RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00683
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20051006

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, CID Special Agent, medically separated for “pain right forearm post dog bite” and “neck and upper back pain,” each rated 10%, with a combined disability rating of 20%.  

CI CONTENTION:  Review all conditions.  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 – 20050629	VARD - 20060914	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain Right Forearm	8799-8716	10%	Residuals of Right Forearm Pain	8516	10%	20060718	
Neck & Upper Back Pain	5299-5237	10%	Neck Injury	5323	NSC		
Generalized Anxiety Disorder/Panic Disorder	Not Unfitting	Anxiety Disorder	9400	30%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Pain Right Forearm.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-hand dominant CI was bitten on the right forearm by a dog on 15 September 2004.  The wound was cleaned and sutured.  The initial neurovascular examinations were normal including sensation and motion.  Five days after the bite, the CI reported decreased motion of the wrist and fingers, but was able to make a fist and had intact sensation to touch.  Nine days after the bite, the range of motion (ROM) of the hand and fingers was intact and pain free.  The neurological examination remained intact.  

At the 25 October 2004 occupational therapy examination, his right 4th and 5th fingers went numb after doing pushups.  He was thought to have possible scar adhesions.  On 3 December 2004 in occupational therapy, the CI reported that he continued to have paresthesia (abnormal sensations) with gripping.  On examination, the scar was well healed.  Grip strength was decreased on the right, but 2-point discrimination remained intact.  It was specifically noted that there was not a claw hand deformity (indicative of a motor loss) nor was atrophy present.  

At the 18 January 2005 neurosurgery examination, the CI was thought to have a recovering ulnar neuropathy, but the neurological examination was intact.  At the 8 February 2005 neurology examination, the CI reported that he initially had a claw hand (the opposite was recorded in the records) and had persistent shooting pain in the forearm in the ulnar distribution if he lifted anything heavy.  On examination, sensory and motor function was diminished in an ulnar distribution.  Provocative maneuvers for cervical nerve root irritation were negative.  The next day in neurosurgery, the examination showed diminished sensory and motor function in an ulnar distribution.  The neck ROM was normal.  The CI was referred for electrodiagnostic testing (EDX) which was performed on 15 February 2004.  The physical examination showed sensory loss in the right ulnar distribution, but a normal motor examination.  The actual EDX studies were normal with no evidence of an ulnar neuropathy.  

The 14 April 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of continued pain in the right forearm if he lifted anything heavier than a pen.  On examination, strength and sensation were reduced on the right in an ulnar distribution.  The orthopedic addendum on 3 May 2005, 5 months prior to separation, noted decreased sensation in the right ulnar distribution, but good strength including grip on the right.  Atrophy was not present.  

At the 18 July 2007 VA Compensation and Pension (C&P) evaluation, 9 months after separation, the CI reported numbness and weakness in the right forearm with use.  On examination, a decreased grip was noted on the right, but atrophy was absent.  Sensation was intact.  A provocative test for nerve irritation was negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right forearm condition 10%, coded 8799-8716 (neuralgia of the ulnar nerve), citing motor loss but with normal EDX studies.  The VA also rated the right forearm condition 10%, coded 8516 (incomplete paralysis of the ulnar nerve), based on the C&P examination, citing weakness.  The panel considered the evidence and observed that most, but not all examinations recorded mild weakness of the right grip.  An evaluation by orthopedics proximate to separation noted normal motor function though and the EDX studies were normal.  Similarly, the sensory loss was present on most but not all examinations.  The evidence does not show more than a mild loss (10%) regardless of the code chosen.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left forearm pain condition.  

Neck and Upper Back Pain.  According to the STR and MEB NARSUM, the CI’s neck and upper back condition began as early as 2000 after a motor vehicle accident.  An examination in internal medicine on 24 January 2005 noted longstanding pain, but that it was aggravated by typing in front of a computer (alternate duty since the forearm injury).  He was noted to have normal strength of both upper extremities and full ROM of the neck.  

The MEB NARSUM examination, 6 months prior to separation, noted full ROM of the neck and negative provocative maneuvers for nerve root irritation.  Sensation and motor function were reduced, but in an ulnar rather than radicular distribution.  The orthopedic addendum noted that the CI had pain primarily between the shoulder blades.  The spine was non-tender but muscle tenderness was present.  On examination, he had good ROM of the neck and thoracic spine.  Motor function was normal, but sensation was reduced in an ulnar distribution.  X-rays of the cervical and thoracic spine were normal other than mild degenerative changes of the lower thoracic spine.  The 4 May 2005 physical therapy examination recorded ROM for the neck as flexion to 60 degrees (normal 45) and combined ROM of 325 degrees (normal 340).  

At the VA Compensation and Pension (C&P) evaluation, 9 months after separation, the CI reported persistent neck pain.  On examination, the goniometric ROM of the neck was normal and pain free in all planes.  Thoracolumbar ROM was recorded as flexion to 80 degrees (normal 90) and combined ROM of 230 degrees (normal 240) with painful motion noted.  X-rays of the neck and thoracic spine were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck and upper back pain 10%, coded 5299-5237 (analogous to cervical strain).  The VA determined the “arthritis, thoracic spine,” coded 5003-5237 (degenerative arthritis – cervical strain) was not service connected, citing a lack of objective evidence that the pain was attributed to an underlying disability.  It determined the “neck injury,” coded 5323 (Torso & Neck Group XXIII muscle code) was also not service connected (NSC), in this instance citing a lack of definitive diagnosis that could be linked to an event in service.  The panel considered the evidence.  The X-rays of the neck and upper thoracic spine were normal on multiple examinations.  The neurological impairment was attributed to an ulnar neuropathy.  The ROM was normal on the PEB examinations and also the VA examination with the exception of thoracolumbar flexion which was limited to 80 degrees.  Painful motion was not recorded for the neck but was present for the thoracolumbar spine.  The panel found no route to a rating higher than the 10% adjudicated by the PEB.  The panel observed this rendered moot a determination of separate unfitness for the neck and upper thoracic spine.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the neck and upper back condition.  

Contended PEB Condition:  Generalized Anxiety Disorder/Panic Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement.  It was judged to meet retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right forearm condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the neck and upper back pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended generalized anxiety disorder/panic disorder, the panel unanimously agrees it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180004734, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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