RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-01662
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20080421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Equipment Technician, medically separated for “left radial palsy with forearm, wrist and hand weakness,” with a disability rating of 20%.

CI CONTENTION:  The CI contends for Veteran’s Administration service-connected condition outside the scope of the Board.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 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:  

SERVICE PEB - 20080306	VARD - 20080828	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Radial Nerve Palsy	8514	20%	Status Post Complicated Left Elbow Fracture with Residual Radial Nerve Palsy (Non-dominant)	8514	20%	20080521	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:  

Left Radial Nerve Palsy.  In May 2006, the CI was involved in a motorcycle accident where he obtained multiple fractures of the left (non-dominant) upper extremity that required various surgical procedures to reduce.  His injury also damaged the left radial nerve resulting in both motor and sensory impairment from the elbow to his fingers.  Electro-diagnostic studies confirmed a severe left radial neuropathy centered about the elbow with localization to the distal 1/3 of the upper arm.  Neurologic deficits included severely limited distal range of motion (ROM) of the left wrist and hand as well as loss of sensation on the back of the hand.  Despite aggressive physical and occupational therapy, his neurologic deficits remained.  A neurologic follow-up on 15 November 2007 (5 months prior to separation), revealed the inability to extend the left wrist or fingers.  The examiner also noted the CI “could not perform a meaningful or useful pinch maneuver, opposing the left index finger to the left thumb.”  The diagnosis was severe radial neuropathy of both sensory and motor components with no innervation seen in muscles of the forearm and hand.  The commander’s statement included comments with regard to the CI’s inability to lift greater than 5 pounds with his left hand as well as having difficulty grasping and extending his left hand.  The CI was profiled and referred to a Medical Evaluation Board (MEB).  The MEB narrative summary (NARSUM) examination on 11 January 2008 (3 months prior to separation), revealed limited active ROM of the left upper extremity.  The complete physical examination (PE) findings were referred back to the 15 November 2007 neurology examination as previously stated above.  At the VA Compensation and Pension (C&P) examination on 21 May 2008 (1 month before separation), the CI reported intermittent pain, stiffness, and hypersensitivity of the left upper extremity resulting in decreased ROM and strength and further stated “running causes severe pain as the arm is jostled.”  The PE revealed tenderness about the left elbow and grip strength of the left hand/arm was non-existent.  His wrist extension was listed as 3 of 5.  The CI’s diagnosis remained as status post complicated left elbow fracture with residuals of radial nerve palsy.  

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the left radial nerve for mild incomplete paralysis at 20% citing no specifics from the PEB and mild to moderate impairment by the VA.  All Board members agreed with the chosen nerve code of 8514 (Incomplete paralysis of the radial nerve) and deliberated if the higher rating of 40% (severe) was supported by the presented evidence.  
  
Board members first agreed that probative value be apportioned to both the neurology evaluation and the primary care evaluation performed at 5 months before and 1 month after separation, because different PE parameters were brought out in each.  The neurologist description of a “severe” radial neuropathy correlated well with the clinical evidence of the absence of nerve innervation to the distal left wrist and hand with minimal improvement as seen at the VA examination.  Board members agreed that the residual symptoms of the neurologically impaired left upper extremity supported a severe level of impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 40% for the left upper extremity condition.  

BOARD FINDINGS:  In the matter of the left upper extremity condition, the Board unanimously recommends a disability rating of 40%, coded 8514 IAW VASRD §4.120.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows and that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Left Radial Nerve Palsy 	8514	40%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140219, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01662.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

Attachment:
Record of Proceedings 

cc:
SAF/MRBR
DFAS-IN