RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00813
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051011

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aerospace Maintenance Journeyman, medically separated for “carpal tunnel syndrome, bilateral mild” with a disability rating of 10% for the right and 10% for the left.  A 20% deduction was applied for “less aggravating/contributory factors” for a combined rating of 0%.  

CI CONTENTION:  “The condition has worsened overtime and with no correct diagnosis nothing can be done to try and fix.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20050829	VARD - 20070112	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Carpal Tunnel Syndrome (CTS), Bilateral Mild	8715	0%	Bilateral Carpal Tunnel Syndrome	8515	NSC	20070112	
		0%					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY: 

Bilateral CTS.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral CTS condition began in 2004 without specific trauma or injury.  A nerve conduction study performed on 22 November 2004 demonstrated bilateral median nerve neuropathy (carpal tunnel).  The CI underwent physical therapy and trials of anti-inflammatory medications without pain relief.  A neurology treatment note dated 22 December 2004 documented a diagnosis of bilateral carpal tunnel syndrome and a recommendation wrist splints be worn at all times.  At a neurosurgery evaluation on 9 March 2005, the CI reported pain, weakness, and tingling in both of his hands.  Physical examination showed that Phalen’s test for carpal tunnel syndrome was positive.  The surgeon recommended a left carpal release; however, the CI declined surgery.  The CI was prescribed an anti-inflammatory and instructed on splint usage.  

The 3 August 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of bilateral wrist pain.  The CI informed that examiner that he only wore his splint occasionally at night and was not using anti-inflammatory medication.  Physical examination showed that Phalen’s test for carpal tunnel syndrome was positive.  There was no VA examination in evidence proximate to separation.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral CTS condition 10% for each wrist, coded 8715 (neuralgia), citing noncompliance resulting in a 10% deduction for each wrist and a combined rating of 0%.  The VA did not service-connect the bilateral CTS condition based on the CI’s failure to attend the scheduled C&P examination.  The deduction for non-compliance was derived from DoDI 1332.39 (E2.A1.3.2.23.7913); stating, “If unfitness derives, in part, from documented non-compliance with prescribed treatment, including diet and weight control, the assigned rating should not be higher than the disease would warrant if under prescribed treatment.” DoDI 1332.39 was rescinded; therefore, the panel rated the condition IAW with VASRD.  The CI’s bilateral carpal tunnel syndrome met criteria for a 10% rating for each extremity for mild median nerve neuralgia. There was no evidence of moderate hand weakness or muscle atrophy for a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for each wrist for a combined rating of 20%, coded 8715.  

BOARD FINDINGS:  In the matter of the bilateral CTS condition, the panel unanimously recommends a disability rating of 10% for each wrist for a combined rating of 20%, coded 8715 IAW VASRD §4.124a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Carpal Tunnel Syndrome	8715	10%	
Left Carpal Tunnel Syndrome	8715	10%	
COMBINED w/BLF	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00813.

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 modification of your assigned disability rating without re-characterization of your 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 direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR