RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03000
BRANCH OF SERVICE:  army	SEPARATION DATE:  20070620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Calvary Scout, medically separated for “left (non-dominant) brachial plexopathy” and “left biceps tendonitis,” rated 20% and 0%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “My disabilities are from injuries received in the line of duty as a direct result of armed enemy actions.  I should have been retired so that I still had medical coverage.”  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 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 - 20070516	VARD - 20070803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Non-Dominant) Brachial Plexopathy	8512	20%	Left Brachial Plexopathy, Lower Trunk, Partial…	8512	30%	20070607	
Left Biceps Tendonitis	5024	0%	Left Shoulder Biceps Tendonitis…	5024-5201	20%	20070607	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Left Brachial Plexopathy.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured his left shoulder during two separate IED detonations in June and November 2005.  A 21 November 2006 electromyogram revealed “chronic, mild, partial left lower trunk brachial plexopathy with mild residual motor deficit” of the C8-T1 muscles of the left forearm and hand (abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals).  

At the 21 April 2007 MEB NARSUM examination, 2 month prior to separation, the CI reported left hand weakness and numbness. Physical examination showed diminished sensation to pinprick and temperature in the left medial forearm and fourth and fifth digits.  There was 5/5 muscle strength throughout all major muscle groups, however, the examiner noted decreased hand strength with repetitive tasks.  

During the 7 June 2007 VA Compensation and Pension (C&P) examination, less than 1 month before separation, the CI reported loss of left hand strength as well as the inability to hold objects with the right hand in addition to numbness and tingling.   Physical examination showed right hand dominance and moderately decreased left hand strength.  There was full range of motion (ROM) of the left digits without additional limitation with repetitive use.  There was decreased sensation at the ulnar aspect of upper extremity from the elbow to the fourth and fifth fingers. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left brachial plexopathy 20%, coded 8512 (paralysis of the lower radical group), citing mild incomplete paralysis.  The VA rated the left brachial plexopathy 30%, also coded 8512, based on the C&P examination, citing moderate incomplete paralysis.  Panel members noted that the NARUM and VA examinations both documented decreased left hand strength and sensation, and that the EMG revealed chronic mild lower brachial plexopathy.  Thus, the panel agreed that the evidence supports a 20% rating for mild, incomplete paralysis under code 8512.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the left brachial plexopathy.

Left Biceps Tendonitis.  As mentioned above, the CI injured his left shoulder during two separate IED detonations.  At the 28 March 2007 MEB physical therapy (PT) examination, 3 months prior to separation, repetitive, goniometric-measured left shoulder flexion was to 88 degrees (normal 180) and abduction to 92 degrees (normal 180), with painful motion.  At the MEB NARSUM examination, left biceps tendonitis was noted with related shoulder ROM limitations due to pain.  

During the C&P examination, less than 1 month before separation, the CI reported constant left shoulder pain, rated at 6/10, and exacerbated by activity.  Physical examination showed signs of weakness, tenderness and impingement signs, and left shoulder flexion was to 170 degrees and abduction to 150 degrees; painful motion was elicited at 90 degrees.  There was weakness and lack of endurance with repetitive motion that impacted function, but not ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left biceps tendonitis 0%, dual coded 5024-5201 (tenosynovitis-arm, limitation of motion), citing ROM limited by pain.  The VA rated the left biceps tendonitis 20%, also dual coded 5024-5201, based on the C&P examination, citing limitation of arm motion at shoulder level.  Panel members noted the VASRD §4.71a threshold for rating for ROM impairment under code 5201 is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  However, the panel agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under code 5202 (humerus, other impairment of), and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203 (clavicle or scapula, impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for left biceps tendonitis, coded 5024-5201.

BOARD FINDINGS:  In the matter of the left brachial plexopathy and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the left biceps tendonitis, the panel recommends a disability rating of 10%, coded 5024-5201 IAW VASRD §4.71a.  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	
Left Brachial Plexopathy	8512	20%	
Left Biceps Tendonitis	5024-5201	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170328, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190008724, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX

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.