RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-03494 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050511

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “chronic right hand pain status post (S/P) right shoulder dislocation” with a disability rating of 10%.

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 - 20050307	VARD - 20050719	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Hand, S/P Right Shoulder Dislocation	5099-5003	10%	Right Hand Hypesthesias/Weakness	8599-8515	30%	20050210	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Right Hand Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right (dominant) hand condition began in August 2004 during basic training when he sustained a right shoulder dislocation during a rope climb. This was reduced in the field, but then he had a residual numbness sensation in the right arm and hand. EMG/NCS showed mild carpal tunnel syndrome, Grade I on the right. MRI was essentially normal. The 14 January 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of some discomfort with weakness and decreased sensation in the right hand in a glove-like distribution. Pain was rated slight and constant per the American Medical Association pain scale. He was taking no medications. The CI was unable to resume training and was restricted from lifting over

10 pounds with the right hand and shoulder. Physical examination showed the right shoulder with mild stiffness, tenderness, and full range of motion (ROM.) The CI reported a right-hand glove pattern of paresthesia from the wrist into the hand, to include all fingers, dorsal and palmar.  Right hand strength was 4 versus 5 in the left hand.

At the 10 February 2005 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported symptoms as described above, which occurred constantly, however he was not receiving any treatment. Functional impairment was difficulty writing and gripping but he could tie shoelaces and fasten buttons. There was no lost time from work. Physical examination showed right hand strength was moderately reduced while left hand strength was normal. Right upper extremity (RUE) weakness was 4/5, right grip strength was 3/5 and sensory function showed decreased pinprick and vibration in the glove distribution. The RUE biceps and triceps reflexes were slightly reduced as compared to the left. ROM of the right and left hands and fingers was equal.  The CI’s request for continuation on active duty was denied.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right hand condition 10%, analogously coded 5003 (degenerative arthritis), citing pain rated as slight and constant. The VA rated the right hand condition 30%, analogously coded 8515 (paralysis of the median nerve), based on the C&P examination, citing incomplete paralysis which is moderate.

Using the PT ROMs recorded in the C&P examination, the panel determined that the CI’s right hand was essentially non-compensable based on the VASRD §4.71a codes for loss of hand motion (5307 through 5309). However, IAW VASRD §§4.40, 4.45, and 4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint. Imaging showed carpal tunnel and the right hand pain was recurring and limiting. The CI was able to work, tie shoelaces and fasten buttons without difficulty. Hence, there was no evidence of a moderate level of disability to meet criteria for 30% disability under the 8515 code. The panel reviewed other coding options for a higher rating for the right hand, but there was insufficient evidence of a significantly disabling hand condition to justify a rating greater than 10%. 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 right hand pain condition.

BOARD FINDINGS: In the matter of the right hand condition and IAW VASRD §4.71, 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.

PD-2017-03494

AR20190010668, XXXXXXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX

	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.

PD-2017-03494