RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01841
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  20030613	DATE REMOVED FROM TDRL:  20061212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Policeman, medically separated from the Temporary Disability Retired List (TDRL) for “left (non-dominant) brachial plexopathy,” with a disability rating of 20%.

CI CONTENTION:  The CI contended that his bilateral ankles were not rated and that his left brachial plexus neuropathy was a permanent condition.  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 based on 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 – 20030507/20061121	VARD – 20030930 & 20040624	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Left Brachial Plexus Neuropathy	8513	30%	--	Left Brachial Plexus Neuropathy	8513	20%	30%	
Left (Non-dominate) Brachial Plexopathy								
		--	20%					
Chronic Ankle Pain Status Post Bilateral Ankle Surgery	Not Unfitting	Right Ankle Condition	5284	0%	0%	
		Left Ankle Condition	5284	0%	0%	
COMBINED RATING:  30% → 20%	COMBINED RATING OF ALL VA CONDITIONS:  30% → 40%	

ANALYSIS SUMMARY:

Left (Non-dominate) Brachial Plexopathy.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left shoulder condition began in December 2001 without a history of trauma.  In January 2002 the CI presented to the emergency department with a 5-week history of intermittent left neck, shoulder and upper extremity weakness.  Radiographic evaluation in February 2002 suggested acromioclavicular impingement.  At a neurology evaluation dated 27 March 2002 the CI reported intermittent left shoulder pain radiating down the left upper extremity with associated numbness and tingling over the little and ring finger and the thumb.  The physical examination showed decreased bulk of the left deltoid, supraspinatus and infraspinatus muscles as compared to the right.  There was left shoulder weakness, dulling of sensations over the deltoid, supraspinatus, and infraspinatus areas. Signs for cervical (Lhermitte) and cranial (Horner Syndrome) neuropathy were negative.  The CI was diagnosed with brachial plexus neuropathy (Parsonage-Turner syndrome).  An electrodiagnostic study dated May 2002 confirmed the diagnosis.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded left brachial plexus neuropathy (Parsonage-Turner syndrome) for PEB adjudication.

At the MEB NARSUM examination dated March 2003, 2 months prior to TDRL placement, the CI reported chronic left shoulder pain and upper extremity weakness.  Physical exam showed 4/5 left upper extremity strength, full left shoulder range of motion, and intact reflexes.  The examiner documented that there was a 90% chance of full recovery in 3 years.  The PEB placed the CI on TDRL May 2003 citing that a permanent evaluation was not possible at that time.  At the TDRL evaluation dated May 2004, a year after TDRL placement, the CI reported persistent left shoulder pain, left hand weakness, and an occasional “uncomfortable sensation” in his elbow and medial hand.  The physical examination showed right hand dominance.  There was decreased left upper extremity strength and sensation. The examiner noted results of a May 2004 electromyogram (EMG) which demonstrated improved nerve conduction.  The CI was continued on TDRL.  At the TDRL evaluation dated August 2006 the examiner noted no change the CI’s overall condition since the time of the MEB and that the CI’s condition was stable.  The physical examination showed left upper extremity weakness.

The VA reviewed the CI’s STR as no VA Compensation and Pension examination was performed at the time of TDRL placement.

The Board directed attention to its rating recommendation based on the above evidence.  At TDRL placement the PEB assigned a 30% rating under the 8513 code (moderate incomplete paralysis of all radicular groups [left brachial plexus]), citing 4/5 weakness in the left shoulder and only able to lift 10 pounds.  At TDRL placement the VA assigned a 20% rating also coded 8513, citing mild incomplete paralysis involving the radicular muscles.  There was no evidence of loss of reflexes and constant excruciating pain for a higher rating for severe paralysis at TRDL placement rating. 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 TDRL placement adjudication for the left brachial plexus neuropathy (Parsonage-Turner syndrome) condition.

At TDRL removal the PEB assigned a 20% rating under the 8513 code citing arm weakness preventing return to duty, stable and mild.  At TDRL removal the VA assigned a 30% rating also coded 8513, citing increased severity of the left shoulder condition.  The Board determined that the physical findings of 4/5 left upper extremity muscle strength and EMG (May 2004) findings demonstrating improved nerve conduction met criteria for mild neuropathy.  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 TDRL removal adjudication for the left (non-dominate) brachial plexopathy condition.  

Contended PEB Conditions:  Left and Right Ankle.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  At the orthopedic clinic appointment on 28 June 2001, the examiner reported that the CI had a stable post operative left ankle, status post Brostrom repair on 20 November 2000.  At the orthopedic clinic appointment on 23 October 2001, the examiner documented the CI with a stable right ankle, status post Brostrom repair on 2 August 2001 and was doing well, but was still going through physical therapy.  There was only one other pre-TDRL placement right ankle clinic note from physical therapy dated 30 November 2001 (4 months after surgery) that documented the CI met the first three rehabilitation goals and was working on the forth.  The bilateral ankle conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  These contended conditions were reviewed and considered by the Board.  There was no performance-based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the either of the contended ankle conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left (non-dominate) brachial plexopathy condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication at both TDRL placement and TDRL removal.  In the matter of the contended left and right ankle conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s TDRL placement and removal disability and separation determinations.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 27 2016

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 XXXXXXXXXXXXXXXXXXXX, AR20160011076 (PD201401841)

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