RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxx	CASE:  PD-2017-00372
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Attack Helicopter Repairer, medically separated for “left (non-dominant) cubital tunnel syndrome” with a disability rating of 10%.   

CI CONTENTION:  “Only given 30% on discharge VA changed to 60% Army did not pay for all service related disability.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20050509	VARD - 20051128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Non-Dominant) Cubital Tunnel Syndrome	8516	10%	Left Ulnar Neuropathy	8599-8515	20%	20051031	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left (Non-Dominant) Cubital Tunnel Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left cubital tunnel syndrome began in January 2004.  The CI underwent an ulnar nerve transposition surgery but his painful symptoms remained.  Further surgery was declined.  Electro-diagnostic studies performed on 18 January 2005 revealed findings consistent with a left arm neuropathy at the elbow.  

At the 25 March 2005 MEB NARSUM examination, 4 months prior to separation, the CI’s chief complaint was left upper extremity pain and numbness.  The physical examination (PE) revealed decreased 3/5 motor strength in left arm as measured by handgrip.  Atrophy was present about the proximal aspect of the left hand.  Sensation was described as “decreased” in the 4th and 5th digits of the left hand.  “No limitation of movement” was documented with regards to the left hand.    

At the 31 October 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported residual throbbing pain of his left arm and decreased grip strength in his left hand.  The PE revealed decreased grip strength in the left hand and decreased sensation along the left ulnar distribution in the 4th and 5th digits.  Atrophy was noted about the hypothenar area of the left hand and numbness was present up into the left forearm.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left upper extremity condition 10%, coded 8516 (incomplete paralysis of the ulnar nerve) citing failed surgical intervention with continuing pain and numbness.  The VA rated the left ulnar neuropathy condition 20%, analogously coded 8599-8515 (incomplete paralysis of the median nerve) based on the C&P examination, citing objective findings of moderate neurological deficits involving the left hand and forearm.

Panel members first agreed that in light of positive electro-diagnostic evidence of a neuropathy coupled with appropriate correlation to clinical findings, the diagnosis and rating criteria under code 8515 was most accurate.  Additionally, members agreed that the evidence of grip weakness and atrophy in a single portion of the left hand would rate greater than “mild” impairment and less than “severe” impairment; therefore, most appropriately rated as “moderate” at 20% for the non-dominant upper extremity.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left cubital tunnel syndrome condition.  

BOARD FINDINGS:  In the matter of the left cubital tunnel syndrome condition, the panel recommends a disability rating of 20%, coded 8516 IAW VASRD §4.124a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation: 

CONDITION	VASRD CODE	PERMANENT RATING	
Left (Non-Dominant) Cubital Tunnel Syndrome	8516	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170207, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008803, XXXXXXXXXX. 

Dear XXXXXXXXXXXXXXXX:

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.