RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01900
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Graphics Document Specialist, medically separated for “left forearm pain,” with a disability rating of 0%.

CI CONTENTION:  The CI contends that his hearing wasn’t tested or rated. 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 - 20040826	VARD - 20041229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Forearm Pain…	5099-5003	0%	Medial. Antebrachial Cutaneous Neuropathy, Left Forearm	8717	10%	20041104	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Forearm Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left forearm condition began initially in January 2002 after his arm was cracked.  These records were not in evidence, but apparently he improved until he began weight lifting.  Then in June 2002, the arm pain was aggravated by lifting heavy equipment.  He denied direct trauma and had an unremarkable examination.  An X-ray showed calcification from an old fracture, but no acute changes.  He was treated with medications and cold packs.  He was thought to have a possible carpal tunnel syndrome (compression of the median nerve at the wrist) and treated with medications, splinting, and duty limitations.  His symptoms persisted.  At a primary care appointment on 16 September 2002, he reported that he had dropped a 150 pound box onto his arm.  X-rays of the forearm were normal.  Electrodiagnostic studies (EDX) were normal on 26 September 2002.  An MRI of the left forearm on 4 November 2002 was also normal.  A bone scan on 2 December 2002 was normal.  The CI was evaluated in orthopedics on 7 January 2002 and found to have tenderness over the mid-forearm about the ulnar aspect (little finger side), but an otherwise unremarkable examination.  No diagnosis was made.  The forearm pain continued despite treatment as outlined above and in physical therapy.  The CI was evaluated in neurology on 5 March 2003 where he reported that his pain began after a hyper-extension injury while lifting a heavy box.  His examination revealed a tender spot over the mid-forearm which was painful when touched.  The pain radiated both towards the wrist and elbow.  Sensation was mildly reduced in the left ulnar nerve distribution and he was thought to have a possible ulnar neuroma.  The CI was then evaluated in neurosurgery.  At the appointment on 26 March 2003, he had sensory changes consistent with a neuropathy of the left medial antebrachial cutaneous nerve (MACB) and the left dorsal cutaneous nerve.  He was begun on medication for pain and then seen in follow up on 28 April 2003.  The CI reported that he stopped the medication after one week without improvement.  On examination, a mass was felt which was thought to be a neuroma of the left antebrachial cutaneous nerve.  He was placed on a different medication and referred for nerve blocks.  The CI was seen in orthopedics on 6 June 2003 and it was noted that the prior EDX studies did not address the MACB and these were repeated prior to a nerve block.  His medications were again changed.  The second set of EDX studies were done on 30 June 2003 and were consistent with a left MACB neuropathy.  A series of two nerve blocks provided temporary benefit.  The CI then had a second opinion in neurosurgery on 27 October 2003.  He was noted to have focal tenderness over the forearm near the ulna, but the sensory and motor examinations were normal.  Muscle atrophy was not present.  It was thought that he did not have an entrapment neuropathy.  The EDX studies were repeated (third set) on 23 January 2004 and were normal including the MABC nerve.  He was seen in neurosurgery and had a normal motor examination.  Sensation was reduced in a sensory superficial radial nerve distribution.  His symptoms were thought to be secondary to soft tissue trauma.  The CI was then referred to orthopedics.  On 10 May 2004, he was recommended for an MEB for persistent MACB neuropathy despite treatment.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated May 2004, 7 months prior to separation, the CI reported numbness and tingling of the left forearm and hand.  The examination was checked normal for the upper extremities and neurologic boxes.  The MEB NARSUM examination was dated 20 May 2004, 7 months prior to separation.  It summarized the above history and examination.  

At the 4 November 2004 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported intermittent pain and weakness of the left forearm.  The examination was unremarkable.  Strength was normal, atrophy was absent, and a provocative maneuver for nerve irritation (Tinels) was negative.  Sensation was not specifically recorded, but it was noted that there was no evidence for a carpal tunnel syndrome.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left forearm pain condition 0%, coded analogously as 5003 (degenerative arthritis) citing the US Army Physical Disability Agency (USAPDA) pain policy and noting a normal examination and that the CI was not on any medications.  The VA rated the left MACB neuropathy condition 10% coded 8717 (neuralgia of the musculocutaneous nerve) noting that there was a moderate impairment with flares even though there was no pathology on the examination.  The panel considered the evidence.  The diagnosis of a MACB neuropathy was made on the second set of EDX studies.  The CI then had injections with temporary relief.  A third set of EDX studies were normal including the MACB.  The physical examinations proximate to separation (MEB and VA) were both normal.  The panel considered the 8717 code used by the VA, but absent physical findings or atrophy indicating decreased use, a mild impairment is supported.  This is consistent with the 0% rating adjudicated by the PEB and provided no advantage to the CI.  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 left forearm pain condition.  

BOARD FINDINGS:  In the matter of the left forearm pain condition and IAW VASRD §4.71a and VASRD §4.124a, 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 20150710, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009260 , XXXXXXXXXXXXXXXXXX 

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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,					       
						      					
Enclosure