RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00150
BRANCH OF SERVICE: Army 	SEPARATION DATE:  20040102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Cavalry Scout) medically separated for a left elbow condition.  The left elbow condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  “Left elbow pain” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “persistent pain left elbow” as unfitting, rated 0%, with possible application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated. 

CI CONTENTION:  His condition continues to worsen and negatively impact him.  His complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON: 

IPEB – Dated 20031023	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Pain L Elbow	5099-5003	0%	… Fracture Of The L Distal Humerus… ORIF	5206-5015	10%	20031118	
Other MEB/PEB Conditions x 0 (Not in Scope) 	Other x 1 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20040224 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Elbow Condition.  The record shows that the right-hand dominant CI sustained a fracture of his left elbow as a child.  He subsequently reported left elbow pain, but was able to meet duty requirements until a motorcycle accident on 29 March 2003.  He then had an open reduction and internal fixation (ORIF) for a fracture.  He had persistent pain after surgery, despite rehabilitation and a mechanical block to full extension.  He had a screw removal on 17 June 2003 for the latter condition with an improvement in his range-of-motion (ROM).  An X-ray on 27 August 2003 noted continued healing of the fracture and good alignment of the bones.  The narrative summary (NARSUM) was the same day.  It noted that the CI was limited in his activity due to pain.  The scar was well healed and the elbow was non-tender to palpation.  The ROM is charted below.  The neurological examination was normal including strength.  He reported pain with daily activities.  At the VA Compensation and Pension (C&P) examination performed on 18 November 2003, 2 months before separation, the CI reported continued pain, but he took no medications for it.  On examination, the scar was well healed and the strength and sensation were normal.  The ROM was reduced as charted below, but repetition caused no further loss of motion or a further increase in pain.  Painful motion was not specifically documented.  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Elbow ROM
(Degrees)	MEB ~4 Mo. Pre-Sep	VA C&P ~2 Mo. Pre-Sep	
Flexion (145 Normal)	125	135	
Extension (0)	10	Limited to 10	
Comment	Pain with daily activities	Painful motion implied	
§4.71a Rating	10% (4.59)	10% (4.59)	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left elbow at 0% for pain, coded 5099-5003 (analogous to degenerative arthritis).  The VA rated the left elbow at 10% for painful or limited motion, coded 5206-5015 (limitation of forearm flexion and bones, new growth).  The loss of motion is non-compensable.  Although not clearly documented, painful motion is implied on both the NARSUM and VA examinations.  This supports a 10% rating IAW VASRD §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left elbow, coded 5206.  

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, possible PEB reliance on the USAPDA pain policy for rating the elbow was operant in this case and the condition was adjudicated independently of that regulation by this Board.  In the matter of the left elbow condition, the Board unanimously recommends a disability rating of 10%, coded 5206 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Persistent Pain Left Elbow 	5206	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXXXXXXX, AR20160000332 (PD201400150)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA