RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXX	CASE:  PD-2020-00207
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Avenger Crewmember, medically separated from the Temporary Disability Retired List (TDRL) for “left ulnar neuropathy…” and “…left shoulder [pain]…,” rated 10% and 0%, respectively, with a combined disability rating of 10%. 

CI CONTENTION:  The VA gave him a higher rating for the injuries that led to his discharge.  He also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and/or the 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 - 20051007	VARD – 20060920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ulnar Neuropathy	8516	10%	Left Hand and Wrist Pain	No VA Examination Proximate to Separation in Evidence	
Left Shoulder Pain	5099-5003	0%	Left Shoulder Pain, Status Post Subacromial Decompression	5202	20%	20050304	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Left Ulnar Neuropathy.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left (non-dominant) ulnar neuropathy began in 2000 following a left shoulder injury which occurred in a 1998 training accident; he underwent a cubital tunnel release in April 2001.  The CI was separated and placed on the TDRL on 5 November 2001.

During the 13 April 2005 TDRL neurology examination, 6 months before separation, he reported continued post-surgery hypersensitivity around the left elbow as well as mild hand weakness with a tendency to drop things.  The examiner noted normal muscle bulk and tone, decreased pin sensation about the 4th and 5th left digits, and hypersensitivity around the left elbow.  The 19 July 2005 TDRL orthopedic examination, 3 months prior to separation, recorded normal neurovascular findings in the distal left upper extremity with no weakness or sensory problems in the ulnar nerve distribution of the hand.  The examiner referenced EMG results on 7 July 2005 which noted CI’s complaints of “pins and needles” in the left small and ring fingers, and numbness over the posteromedial left elbow.  The EMG study showed slowing of the ulnar nerve conduction at the elbow, but improvement since January 2005.  The examiner also noted that previous findings in April 2005 recorded left elbow flexion to 132 degrees (normal 145), with full pronation and supination.  There was no VA examination proximate to separation that addressed the neuropathy condition. 

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from the TDRL with a permanent disability disposition of separation with severance pay at 10% for the left ulnar neuropathy.  The PEB cited “slight hand dysfunction with fine manipulation…rated as non-dominant, mild.”  The VA continued a 10% rating for the left upper extremity nerve condition, dual coded 8616-5309 (ulnar nerve neuritis-Group IX. Function (the forearm and hand).  Panel members agreed that a 10% rating, but no higher, was justified for mild incomplete paralysis under code 8516 (ulnar nerve).  There was no hand deformity, atrophy, or muscle weakness, and the CI demonstrated full left forearm pronation and supination, with a mildly decreased left elbow flexion.  Although he complained of numbness and tingling, there was no loss of motor function. 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 ulnar neuropathy at the time of TDRL removal.

Left Shoulder Pain.  According to the STR and MEB NARSUM, the CI’s left shoulder condition began in the 1998 training accident and led to two subsequent arthroscopic subacromial decompressions surgeries.  

At the 4 March 2005 VA Compensation and Pension (C&P) examination, 8 months before separation, he reported stiffness, weakness, pain, and lack of endurance.  Physical examination revealed left shoulder posterior tenderness and full upper extremity strength.  Left shoulder range of motion (ROM) testing showed both flexion and abduction to 120 degrees (normal 180).  

During the TDRL period, the CI underwent another arthroscopic subacromial decompression on 25 March 2005.  At an orthopedic follow-up on 11 July 2005 to discuss the July EMG results, the provider documented full, painless left shoulder ROM.  The 19 July 2005 TDRL examiner noted complaints of left shoulder sensitivity as well as constant, moderate pain, which worsened at times, but was less severe than before surgery.    Physical findings showed superior left shoulder sensitivity with ROM tests demonstrating flexion to 112 degrees and abduction to 100 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from the TDRL with a permanent disability disposition of separation with severance pay at 0% for the left shoulder condition.  The PEB cited “slight loss of motion, good stability” and continued painful motion. The VA rated the left shoulder condition 20%, coded 5202 (other impairment of humerus), based on the C&P examination, citing episodes of scapulohumeral joint dislocation with guarding of arm movements at the shoulder level.  A 20% rating for non-dominant arm under code 5201 (arm, limitation of motion of) is granted when there is arm limitation of motion at shoulder level (90 degrees); however, this was not supported by the evidence closest to separation.  The panel considered other VASRD shoulder and analogous codes, but all were less applicable and not advantageous for rating.   Although there was insufficient limitation of motion to support a compensable rating, panel members agreed the TDRL examination, which was closest to separation, provided evidence of limited painful motion with functional loss to support a 10% rating IAW VASRD §4.59, §4.40 or §4.45.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the left shoulder condition at the time of TDRL removal.
BOARD FINDINGS:  In the matter of the left ulnar neuropathy and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication at the time of TDRL removal.  In the matter of the left shoulder condition, the panel majority recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a, at the time of removal from TDRL and permanent disability disposition. The single voter for dissent recommends re-characterization and 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, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Ulnar Neuropathy	8516	10%	
Left Shoulder Pain	5099-5003	10%	
COMBINED	20%	

AR20210017048

Dear XXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs. 

Sincerely,