RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04856
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “mild incomplete paralysis of the minor (non-dominant) ulnar nerve” with a disability rating of 10%.   

CI CONTENTION:  The condition continues to worsen.  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 - 20050908	VARD - 20051207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Incomplete Paralysis of the Minor (Non-Dominant) Ulnar Nerve	8516	10%	Cubital Tunnel Syndrome, Left Arm	8516	10%	20050729	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Mild Incomplete Paralysis of the Minor [Left] Ulnar Nerve.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a left ulnar nerve transposition in March 2005 for cubital tunnel syndrome.  Even though the paresthesias almost completely resolved and sensation had nearly returned to the left ulnar two digits, she had difficulty performing her military duties.  A 27 June 2005 neurodiagnostic test showed no evidence of axonal degeneration.  Also, ulnar motor nerve conduction velocity was normal and the mild ulnar neuropathy at the elbow had improved since a previous study.  

The 14 July 2005 MEB NARSUM examination, 4 months prior to separation, noted near complete resolution of CI’s left arm paresthesia but continued pain and a small nodule at the incision site that caused tingling in the fingers when bumped.  She could only lift up to 5 pounds before having left elbow pain.  Physical examination showed lateral pinch tests measuring 12 pounds on the left compared with 19 on the right.  Grip strength was 30 and 24 pounds compared with 80 and 92 on the right.  There was no hypothenar or first dorsal interossei atrophy, and interossei muscles showed 5/5 strength.  A 1-2 mm nodule (presumably on the ulnar nerve) was freely mobile and had a positive Tinel’s sign (tapping on the nodule caused tingling sensation distally).  

At the 29 July 2005 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported tingling and numbness in the ulnar aspect of the hand that occurred constantly but did not cause incapacitation.  Physical examination demonstrated abnormal sensation in the left ulnar nerve distribution with normal motor function.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left elbow condition 10%, coded 8516 (incomplete paralysis of the ulnar nerve), citing the 27 June 2005 electrodiagnostic study which showed “mild ulnar neuropathy at the elbow.”  The VA also rated the left elbow condition 10%, coded 8516, based on the C&P examination, citing “incomplete paralysis of finger and wrist movements which is mild.”  The panel noted the VASRD §4.124a standard for rating peripheral nerve disorders states, “When the involvement is wholly sensory, the rating should be mild, or at most, the moderate degree.”  There was no evidence on the electrodiagnostic study proximate to separation of any motor involvement and mild sensory impairment of the left (non-dominant) ulnar nerve for a rating higher than 10% under code 8516 as adjudicated by the PEB.  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 left ulnar nerve condition.  

BOARD FINDINGS:  In the matter of the left elbow 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.  

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Dear XXXXXXXXXX:

	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