RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05783
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Structural Journeyman, medically separated for “left hand pain, numbness and weakness” with a disability rating of 10%.   

CI CONTENTION:  Review requested of the unfitting condition as well as additional conditions (right wrist, back, feet and lungs) 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 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 - 20070907	VARD - 20080319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hand Pain, Numbness and Weakness	5307	10%	Mild Carpal Tunnel Syndrome, Status Post Nerve Graft and Carpal Tunnel Revision, Left	8599-8515	10%	20080123	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Hand Pain, Numbness and Weakness.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left (non-dominant) hand condition began in 2005 when he sustained a laceration to his wrist and thumb.  After an initial repair of the wound, he continued to have pain, numbness and weakness which worsened over time.  Subsequent radiologic imaging revealed fibrous tissue entrapping the median nerve, and in October 2006, he underwent a carpal tunnel release surgery with grafting of the left radial nerve to the thumb.  Post-operatively, the symptoms continued.  The 4 July 2007 MEB NARSUM examination, 4 months prior to separation, noted the CI’s chief complaint as, “persistent left hand pain, numbness and weakness.”  The physical examination (PE) documented atrophy as well as diminished sensation around the base of the left thumb.  Left wrist and thumb range of motion (ROM) were normal, but painful.  Grip strength as measured, by physical therapy on 29 June 2007, revealed a significant decrease in the left hand compared to the normal right hand.  A clinical encounter on 17 August 2007 noted the CI continued to endorse pain and numbness about the left wrist and thumb.  The PE specifically noted left hand grip strength as 5/5 (times two) attempts “…when encouraged to grip with full strength in the left hand.”  Additionally, there was a minor amount of thenar atrophy and diminished sensation to light touch.  

At the 23 January 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported left wrist and hand pain associated with decreased sensation, numbness and weakness about the left thumb.  He additionally endorsed occasional swelling and “lock-up” of the left wrist.  The PE revealed left wrist tenderness as well as an undefined sensory deficit about the left thumb.  Although crepitation was present, bilateral wrist ROM was normal.  There was no comment regarding the presence of painful motion.     

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hand condition 10%, coded 5307 (Group VII; muscle function), citing VASRD guidelines.  The VA also rated the left hand condition 10%, but analogously coded 8599-8515 (median nerve; incomplete paralysis), based on the C&P examination, citing a “mild” condition.  When deliberating over the use of a VASRD muscle or nerve code for rating, panel members agreed that although the PEB’s muscle code was appropriately utilized given the early evidence of unilateral weakness, the VA’s nerve code was also appropriate as reflected in the nerve grafting surgical procedure.    The panel further agreed that the specific involvement (grafting) of the left radial nerve was a prominent factor in the CI’s persistent symptoms and this, coupled with a seriously impaired unilateral hand grip that significantly improved by August 2007, corresponded well under VASRD code 8514 (radial nerve; incomplete paralysis).  Therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that the totality of physical factors culminating to improved grip strength with continued sensory deficit would best be described as “moderate” impairment, and thus recommends a disability rating of 20% for the non-dominant left hand condition, coded 8514

BOARD FINDINGS:  In the matter of the left hand condition, the panel recommends a disability rating of 20%, coded 8514 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, effective the date of medical separation:    

CONDITION	VASRD CODE	PERMANENT RATING	
Left Hand Pain, Numbness and Weakness  	8514	20%	

SAF/MRB

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05783.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not in accordance with the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept the recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.