RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02543
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20040915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aircraft Forward Looking Infrared/Electro-Optical Technician, medically separated for “carpal tunnel syndrome right” with a disability rating of 10%.   

CI CONTENTION:  “I was put up for a PEB due to compartment syndrome fasciotomies of both legs and carpal tunnel for right hand.  The PEB discharged me for 10% for diabetes.  The other items were not rated during discharge.”  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20040701	VARD - 20050411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Carpal Tunnel Syndrome Right	5299-8715	10%	Residual, Status Post Surgery, Carpal Tunnel Syndrome, Right Hand	8515	10%	20050128	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Carpal Tunnel Syndrome Right.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s carpal tunnel syndrome (CTS) right condition began in May 2017 after falling while running and landing on his right wrist.  The CI is right hand dominant.  There was mild swelling of the ulnar/dorsal hand.  X-rays were initially negative but one month after the accident showed a fracture of the base of the right fifth metacarpal.  Two months later he reported pain and limited motion of the right hand.  He was seen in Orthopedics and pain medication was prescribed.  By December 2012 the CI reported constant right hand numbness for 2 weeks and a diagnosis of carpal tunnel syndrome was rendered.  Orthopedics treated him with a wrist splint and non-narcotic pain medication.  The 12 May 2004 electro myelogram (EMG) showed moderate demyelinating median nerve compression at the right wrist.  One week later, the CI underwent right carpal tunnel release surgery but, while in the early recovery period, remained symptomatic, to a lesser degree, with carpal tunnel syndrome of the right wrist.  

The 17 June 2004 MEB NARSUM Orthopedic examination, 3 months prior to separation, noted most of his symptoms had resolved but he had complaints of weakness of grip strength on the right and scar sensitivity which gave him difficulty with using hand tools.  He had no pain/problems with performing activities of daily living or lifting up to 10 pounds with the right hand.  Physical examination of the right wrist showed full range of motion in the wrist, moderate subcutaneous scar formation which is improving.  His fingers were neurovascular intact.  Grip strength was 85 pounds on the left and 50 pounds on the right.  There was a negative Tinel’s and Phalen’s, and carpal tunnel compression tests on the right.  Scar message and desensitization were recommended. 

At the 28 January 2005 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported that as a sawmill supervisor trainee, he had to work with machines and punch buttons and this caused pain.  He had to use the left hand more.  He reported numbness in both hands exacerbated by use and trouble grasping with the right hand.  Expected surgery recovery time was reportedly 6 months for complete repair and healing.  Physical examination showed good range of motion of the right wrist.  Tinel and Phalen signs were both positive on the right side and he had a 3 cm long surgical scar of the anterior right wrist.  He wore a splint at night for this condition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the CTS condition 10%, analogously coded 5299-8715 (median nerve; neuralgia).  The VA also rated the CTS condition 10%, coded 8515, (median nerve; paralysis of; incomplete), citing “documentation of incomplete paralysis of hand movement which is mild.”  Panel members agreed the condition was properly coded 5299-8715, due to the pain and numbness which characterized the CI’s condition.  The NARSUM (Orthopedics) noted most of the right carpal tunnel symptoms had resolved and there was full range of motion of the right wrist, thus there was no evidence of moderate severity to achieve a higher 30% 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 carpal tunnel syndrome, right condition.  

BOARD FINDINGS:  In the matter of the carpal tunnel syndrome, right condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20151116, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN

		
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	     				  Acting