RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04325
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Combat Engineer, medically separated for “left C5-6 brachial plexopathy” with a disability rating of 20%.  

CI CONTENTION:  “The VA rated me at 30%.”  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 - 20060317	VARD – 20060809	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left C5-6 Brachial Plexopathy	8510	20%	Left Brachial Plexopathy	8510	30%	20060707	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left C5-6 Brachial Plexopathy.  According to the service treatment record and MEB narrative summary (NARSUM), the right-handed CI’s left brachial plexopathy condition began in January 2005 with no history of trauma.  Electrodiagnostic studies on 8 July 2005 were consistent with a mild to moderate left C5-7 brachial plexus palsy.  After a dedicated 3-month strengthening program the CI continued to have difficulty abducting his left arm.  The 10 November 2005 orthopedic examination showed 0/5 weakness of the left deltoid in abduction and atrophy of the left anterior deltoid muscle.  At the 5 December 2005 MEB physical therapy range of motion (ROM) study, 5 months prior to separation, the CI reported 8/10 left shoulder pain with movement.  On examination, there was painful limitation of left shoulder motion with abduction to 35 degrees (normal 180), flexion of 45 degrees (normal 180), external rotation of 15 degrees (normal 90) and internal rotation of 35 degrees (normal 70).  

During the 6 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported pain and limited motion of the left shoulder with numbness and tingling in the left arm and hand.  Physical examination revealed left upper extremity abduction limited to 45 degrees.  There was obvious muscle atrophy of the left deltoid and supraspinatus muscles.  The 19 February 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of left shoulder pain and limited ROM.  Physical examination showed flexor and abductor muscle strength of 4+/5 with exertion against gravity of the left shoulder.  The examiner noted the CI had a deformity with left shoulder instability, limited motion and constant pain.

At the 7 July 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported left shoulder pain and limited ROM.  Physical examination showed left shoulder strength of 4/5 in flexion, extension, internal and external rotation and abduction.  The ROM study showed flexion and abduction of 80 degrees, external rotation of 70 degrees and internal rotation of 70 degrees with 7-9/10 pain.  The left upper arm measured 35cm in diameter compared to 37.5cm on the right.  Electrodiagnostic studies in March 2006 showed mild neurogenic motor unit changes at the left C5-6 deltoid and supraspinatus muscles.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left brachial plexopathy 20% coded 8510 (incomplete paralysis of the upper radicular group), citing mild incomplete paralysis.  The VA rated the left brachial plexopathy 30%, coded 8510, based on the C&P examination, citing moderate incomplete paralysis of shoulder and elbow movements.  Although the CI met the VASRD §4.71a threshold for a 20% rating for limitation of arm motion under code 5201, the combination of marked limitation of left arm motion in all planes of movement, muscle atrophy and pain added up to more than mild incomplete paralysis.  Therefore, IAW VASRD §4.7 (higher of two evaluations) the panel agreed the CI met the VASRD §4.124a standard for moderate incomplete paralysis of the upper radicular group (fifth and sixth cervical nerves).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the left brachial plexopathy, coded 8510.  

BOARD FINDINGS:  In the matter of the left brachial plexopathy, the panel recommends a disability rating of 30%, coded 8510 IAW VASRD §4.124a.  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 C5-6 Brachial Plexopathy	8510	30%	

The following documentary evidence was considered:

AR20190006885, XXXXXXXXXXXXXXXXXX
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 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 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), XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.

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