RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04984
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “left (non-dominant) hand pain and weakness” with a disability rating of 20%. 

CI CONTENTION:  In addition to the left hand condition, the CI also requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 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 - 20061010	VARD - 20070129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hand Pain and Weakness	8799-8715	20%	Ganglion Cyst Removal of Left Wrist 	7819-5015	0%	20061120	
			Status Post Left Carpal Tunnel Release	8516	0%	20061120	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Left Hand Pain and Weakness.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left hand condition began in October 2004 without evidence of trauma or frank injury.  Electrodiagnostic studies confirmed the presence of carpal tunnel syndrome and the CI underwent left carpal tunnel release in January 2006 along with the removal of a ganglion cyst.  He had little improvement of symptoms and underwent left carpel tunnel release revision in July 2006 with marginal improvement.  

During the 28 August 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported left wrist pain.  The range of motion (ROM) evaluation showed decreased flexion, extension, radial deviation and ulnar deviation, but measurements were not documented.  At the 20 September 2006 MEB NARSUM examination, 3 months prior to separation, the right-handed CI noted loss of left hand strength, numbness in middle and ring fingers and left wrist stiffness.  Physical examination showed well-healed incisions without tenderness and left grip strength was 30% of normal.  The ROM evaluation showed left wrist dorsiflexion of 40 degrees (normal 70) and palmar flexion of 60 degrees (normal 80).  

During the 20 November 2006 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported left wrist decreased ROM.  Physical examination showed decreased sensation to sharp and light touch throughout the left middle and ring fingers.  There was tenderness over the dorsal aspect of the left wrist.  The ROM evaluation showed left wrist dorsiflexion of 50 degrees, palmar flexion of 60 degrees, ulnar deviation of 45 degrees (normal) with pain and radial deviation of 15 degrees (normal 20) without pain on motion.  All fingertips were able to approximate the midline transverse fold of the palm and all left fingertips were able to approximate the thumb.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hand condition 20%, analogously coded 8799-8715 (median nerve neuralgia), citing moderate incomplete paralysis.  The VA rated the left hand condition 0%, coded 8516 (ulnar nerve), based on the C&P examination.  Although there was no ankylosis or limitation of motion of the wrists to justify a rating under VASRD wrist codes (5214, 5215), there was moderate muscle weakness (grip strength) noted on the NARSUM examination to justify a 20% rating under code 8515.  The panel considered alternative VASRD wrist and analogous codes, but all were not applicable or not advantageous to rating.  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 left hand condition.  

BOARD FINDINGS:  In the matter of the left hand 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.  

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.

A copy of this decision has been provided to the counsel you listed on your application, Disabled American Veterans (DAV), 701 Clay Avenue, Waco, TX  76706.

Sincerely,					      
Enclosure