RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01180
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “right shoulder and right arm pain” with a disability rating of 0%.

CI CONTENTION:  Current condition supports a higher rating.  Additional unfitting conditions were not considered.  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 - 20040212	VARD - 20040618	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder and Arm Pain	5099-5003	0%	Residuals, Surgery, Right Shoulder, TOS	8699-8619	10%	20040322	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Right Shoulder and Right Army Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI noted right hand grip weakness beginning in 2001 and then developed atrophy of the muscles at the base of the right thumb (thenar).  There was no history of trauma.  He presented with these complaints in the summer of 2002 and was referred to neurology.  An MRI of the brachial plexus (nerve group controls movement and sensation of the arm and hand) was normal.  Electrodiagnostic studies were consistent with a thoracic outlet syndrome (TOS; compression of the nerves of the upper extremity by other structures in the neck and shoulder region).  Changes consistent with a carpal tunnel syndrome (CTS) were also noted.  An MRI of the cervical spine was negative for a herniated disc or nerve root compression, but a cervical rib (extra rib) was noted.  The CI then underwent a TOS release on 3 December 2002 with removal of the cervical rib.  Despite rehabilitation following surgery, the CI continued to be symptomatic and was then evaluated in orthopedics for a possible CTS.  On 18 November 2003, the CI underwent a carpal tunnel release and again entered rehabilitation.  On 7 January 2004 in physical therapy, the CI was noted to have shoulder abduction of 140 degrees (normal is 180) and flexion of 160 degrees (normal is 180); shoulder strength was normal.

During the 13 January 2004 MEB NARSUM, 5 months before separation, the CI still had TOS and CTS symptoms.  Physical examination showed right shoulder abduction to 180 degrees; flexion was not recorded.  Sensation was reduced over the right upper extremity, but apparently normal over the hand.  Motor and vascular function were normal.  Both incisions were well healed.  During the 20 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported residual right thumb numbness and periodic hand cramps and no significant improvement in his shoulder pain.  Physical examination revealed right shoulder decreased strength, range of motion (ROM), and sensation.  The right thumb also had decreased sensation.

At the 22 March 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported right shoulder wasting and weakness associated with pain.  Abduction was reduced to 175 degrees and flexion to 166 degrees.  Strength was reduced to 4/5 for right shoulder elevation, right elbow extension, and right elbow flexion.  The CI reported his left thumb tingling had resolved, but the thumb still tightened up at times and that his grip strength was reduced.  Physical examination showed a strong right hand grip and sensation intact.  Motion of the right thumb and wrist were slightly reduced compared to the left side; however, the thumb was able to move freely and independently.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder and right arm pain condition 0%, analogously coded 5099-5003 (degenerative arthritis) citing pain without sleep disturbance.  The VA rated the right shoulder condition 10%, analogously coded 8699-8619 (neuritis of the long thoracic nerve), and the right wrist (CTS release) condition was rated 10%, analogously coded 8599-8515 (paralysis of the median nerve), based on the C&P examination 2 months before separation, citing a loss of shoulder and wrist strength and motion.

The CI had surgery for two separate conditions and remained symptomatic from each after surgery with impaired function.  The evidence supported a finding that each condition was separately unfitting at separation.  The limitation in motion was not compensable under any code specific to these regions.  Weakness and reduced ROM were noted for the shoulder, wrist and thumb on some examinations, but not others including the orthopedic evaluation.  This supports a “mild” level of impairment for the shoulder and wrist conditions coded 8619 and 8515 for a 0% and 10% rating, respectfully.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the right shoulder status post TOS release condition, coded 8619, and 10% for the right arm status post CTS release condition, coded 8515.

BOARD FINDINGS:  In the matter of the right shoulder status post thoracic outlet syndrome release condition, the panel unanimously recommends a disability rating of 0%, coded 8619 IAW VASRD §4.124a.  In the matter of the right arm status post carpal tunnel syndrome release condition, the panel unanimously recommends a disability rating of 10%, coded 8515, IAW VASRD §4.124a.  There are no other conditions within the panel’s scope of review for consideration.  
The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Shoulder status post TOS Release	8619	0%	
Right Arm status post CTS Release	8515	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160927, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170018490, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

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

Sincerely,	
Enclosure