RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03204
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080211

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, M1 Armored Crewman, medically separated for “left (non-dominant) ulnar neuropathy” with a disability rating of 10%. 

CI CONTENTION:  “My condition is worsening pain in left shoulder and neck is constant:  use of left hand is getting worse.”  The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  

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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080328	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Non-Dominant) Ulnar Neuropathy	8516	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left (Non-Dominant) Ulnar Neuropathy.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent left ulnar transposition surgery in November 2004 for cubital tunnel syndrome of the elbow.  Imaging of the left elbow on 14 August 2007 was unremarkable.

The 5 August 2007 MEB NARSUM examination, 6 months prior to separation, noted CI complaints of left arm pain, weakness and numbness.  He reported constant tingling and numbness in his left fourth and fifth digits which was worse in the morning and with hand movements.  The numbness caused difficulty with grip and other tasks requiring dexterity, and he could not shoot a rifle or do push-ups.  The CI stated the sensation in his hand was painful, significantly annoying, and interfered with daily activities, but was not disabling.  A left elbow X-ray was normal, but an MRI showed focal enlargement and increased signal of the surgically transposed ulnar nerve.  Physical examination revealed a decrease in bulk of the left first dorsal interosseous muscle compared to the right.  There were no abnormal or involuntary movement and otherwise bulk and tone were symmetric.  Sensation was decreased to all modalities in the fourth and fifth digits of the left hand to the wrist.  Left upper extremity strength was 5/5 in the major muscles.  The neurologist noted the evaluation was significant for mild atrophy of the ulnar innervated muscles and sensory decrement in ulnar distribution, with likely intermittent worsening of symptoms due to stretch or compression of the nerve.  Although the CI’s condition was expected to improve, it was opined that some remaining deficit and symptoms would leave him unable to perform duties of his military specialty.  Medication was ordered to treat neuropathic pain and an elbow pad was recommended to prevent nerve compression.  

During the 13 August 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported left hand tingling, and stiffness in the left elbow and hand due to left ulnar neuropathy.  Physical examination revealed tenderness over the radial/ulnar area with decreased sensation to the left dorsal fourth and fifth digits.  Strength was 4/5, but no atrophy was noted.  There was a scar to the left elbow and full range of motion of the left upper extremity/elbow.  There was no VA examination proximate to separation in evidence

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ulnar neuropathy condition 10%, coded 8516 (ulnar nerve, paralysis of), citing mild incomplete paralysis.  Members agreed that a 10% rating, but no higher, was justified for the mild ulnar inner muscle atrophy and sensory decrement with intermittent worsening of symptoms, as documented by the MEB NARSUM.  The CI was taking a medication and using an elbow pad to treat pain and symptoms, and the condition was expected to gradually improve.  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 ulnar neuropathy.  

BOARD FINDINGS:  In the matter of the left ulnar neuropathy and IAW VASRD §4.124 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 20170412, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180010945, 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