnel syndrome, left hand, was not unfitting or ratable, as symptoms are mild compared to the right hand.  The remaining conditions were determined to be not unfitting and therefore not ratable.  

CI CONTENTION:  The applicant makes no specific contention in her application.  Her 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 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 Veterans Affairs Schedule for Rating Disabilities (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:  

Admin Correction PEB - Dated 20090218	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Carpal Tunnel Syndrome, Right Dominant Hand	8715	10%	Residuals of Right Carpal Tunnel Release with Scar and Mild Cubital Tunnel Syndrome	8599-8515	10%	20080517	
Other MEB/PEB Conditions x 5 (Not In Scope)	Other x 7 	
RATING:  10%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20080827 (most proximate to date of separation [DOS]).  
ANALYSIS SUMMARY:  

Carpal Tunnel Syndrome, Right Dominant Hand Condition:  Service treatment records note that the CI had carpal tunnel release surgery January 2005 after a long history of right wrist pain with radiating numbness to the radial digits of the right hand.  Electromyogram (EMG) and nerve conduction studies revealed right carpal tunnel syndrome.  The right hand is the dominant hand.  The narrative summary (NARSUM), dated 27 August 2007, noted the procedure relieved symptoms “about 80%” but the hand still cramped and tingled.  She did not drop objects and writing was not difficult but she did not think she could reliably and accurately fire a weapon.  Physical exam of the right wrist, fingers and thumb showed a full range-of-motion (ROM).  Strength was 5/5 in the right wrist and grip.  There was no atrophy or symmetry.  There was still episodic numbness.  She had symptoms in both hands, but the right gave her more problems. She was diagnosed with bilateral carpal tunnel syndrome but the physician examiner noted it was worse on the right.  

Nerve conduction studies dated 28 August 2007 showed bilateral carpal tunnel syndrome, worse in the right wrist compared to the left, showing slowing of the median sensory and motor nerve latency, suggestive of focal demyelination (damage to the nerve’s protective covering).  The neurologist recommended injections or referral to a hand surgeon to repeat the carpal tunnel surgery.  The commander’s statement noted she worked 40 hours per week, providing light administrative support but she could not perform duties in her MOS due to carpal tunnel syndrome and other medical conditions. 
 
At the VA Compensation and Pension (C&P) Neurology exam performed 2 months after separation, the CI reported right wrist numbness going down into the small and ring fingers.  There was also slight decrease sensation of the small finger on the right.  She had brisk refill of the small blood vessels in all digits.  There was no excessive wasting or prominence of the first section of the fingers. ROM showed ulnar deviation of 30 degrees and radial deviation of 20 degrees.  She had 5/5 muscle and grip strength.  She had full supination and pronation without pain.  She could not load or fire her weapon.  She still used assistive devices i.e. a splint on the right side at night.  She had no incapacitating episodes and no deformity that would affect her usual occupation or daily activities.  Diagnoses of bilateral carpal tunnel releases with minimal residuals and early cubital tunnel syndrome (compression of the nerve at the elbow) on the right were diagnosed.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA chose similar coding options for the condition and arrived at identical ratings.  The MEB listed bilateral carpal tunnel syndrome (more in dominant right hand) as not meeting retention standards but the PEB adjudicated the carpal tunnel syndrome-right dominant hand as unfitting but determined the carpal tunnel syndrome-left hand was not  unfitting or ratable as symptoms were mild compared to the right hand with VASRD §4.124 standards.  All exams agreed that impairment was mild: she could still write and did not drop objects.  Numbing and tingling in the right hand was episodic.  Strength was normal in the right hand with no evidence of deformity and atrophy.  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 carpal tunnel 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 carpal tunnel condition and IAW VASRD §4.124a, the Board 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 20140130, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20160002612 (PD201400692)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA