RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01227
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Field Artillery Cannoneer, medically separated for “chronic neck pain” and “left (non-dominant) ulnar neuropathy,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  The CI’s 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 - 20050712	VARD - YYYYMMDD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5242	10%	Chronic Neck Pain due to Cervical Strain and DDD	5242	10%	20060616	
Left (Non-Dominant Ulnar Neuropathy 	8516	10%	History of Ligamentous Rupture, Left Wrist, Status Post (S/P) Surgical Correction with Persistent Left Extensor Carpi Ulnaris Tendinopathy and Left Extensor Carpi Radialis Tendonopathy 	5099-5215	10%		
			Ulnar Neuropathy, Left Wrist with Weakness and Sensory Impairment of the Left Ring and Little Fingers	8616	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic neck pain condition began in January 2002 without any specific injury or trauma.  Magnetic resonance imaging studies from 2004 revealed multi-level degenerative disc disease (DDD) of the cervical spine with associated minimal narrowing of space for exiting spinal nerves.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “DDD of the cervical spine with radicular symptoms” for PEB adjudication.

At the 12 May 2005 MEB NARSUM examination, 4 months prior to separation, the CI endorsed constant neck pain that migrates into his left shoulder.  His physical examination (PE) revealed decreased range of motion (ROM) of the cervical spine in all directions except for extension, which was normal.  Other cervical directional measurements were documented as flexion at 30 degrees (normal 45), right and left lateral flexion at 20 and 30 degrees respectively (normal 45), right and left rotation at 40 and 35 degrees respectively (normal 80), and a combined ROM of 200 degrees (normal 340).  There were no other comments with regards to the cervical spine examination.     

At the 16 June 2006 VA Compensation and Pension (C&P) evaluation, 10 months after separation, the CI reported constant neck pain scaled at 3/10 with painful flare-ups to 7/10 occurring approximately twice per week.  Duration of flare-ups was not documented.  Additionally, he endorsed occasional tingling over his left upper shoulder.  His PE revealed minimal decrease in cervical ROM of a 5 degree deficit in bilateral lateral flexion and a 10 degree deficit in bilateral rotation.  Tenderness was present to multi-level cervical spinous process and its adjacent muscle mass.  

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA utilized (in various combinations) the same primary VASRD code of 5242 (degenerative arthritis of the spine) and rated at 10% citing painful motion.  Panel members first acknowledged and discussed the degree of probative value between the MEB NARSUM and the VA examinations (having significant implications for the panel's rating recommendation) and agreed that although both provided valuable physical findings, the time reference from separation of 4 months versus 10 months lent significant greater value towards the NARSUM.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that the most probative examination supported an impairment level of 20% based upon forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees. 

Left (Non-Dominant) Ulnar Neuropathy.  According to the STR and the MEB NARSUM, the CI’s left upper extremity pain condition began in April 2003 after loading heavy armament while on deployment.  On 01 April 2004, the CI underwent surgical repair of a cartilaginous tear within his left wrist.  Postoperatively, he developed numbness and tingling in his left hand and electro-diagnostic studies revealed an ulnar neuropathy at the left wrist.  Despite medication, splinting, and occupational therapy, the CI’s painful condition did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “ulnar neuropathy of the left wrist status post arthroscopic surgery” for PEB adjudication.  

At the MEB NARSUM examination, 4 months prior to separation, the CI endorsed continued left wrist pain as well as pain and numbness about the left little finger.  “He is unable to grip things in a vigorous fashion with his left hand.”  His PE revealed marked weakness and sensory deficit about the left little finger.  Specifically, “There was sensory numbness noted over a two and one half centimeter strip beginning at the left elbow and progressing dorsally to the ulnar aspect of the hand and to the entire left small finger.”  ROM of the left wrist was significantly decreased with dorsiflexion at 34 degrees (normal 70), palmer flexion to 70 degrees (normal 80).  The pain rating for the left wrist was listed as “frequent” and “slight”.   

At the C&P evaluation, performed 10 months after separation, the CI reported continued left wrist pain and weakness in his little finger.  His PE revealed left wrist tenderness with full ROM.  The left little finger remained unchanged in its weakness and sensory deficit.  Painful motion was present only with radial deviation of the left wrist.         

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist/hand condition at 10%, utilizing the nerve code of 8516 (incomplete paralysis of the ulnar nerve), citing weakness and sensory deficit.  The VA also rated the same condition at 10% utilizing the nerve code of 8616 (neuritis of the ulnar nerve), based on the C&P examination 10 months after separation, citing tenderness and painful motion.  Panel members considered the various voting options in this case and agreed that a rating under the wrist ROM code would provide a maximum impairment level no greater than the PEB’s current 10%.  Members further agreed that the electro-diagnostic finding of an ulnar neuropathy clearly was supported under the 8516 code of incomplete paralysis of the ulnar nerve.  Impairment levels for the non-dominant extremity are 10% for mild, 20% for moderate, and 30% for severe.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority agreed the more probative examination reflecting “marked weakness” in the left hand/finger as well the sensory numbness along the entire left forearm would be supported above “mild” impairment and more appropriately be described as “moderate” at 20%. 

BOARD FINDINGS:  In the matter of the chronic neck pain condition, the panel unanimously recommends a disability rating of 20%, coded 5299-5242 IAW VASRD §4.71a.  In the matter of the ulnar nerve injury condition and IAW VASRD §4.124a, the panel majority recommends a disability rating of 20%, coded 8516.  The single voter for dissent recommended no change in regards to the ulnar nerve injury and did not elect to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  

CONDITION	VASRD CODE	PERMANENT RATING	
Neck Pain	5299-5242	20%	
Ulnar Nerve Injury	8516	20%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007508, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 40% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					       
Enclosure