RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02008
BRANCH OF SERVICE:  Army 	DATE REMOVED FROM TDRL:  20081007

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Army National Guard E4, Military Police, medically separated from the Temporary Disability Retired List (TDRL) for “traumatic right (dominant) ulnar nerve injury,” with a disability rating of 10%.

CI CONTENTION:  The CI requests the Board consider all conditions.  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations 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 at the time of separation.  The Board 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 Board 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 – 20050520/20080903	VARD – No VA Claim in evidence	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Traumatic Right Ulnar Nerve Injury	8516	30%	10%	--	--	--	--	
COMBINED RATING:  30%% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Traumatic Right Ulnar Nerve Injury.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s traumatic right ulnar nerve injury condition began in January 2005 after hitting his elbow on a weapons rack.  The CI also sustained two additional injuries to the right elbow over the following 5 weeks.  The MEB forwarded right ulnar neuropathy manifested by pain, numbness and weakness for PEB adjudication.  

The TDRL placement MEB NARSUM examination on 27 April 2005, 3 years prior to removal from TDRL, noted complaints of sharp and occasionally burning pain of the right elbow that increased with exertion.  In addition, he had burning numbness that extended down the arm from the elbow to the small finger side of the hand.  Physical examination showed elbow range of motion (ROM) flexion to 120 degrees (normal 150) with marked Tinel’s sign (increase in neurological symptoms with tapping over the nerve) over the ulnar nerve at both the right elbow and the right wrist.  There was also noticeable weakness in the ulnar distribution of the right hand (grip), noticeable hypothenar atrophy.  In addition, there was decreased sensation of the 4th and 5th fingers of the right hand.  The TDRL review examination on 14 December 2006, approximately 2 years prior to TDRL removal, noted complaints of pain twice each day with varying intensity.  The CI reported that there had been a surgery in the interim; however the operative report and all of the perioperative evaluations were not available for review.  Physical examination showed hypothenar atrophy of the right upper extremity with decreased strength and sensation in the ulnar nerve distribution.  The examiner cited a May 2005 nerve conduction study (after surgery) that showed no abnormalities.  The TDRL removal evaluation on 12 August 2008, 2 months prior to TDRL removal, noted complaints of tingling of the right arm and hand and dropping items in his right hand.  The CI reported that his symptoms had improved but were still not at baseline.  Physical examination showed weakness of the right hand intrinsic (innervated by the ulnar nerve) muscles and “slight atrophy” of the right hypothenar compartment.  There was no VA Compensation and Pension examination in evidence.  

The Board considered its recommendation for permanent disability rating at the time of removal from the TDRL.  At the time of TDRL removal the PEB rated the right ulnar nerve condition 10%, coded 8516, citing residual tingling in the ulnar nerve, but the symptoms were intermittent and without numbness or paresthesia.  The CI’s ulnar nerve condition proximate to the time of TDRL removal had improved but continued to involve both sensory and motor components as evidenced by the tingling, hand weakness and muscle atrophy (8516).  Applying the same VASRD §4.124a reasoning above and noting sensory and motor components were still involved, Board member agreed that the evidence supports a moderate severity ulnar nerve partial paralysis rating of 30%.  There was not severe weakness to the point the CI could not lift anything and sensation was largely improved; therefore a higher 40% rating was not supported.  Although elbow ROM was not addressed in the final TDRL examination, there was no complaint of elbow pain or limited motion.  In addition, the MEB NARSUM examination lists the elbow ROM at 0-120 degrees.  Elbow flexion was never recorded as limited to 100 degrees or less (5206) and extension was never limited to 45 degrees or less (5207); therefore, additional disability codes cannot be applied.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a TDRL removal disability rating of 30% for right ulnar nerve condition, coded 8516.  

BOARD FINDINGS:  In the matter of the traumatic right ulnar nerve injury condition, the Board unanimously recommends a disability rating of 30%, coded 8516 IAW VASRD §4.124a at TDRL removal.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Traumatic Right Ulnar Nerve Injury	8516	30%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150622, with attachments
Exhibit B.  Service Treatment Record

AR20170004071, 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 30% 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,