RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2018-00318 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060428

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Hull Technician, medically separated for “left hand intrinsic minus hand” with a disability rating of 10%.

CI CONTENTION: No specific contention was made. 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 - 20060110	VARD - 20070110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hand Intrinsic Minus Hand	8516	10%	Left, Ulnar Nerve Neuropathy with Partial Contracture of 4th and 5th Digits	8516	10%	20061002	
Left Ulnar Nerve Palsy	Cat II					
Left Median Nerve Palsy	Cat II	No VA Placement	
Left Wrist Transchaphoid
Perilunate Fracture Dislocation	Cat II	Left Wrist Fracture with Degenerative
Joint Disease	5215	10%	20061002	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Left Hand Intrinsic Minus Hand (Claw Hand, Deficient Intrinsic Hand Muscles). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left hand condition began on 5 October 2004 after a motorcycle accident. He sustained a left hand transcaphoid-perilunate fracture dislocation. The CI underwent surgery for open reduction internal fixation of the scaphoid with bone graft during his initial hospitalization. He had a second surgery on 5 November 2004 for further stabilization of the involved hand ligaments. He also sustained a laceration of the left brachium (anterior aspect of elbow) just proximal to the ulnar groove (postero-medial). At postoperative follow-up examinations, the CI reported aching pain of the left hand and inability to extend his fingers. A neurology consult felt this was left ulnar neuropathy related to the trauma and scar tissue formation at the laceration near the ulnar groove. The CI reported the symptoms were improving and he was still in a cast (for the hand fracture) at the time.

At a hand surgery follow-up examination on 25 January 2005, when the splint came off, the CI’s hand was noted to be held in an “ulnar minus” position (ulnar nerve related “claw hand”). At an electrodiagnostic laboratory examination on 4 March 2005, physical examination was consistent with severe left ulnar nerve injury. Electrodiagnostic studies (EMG/NCV) showed severe ulnar nerve injury and median nerve sensory loss evidencing co-existing median nerve injury, most likely at the wrist. The hand specialist thought the injuries were most likely not complete and expected the CI to have improvement of both nerves. Serial electrodiagnostic studies showed continuing improvement in the median and ulnar neuropathies; the EMG/NCV on 22 November 2005, 5 months prior to separation, still showed absent sensory response of the ulnar nerve, but some muscle activity where it had been absent on the most recent prior study. Follow-up examinations showed weakness and decreased sensation in the ulnar aspect of the arm and little finger. Continued improvement in wrist range of motion (ROM) was noted as well.

At the 29 November 2005 MEB NARSUM examination, 5 months prior to separation, the CI reported decreased sensation in the left ulnar distribution and left small finger clawing. Physical examination showed right grip strength was 140 pounds and left was 60 pounds. The left wrist had 50 degrees of palmar flexion and dorsiflexion, pronation and supination of the forearm were normal. The CI was able to make a full fist. There was evidence of intrinsic muscle (hand muscles) weakness with some evidence of clawing of the small finger. During the 12 December 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported limited movement of the left wrist and hand, and lack of sensation in the left hand due to the ulnar nerve injury. Physical examination showed left wrist ROM of dorsiflexion 20 degrees and palmar flexion 35 degrees.

At the 2 October 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported pain, numbness, tingling, and weakness of the left arm, wrist and hand. He reported lack of grip strength and he could “not extend the left pinky.” The CI was currently employed as a welder. He reported he was able to perform routine daily activities, vacuum, drive, cook, take out the trash, perform gardening activities, and push a lawn mower. Physical examination showed abnormal sensation of the small and ring fingers and the border of the hand. Motor function was normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the left intrinsic minus hand condition 10%, coded 8516 (paralysis of the ulnar nerve). The VA based the rating on the C&P examination, citing mild incomplete paralysis of finger and wrist movements. The Category II diagnosis of ulnar palsy is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed under the same rating. The PEB also adjudicated two other conditions as Category II. There was evidence of residual decreased sensation in the ulnar distribution of the left hand and decreased grip strength at the MEB NARSUM examination and proximate to separation the clawing of the left hand was limited to the small finger. The panel agreed this was best characterized as mild incomplete paralysis of the ulnar nerve to support a 10% rating for the non-dominant upper extremity. There was no evidence of more proximal weakness of ulnar innervated muscles or sufficient loss of use of the arm or hand to support a higher rating for moderate incomplete paralysis. 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.

Contended PEB Conditions: Left Median Nerve Palsy and Left Wrist Transcaphoid Perjlunate Fracture Dislocation. The PEB listed the contended conditions as Category II, related and contributing to the primary unfitting condition. The panel’s first charge for this these contended conditions is to assess whether either of them can be reasonably justified as separately unfitting for rating consideration. The 25 April 2005 limited duty report, 12 months prior to separation, listed transcaphoid-perilunate injury, nerve injuries of the ulnar and median nerves, and right

radial head fracture. The MEB NARSUM examination included diagnoses of right radial head fracture, left hand ulnar nerve injury, and left median nerve injury. The 28 December 2005 non- medical assessment did not implicate either the hand fracture or median nerve injury as impairing the CI’s successful performance of his duties. The panel majority concluded both Category II conditions were reasonably considered separately unfitting and eligible for rating consideration.

Median Nerve. The November 2005 EMG/NCS noted improvement in both sensory and motor conduction in the median nerve and examinations proximate to separation did not note any motor or sensory loss in the median nerve distribution. The panel agreed proximate to separation the evidence of median nerve impairment did rise to the threshold of a 10% rating for mild incomplete paralysis. After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of median nerve condition favors its recommendation as an additionally unfitting condition for disability rating. It is appropriately coded 8515 and meets the VASRD §4.124a criteria for a 0% rating.

Left Wrist Fracture-Dislocation. At the MEB NARSUM examination there was no limitation of wrist dorsiflexion or palmar flexion or evidence of painful motion to support a rating under the VASRD diagnostic code for limitation of motion (5215). There was no ankylosis (5214) for rating under that code. At the post-separation VA examination the CI reported pain of the wrist, however, there was no examination of the left wrist performed. The panel agreed a 0% rating was supported for the left wrist and no higher. After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of the left wrist condition favors its recommendation as an additionally unfitting condition for disability rating. It is appropriately coded 5215 and meets the VASRD §4.71a criteria for a 0% rating.

BOARD FINDINGS: In the matter of the left hand intrinsic minus hand condition and IAW VASRD
§4.124a, the panel recommends no change in the PEB adjudication. In the matter of the contended Category II left median nerve palsy and left wrist transcaphoid perilunate fracture dislocation, the panel agrees they were unfitting and recommends a disability rating of 0%, coded 8515 for the median nerve palsy condition IAW VASRD §4.124a and a rating of 0%, coded 5215 for the left wrist transcaphoid perilunate fracture dislocation, IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration. As the proposed new combined disability ratings result in no change to the combined disability rating previously assigned, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

CONDITION	VASRD CODE	PERMANENT RATING	
Left Hand Intrinsic Minus Hand	8516	10%	
Median Nerve Palsy	8515	0%	
Left Wrist Transchaphoid Perilunate Fracture Dislocation	5215	0%	
	COMBINED	10%	

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO,
1850
CORB: 003
10 Sep20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.