DEPARTMENT  OF  THE  NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01703

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 7 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01703 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20081129

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Basic Musician, medically separated for “chronic bilateral wrist pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 – 20080825	VARD - 20090302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Wrist Pain	8615	10%	Right Wrist Carpal Tunnel Syndrome (CTS)	8515	10%	20081205	
	8615	10%	Left Wrist CTS	8515	10%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Bilateral Wrist Pain. According to the service treatment record and MEB narrative summary (NARSUM), the right-hand dominant CI underwent surgical release for CTS and DeQuervain’s (tendon) syndrome on the left wrist in April 2007 and on the right wrist in June 2007. Bilateral upper extremity electro-diagnostic studies performed on 8 February 2008 were normal. Despite surgery, his bilateral wrist pain was not completely relieved. The 19 May 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of constant bilateral wrist pain aggravated by activity. The physical examination (PE) revealed decreased and painful range of motion (ROM) of both wrists. There was decreased sensation to the medial aspect of the left palm, little and ring fingers.

At the 5 December 2008 VA Compensation and Pension (C&P) examination, 1 week after separation, the CI reported intermittent numbness, tingling and weakness of the fingers. The PE revealed normal ROM of both wrists without evidence of abnormal peripheral neuro-sensation; however, both the Tinel and Phalens tests were positive indicating the presence of CTS.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated each wrist condition 10%, coded 8615 (neuritis, median nerve). The VA also rated each wrist condition 10%, but coded them under 8515 (incomplete paralysis of the median nerve), based on the C&P examination, citing mild incomplete paralysis of hand movements. Panel members agreed the VA examination held nearly exclusive probative value secondary to its close reference to the date of separation. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that, despite having normal electro-diagnostic studies, the positive tests indicating CTS in the probative examination highly supported a condition of incomplete paralysis of the median nerve at a maximum level of “mild” (10%) impairment. Therefore, there was insufficient cause to recommend a change in the PEB’s adjudication for the chronic bilateral wrist pain.

BOARD FINDINGS: In the matter of the bilateral wrist pain condition and IAW VASRD §4.124a- 221, the panel recommends no change in the PEB adjudication. 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.