RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-05822
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040919

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Tactical Aircraft Maintenance Journeyman, medically separated for “[left] median nerve injury” with a disability rating of 10%.  

CI CONTENTION:  Given a higher rating by the VA.  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 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 - 20040706	VARD - 20050406	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Median Nerve Injury	8515	10%	Traumatic Injury to Left Palm	8615	10%	20050307	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Median Nerve Injury.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the left-handed CI underwent emergent surgery for a partial laceration of the left median nerve in January 2002.  Subsequent surgery was required in October 2003 with neurolysis and nerve grafting, and post-operatively, he had immediate loss of thenar (base of thumb) motor function, indicating an iatrogenic (surgery induced) injury to the motor branch of the median nerve.  At the 17 March 2004 MEB NARSUM examination, 6 months prior to separation, he complained of loss of sensation and motor function of the left index finger and thumb.  Physical examination revealed an insensate (complete loss of sensation) left thumb and index finger.  Additionally, the motor function at the base of the left thumb was diminished.  The commander’s statement specified that the CI did not “have full use of his [left] hand.”  

At the 7 March 2005 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported numbness and significant sensation loss about the left thumb, index finger and palm, but denied any pain about the left hand.  He had a decreased ability to write, turn locks or keys, or open snack bags or other sealed food items with the left hand.  The examiner noted comparison atrophy of the base of the left thumb, full digit range of motion without focal weakness, “subjective decrease to sensation over the left finger, lateral palm and thumb,” and a large area of decreased sensation around the graft donor site in the proximal left forearm.  The diagnosis was listed as traumatic injury to left palm with decreased sensation and thenar muscle atrophy of the left hand. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hand injury 10%, coded 8515 (incomplete paralysis of the median nerve), citing “satisfaction with [the] left hand motor function.”  The VA also rated the left hand condition 10%, but coded 8615 (median nerve neuritis), based on the C&P examination, citing mild, incomplete paralysis of hand movements.  Panel members agreed that the PEB’s use of nerve code 8515 was most appropriate in this case given its corresponding surgical identification of the median nerve.  The VASRD schedule of ratings for peripheral nerve diseases specifically states that “when the [nerve] involvement is wholly sensory, the rating should be for the mild (10%), or at most the moderate (20%) degree.”  However, this case involved both sensory and motor deficits demonstrated by evidence of palmar insensate and local weakness secondary to atrophic muscles of the hand.  The panel majority adjudged that the documented large area of diminished sensation in the proximal left forearm (which extended into the main grasping digits of the thumb and index finger) coupled with surrounding muscular atrophy in the dominant extremity, indicated an impairment level above “mild” (10%) and below “severe” (50%), and thus recommended a “moderate” disability rating of 30% under code 8515.  The minority voter best characterized the CI’s condition as closer to “mild.”   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 hand injury, coded 8515.  

BOARD FINDINGS:  In the matter of the left hand injury, the panel majority recommends a disability rating of 30%, coded 8515 IAW VASRD §4.124a.  The single voter for dissent recommended no change but did not elect to submit a minority opinion.  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 Median Nerve Injury	8515	30%	

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05822.

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 your separation be re-characterized to reflect disability retirement, rather than 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 determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 90 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married, in such a case, failure to render an election will result in automatic enrollment by law.