RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00900
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Traffic Management Coordinator, medically separated for “right forearm pain, status post volar fasciotomy” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that he “was separated for right forearm complications.”  He “had surgery in Landstuhl, Germany leaving a four inch scar on [his] arm.”  He has “had a problem with forearm since surgery.”  He feels that he was “not properly evaluated after surgery.”  He has a nerve issue with arm that was not evaluated before surgery” and that it made him unfit for service.  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 - 20060125	VARD – 20060824 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Forearm Pain, Status Post Volar Fasciotomy	5099-5003	10%	Right Forearm Pain with Median and Ulnar Nerve Injury (Dominant)	8799-8515	NSC	20060824	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Forearm Pain, Status Post Volar Fasciotomy.  According to the service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right (dominant) wrist condition began on 4 February 1999 following a fall onto his outstretched hand.  On 24 October 2003 he underwent surgery for a right forearm mass excision and volar fasciotomy (opening the forearm) (and possibly re-exploration in October 2005 per MEB).  The CI had right arm pain, swelling and paresthesias (abnormal sensations) in his forearm and hand that did not resolve with continued therapy.  During the 1 December 2005 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation, the CI reported pain in the right wrist and forearm with swelling after repetitive use and numbness in the right forearm when flexed.  The physical exam showed tenderness to the right wrist with no limitation in range of motion (ROM).  There was pain on flexion.  The right forearm had mild edema with hypersensitivity along the scar.  Grip strength was 4/5 (normal 5/5).  

The 4 January 2006 MEB NARSUM examination, a month prior to separation, noted complaints of right wrist pain and lack of endurance.  The physical examination showed the CI was able to flex and extend all digits without neurologic deficit as well as to perform abduction and adduction of all digits and wrist flexion and extension.  Referenced occupational therapy ROM from 23 November 2005 (3 months prior to separation), showed right wrist dorsiflexion of 70 degrees (normal) and palmar flexion of 65 degrees (normal 80).  There was normal gross muscle strength and grip strength was 70 pounds (compared to left grip of 95 pounds).  There was no sensory examination abnormalities and there was minimal scar-hypersensitivity.  Cited nerve conduction testing (NCS/EMG) in October 2005 demonstrated significant sensory neuropathies of the median and dorsal ulnar cutaneous nerve distributions, with no motor neuropathy.  

At the 24 August 2006 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported mild pain, weakness, stiffness, swelling, instability, and lack of endurance in his right arm.  The physical exam showed normal ROM of the elbow, wrist, hand and fingers with no additional limitation of function with repetition.  There was good grip strength and dexterity.  No pain, weakness or tenderness was noted on the examination.  X-rays of the right wrist and hand were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right forearm condition 10%, coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the right forearm condition NSC (not service connected) coded 8799-8515 (median nerve, partial incomplete paralysis), based on examination 6 months after separation, citing no evidence of residual disability.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of motion of the forearm or wrist (codes 5206 thru 5215).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The panel considered the provisions of VASRD §4.14 (avoidance of pyramiding) and considered that there was no muscle injury IAW VASRD §4.55 and §4.56 and §4.73 that would provide any higher rating, nor sufficient evidence of an incomplete nerve paralysis (VASRD §4.124a) above the slight level for any higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right forearm pain condition.  

BOARD FINDINGS:  In the matter of the right forearm pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007152, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,