RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02960
BRANCH OF SERVICE:  Army	BOARD DATE:  20150512
SEPARATION DATE: 20041007

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Administrative Specialist) medically separated for right (non-dominant) elbow pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “lateral epicondylitis, right elbow (chronic)” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic pain, right (non-dominant) elbow” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI appealed to the Formal PEB, which affirmed the PEB findings and rating, 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:

FPEB – Dated 20040402	VA* - 4 months Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right (non-dominant) Elbow	5099-5003	10%	Epicondylitis, Right Elbow, S/P Surgery	5299-5206	10%	20050208	
Other x 0 (Not In Scope)	Other x 6	
RATING:  10%	COMBINED RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20050316 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Pain, Right (non-dominant) Elbow.  The first record in evidence for the right elbow condition was an orthopedic note dated 16 July 2003 in which it was noted that conservative treatment had failed and the CI desired surgical intervention.  The surgery was on 25 August 2003 and the CI was then entered into rehabilitation.  On 6 January 2004, the orthopedist noted good healing and full range-of-motion (ROM), but tenderness on examination and resistance to extension.  The narrative summary was dated 2 March 2004, 7 months prior to separation and less than seven months after surgery.  The CI reported limitations using the right arm secondary to the elbow pain.  The ROM was full.  The scar was well healed with tenderness present in this region.  Her grip strength was reduced compared to the dominant left side.  Electrodiagnostic (EDX) testing on 11 March 2004 showed a right distal radial neuropathy.  On 4 May 2004, an orthopedist noted that this was improving.  Another orthopedics appointment on 29 June 2004 noted some diminishment in sensation, but normal motor function.  At the VA Compensation and Pension (C&P) neurological examination performed on 21 January 2005, 4 months after separation, the CI reported continued pain.  On examination, she had a painful grip and a sensory loss in the ulnar nerve distribution.  She also had weakness consistent with mild radial nerve impairment, but a soft tissue injury could not be excluded.  Two weeks later, on 8 February 2005, a general C&P examination was accomplished.  The ROM was reduced with supination 20-60 degrees (normal 0-85) and pronation 20-60 degrees (normal 0-80).  On 24 March 2005, repeat EDX studies of the right arm were normal.  These were subsequently repeated in 2010 and remained normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right elbow condition, using the pain policy, at 10% and the code 5099-5003 (analogous to degenerative arthritis).  The VA rated the elbow at 10% as well using the analogous code 5299-5206 (limitation of flexion of the forearm).  The Board considered these codes as well as the code 5213 (limitation of supination and pronation), but found no route to a rating higher than the 10% adjudicated by the PEB and VA.  The Board then considered if an unfitting neuropathy was present at separation.  The initial EDX was abnormal.  However, a second test was equally proximate to separation, but 12 months further from surgery and consistent with a third study remote from separation.  It was, therefore, assigned a higher probative value.  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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the right elbow condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right elbow condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

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 20140616, with attachments
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 XXXXXXXXXXXXXXXXXX, AR20150018829 (PD201402960)

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