RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02841
BRANCH OF SERVICE:  Army	BOARD DATE:  20150422
SEPARATION DATE:  20020405

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active drilling National Guard E-4 (Cannoneer) medically separated for proximal left radial/ulnar joint chondromalacia.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a temporary U3 profile and referred for a Medical Evaluation Board (MEB).  “Left radial head chondromalacia” and “posterolateral elbow pain,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “proximal left radial/ulnar joint chondromalacia secondary to blunt trauma” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  The USAPDA completed an Administrative Corrections which had no bearing on the PEB rating and recommendation.

CI CONTENTION:  “Review all records”

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 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:

PDA Admin Correction – Dated 20020314	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Proximal Left Radial/Ulnar Joint Chondromalacia	5099-5003	10%	Status Post Injury to the Left Elbow; Status Post Surgeries with Severe Arthritis	5010-5208	20%	20020807	
Other x 0 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20040102 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Proximal Left Radial/Ulnar Joint Chondromalacia Condition.  On 19 June 2000, the right hand dominant CI was tossed a tent peg which struck him on the left elbow with a laceration and contusion.  He was taken to the emergency room and the laceration sutured.  His range-of-motion (ROM) was normal.  His pain persisted despite treatment with medications and putting the elbow in a sling.  An X-ray showed an avulsion fracture.  An orthopedic evaluation on 27 September 2000 documented that pressure over the bone fragment reproduced his symptoms; it was excised that day.  He had rehabilitation in occupational therapy (OT) with improved function, but was discharged from OT on 29 March 2001 as he cancelled more appointments than he had actually attended.  A CT on 30 March 2001 revealed small bony flecks near the elbow which might represent avulsion fractures.  In orthopedics that day, he had tenderness to palpation, but the examination was otherwise normal with full ROM and without instability.  He underwent diagnostic arthroscopy on 25 April 2001.  This showed chondromalacia (a degeneration of the cartilage of the joint) which was treated surgically.  However, he was not able to return to full duty.  The narrative summary was dated 30 July 2001 and noted that the CI had returned to nearly full ROM after the second procedure, but had persistent pain with lifting and repetitive movement.  He was not thought to be fit for continued military service.  His ROM was full and is charted below.  He was tender on examination.  At the VA Compensation and Pension evaluation performed 4 months after separation, the CI reported that the pain in his left elbow precluded working at his civilian construction job.  On examination, the ROM was painful, but full (charted below), and the scar well healed.  It was noted that he could curl 22 pounds 15 times on the right, but not at all on the left.  The goniometric 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)	PT ~11 Mo. Pre-Sep	MEB ~9Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
Flexion (145 Normal)	145	145	140	
Extension (0)	-5	-5	0	
Comment	Pre arthroscopy	Painful Motion	Pain at end motion	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the elbow condition at 10% using the analogous code 5099-5003 (degenerative arthritis).  The VA rated the CI at 20% using the combined code 5010 (traumatic arthritis) and 5208 (limited flexion of the forearm).  The examiner noted that the CI did not specifically meet the criteria for 20%, but cited VASRD §4.40 (functional loss) and VASRD §4.45 (the joints) to support the 20% rating.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the right 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left elbow condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140611, 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 XXXXXXXXXXXXXXXXX, AR20150018720 (PD201402841)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA