RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-02700 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060903

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Indirect Fire Infantryman, medically separated for “right (dominant) radial nerve injury” with a disability rating of 10%.

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 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 - 20060720	VARD - 20060830	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right (Dominant) Radial Nerve Injury, with Extension of Fingers Limited	8514	10%	Radial Nerve Palsy, Right Upper Extremity	8514	30%	20060607	
Clubfoot	Not Unfitting	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Right Radial Nerve Injury. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right radial nerve condition began in January 2006 after he was hit with shrapnel in his right upper extremity while deployed. He was triaged in-theater, sent to Germany and diagnosed with neuropraxia (peripheral nerve injury). Electro-diagnostic (EDX) testing of the right upper extremity performed on 17 May 2006, 4 months prior to separation, revealed a neuropathy of the radial nerve.

Both the MEB NARSUM and VA Compensation and Pension (C&P) examinations were conducted on 7 June 2006, 3 months prior to separation, and noted the CI’s symptoms as pain and paralysis about his right hand. The NARSUM referred its physical findings to the VA examination which revealed the individual digits of the right hand as being functional with flexion. Severe right- sided digital weakness was present upon global digital extension. “Numbness present on the right lateral hand including the thumb and loss of motor function with use of all fingers on extension.” “The [CI] wears a specialized brace intermittently, which extends the fingers on his right hand to prevent contraction of the joints.”

The panel directed attention to its rating recommendation based on the above evidence. Both the PEB and VA utilized the same VASRD coding scheme 8514 (incomplete paralysis; radial nerve) and arrived at different rating levels. The PEB rated the right radial nerve condition as “mild” 10%, whereas the VA rated as “moderate” 30%, citing limited motion and symptoms of a radial nerve palsy, respectively. Panel members first acknowledged that conditions of the individual fingers dealing strictly with range of motion (excluding the thumb) rate at 0% to a maximum of 10%. Absent non-functional limitation of motion coupled with objective evidence of abnormal clinical findings and EDX tests, members agreed that a nerve code rating was most appropriate. The identified impaired nerve in this case was indeed the radial nerve (8514) which has three separate incomplete rating levels of ‘mild’ (20%), ‘moderate’ (30%) and ‘severe’ (50%). Members agreed that the global weakness found in the digits of the right hand did support an impairment rating greater than that of a ‘mild’ (20%) degree and therefore, their main decision was to determine if the condition would support a level of moderate or severe intensity. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that having the preservation of strength in digital flexion maneuvers as well as needing only intermittent use of a hand brace, the severe impairment level was not supported. Therefore, the panel recommends a disability rating of (moderate) 30% coded 8514 for the right hand nerve condition.

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

BOARD FINDINGS: In the matter of the right hand condition, the panel recommends a disability rating of 30%, coded 8514 IAW VASRD §4.124a. In the matter of the contended clubfoot condition, the panel recommends no change from the PEB determination as not unfitting. 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Radial Nerve Injury, with Extension of Fingers	8514	30%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170323, w/atchs Exhibit B.  Service Treatment Record

AR20190015537, XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a permanent disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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

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