RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02839
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20081211

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, AH-64 Attack Helicopter Repairman, medically separated for “postural and intention tremors” with a disability rating of 10%.  

CI CONTENTION:  The VA rated higher for his condition.  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 – 20081103	VARD - 20090526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Postural and Intention Tremors	8199-8105	10%	Essential Tremor	8199-8105	30%	20090122	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Postural and Intention Tremors.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s postural and intention tremors began in late 2005 when he noticed mild tremors, but did not feel they caused any significant limitations for the first 2.5 years.  In March 2008 his command directed an evaluation after he gouged a panel on an aircraft.  Neuroimaging of the brain was normal.  The 15 October 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of tremors interfering with the performance of duties.  Medication was begun, but a neurology review in September 2008 recommended discontinuing the medication due to cardiac side effects.  No other treatment was recommended.  He was restricted from performing his normal MOS.  Physical examination showed mild persisting tremors while sitting and holding paperwork in his hand.  There was a slightly greater tremor on the right compared to the left.  Grip, strength, and movement were normal in both hands and arms.  Holding hands out for 2 minutes, he had more marked tremors in both hands.  Coordination, finger to nose, and function remained otherwise intact.  Neurological examination showed a subtle tremor with scribing four standard geometric shapes, and high frequency and low amplitude intention tremor with holding a cup of water.  The remainder of the examination was normal.  There was normal strength and range of motion (ROM) in upper and lower extremity joints and muscles.  Neurology diagnosed postural and intention tremors, a variant of essential tremors, usually not severe enough to fail retention standards.  Symptoms were much worse under stress, and in a combat environment would be exacerbated.  Baseline tremors were not significant in daily life but exacerbations in stress or combat/deployed situation could severely impact performance.  

At the 22 January 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported his hands shook almost constantly.  Other parts of his body would shake if he was under stress.  His course had been stable and he had no current treatment.  Physical examination showed normal strength and muscle tone.  There was a moderate tremor noted in all extremities at rest, which was consistent with essential tremor.  Sensory and motor examinations were normal.  There was no evidence of chorea and no effects on activities of daily living, chores, shopping, or exercise.  He was unemployed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the tremor condition 10%, coded 8199-8105 (analogous to chorea, Sydenham’s), citing tremors rated as mild.  The VA rated the essential tremor, symptomatic condition 30%, coded 8199-8105, based on the C&P examination, citing moderate type of chorea. The NARSUM examination noted symptoms were insignificant in daily life, but exacerbated under stress; and the CI was not receiving any treatment.  Panel members agreed the condition was mild and therefore did not meet criteria under 8105 for a higher rating.  After due deliberation, considering all 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 tremor condition.  

BOARD FINDINGS:  In the matter of the tremors condition and IAW VASRD §4.124a, 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170426, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180008725, 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