RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2015-01062
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20050805

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Unit Supply Specialist, medically separated for “bilateral forearm myopathy…” with a disability rating of 0%.

CI CONTENTION:  All conditions were requested.  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 - 20050628	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
B/L Forearm Myopathy…	5099-5021	0%	No VA Examination In Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Forearm Myopathy.  The PEB combined the left and right forearm myopathy under a single disability rating, coded 5099-5021 (analogous to myositis) rated 0%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI’s bilateral forearm myopathy began in July 2000 following an injury.  Electrodiagnostic study in July 2004 demonstrated early signs of carpal tunnel syndrome and mild myopathy (the examiner opined that the myopathy was most likely secondary to Prednisone).  The 7 February 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of pain and intermittent swelling of the arms and wrist. The physical examination showed full range of motion (ROM) of both wrists, with no painful motion noted.  There was no VA examination in evidence.  

The panel first considered whether the bilateral forearm myopathy was reasonably justified as separately unfitting and warranted unbundling. In this case the bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement.  Members agreed that each forearm was separately unfitting and that identical coding and ratings would be most appropriate.  The panel next directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral forearm myopathy at 0%, coded 5099-5021 (analogous to myositis), citing an absence of limitation of motion.  The evidence did not support a 10% rating for moderate wrist and finger weakness under the muscle injury codes (5307 and 5308), there was no limitation of motion of the wrists for a rating under 5309 (Group IX: forearm muscles), and painful motion was not noted on examination (VASRD §4.59).  Panel members therefore agreed that the evidence supports a 0% for slight muscle dysfunction.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral forearm myopathy.  

Contended PEB Conditions:  Right Ulnar Palsy and Right Shoulder Sprain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  These conditions were not profiled or specifically implicated in the commander’s statement.  The commander noted that duty restrictions prevented the CI from performing her assigned duties, and duty restrictions associated with the profile were for the bilateral forearm myopathy.  Performance-based evidence from the record did not support that right ulnar palsy or right shoulder sprain significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bilateral forearm myopathy condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended right ulnar palsy and right shoulder sprain conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20170510 w/atchs
Exhibit B.  Service Treatment Record

AR20170008429, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure