RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02382
BRANCH OF SERVICE:  Army	BOARD DATE:  20150115
SEPARATION DATE:  20020429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-2 (Ammunition Specialist Trainee) medically separated for left elbow condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3L2 profile and referred for a Medical Evaluation Board (MEB).  The left elbow condition, characterized as “healing olecranon fracture” and “healing iliac crest bone graft donor site,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “left elbow pain” as unfitting, rated 0%, citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “PLEASE CONSIDER ALL CONDITIONS”

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:

Service IPEB – Dated 20020314	VA - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Elbow Pain	5099-5003	0%	Fracture Left Elbow	NSC*	STR	
Other x 0 (Not In Scope)	Other x 0	
Combined:  0%	Combined:  0%	
Derived from VA Rating Decision (VARD) dated 20040108 (most proximate to date of separation [DOS]).
* CI did not report for a scheduled C&P exam until seven years later.  His first completed C&P exam 20090818, rated left elbow at 10%.

ANALYSIS SUMMARY:

Left Elbow Condition.  The narrative summary (NARSUM) dated 20 February 2002 recorded the CI fractured his left elbow during basic combat training in October 2001.  He underwent surgery to repair the fracture; however, it failed to heal and resulted in a nonunion.  On 4 December 2001, 45 days later, a bone graft was performed to stimulate new fracture healing response.  The CI’s elbow was casted for a brief period of time.  He participated in occupational therapy.  His primary symptom was pain in the elbow that decreased in intensity over time and pain at the donor site (iliac crest of hip).  The CI reported his elbow ached for about an hour in the morning and then the pain resolves without the use of medication.  He was free of the cast and was able to use his left hand for daily activities.  He noted aching at the donor site with prolonged walking and indicated the pain had decreased over the prior 2 months.  Physical examination recorded a normal gait and a well-healed incision over the elbow.  Left elbow range-of-motion (ROM) was 15 to 140 (145) degrees and ROM for supination and pronation was full and symmetrical with the right elbow.  The examiner noted the fracture and the donor site were still in the healing process, and once healed, the CI may still lack a few degrees of full extension of the left elbow.  The examiner opined the CI would not have any permanent impairment or pain; however, his condition at the time had prevented him from doing heavy work with his left arm.  Strength testing was not performed secondary to the fractured being in the healing process.  Radiographs of the left elbow in February 2002 demonstrated fracture line through the olecranon extending into the elbow joint and an anatomically reduced elbow joint.  There was evidence of fracture healing.  There was no additional clinical evidence to consider prior to separation.  The commander statement noted the CI had not adequately recovered from his injury, and therefore, was not able to perform many physical exercises and activities necessary to perform military duties.  The CI was non-attendant to the scheduled VA Compensation and Pension examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 0% coded analogously to 5003, under the pain policy for slight and intermittent pain.  As noted above the CI did not report to the scheduled appointment; therefore, the VA did not service-connect the condition.  A compensable rating under the 5003 code requires evidence of limitation of motion or evidence of painful motion.  The Board agreed the ROM recorded at the NARSUM was not compensable, and pain during ROM testing was not recorded.  The Board next considered the application of VASRD §4.40 (functional loss), and concluded the condition was supported under the provision.  There were no other applicable codes to consider.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10%, IAW VASRD §4.40 for the left elbow condition.

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, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating the left elbow was operant in this case and the condition was adjudicated independently of that policy/instruction by the Board.  
In the matter of the left elbow condition, the Board unanimously recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a and §4.40.  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:

UNFITTING CONDITION	VASRD CODE	RATING	
Left Elbow Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150010601 (PD201402382)

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:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA