RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03387
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20090429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-2, Parachute Rigger, medically separated by the Informal Physical Evaluation Board (PEB) for “left (non-dominant) ulnar neuritis described as left elbow cubital tunnel syndrome” with a disability rating of 20%.

CI CONTENTION:  “Please consider all conditions.”  The applicant’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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 PEB – 20090108	VARD - 20100830	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Non-Dominant) Ulnar Neuritis Described As Left Elbow Cubital Tunnel Syndrome	8616	20%	Left Ulnar Neuritis	8515	20%	20100707	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left (Non-Dominanat) Ulnar Neuritis Described as Left Elbow Cubital Tunnel Syndrome.  An orthopedic evaluation dated 26 February 2008 noted a childhood open fracture of the left elbow which resulted in intermittent symptoms.  The CI reported posterior elbow pain with numbness and tingling in three fingers innervated by the ulnar nerve.  He reported sleep disturbance due to pain, but denied dropping things.  The CI was diagnosed with cubital tunnel syndrome and lateral epicondylitis.  An electromyogram performed on 26 February 2008 demonstrated an ulnar neuropathy.  The CI was treated conservatively without symptom resolution.  On 23 July 2008, the CI underwent decompression of the ulnar nerve with anterior transposition subcutaneously of the ulnar nerve of the left elbow.  Post-operatively there was reduction, but not resolution of the pain.  An orthopedic evaluation dated 6 November 2008 noted a healed incision, left elbow flexion to 130 degrees without motor weakness or atrophy of the muscles of the hand.  At the narrative summary examination approximately 5 months prior to separation the CI reported persistent pain in the left elbow with activity and one episode of locking.  He rated the pain 5/10 which increased to 7/10 with activity.  The examination demonstrated painless elbow motion and positive Tinel’s over the antecubital fossa which reproduces the pain in his ring and small finger. The examiner referenced Occupational Therapy (OT) grip strength measurements of 76 pounds on the right and 58 on the left.  At the VA Compensation and Pension (C&P) exam performed 15 months after separation, the CI reported constant left elbow pain, left hand tingling, numbness, weakness, and locking of the fingers.  The locking occurred 2-4 times a day and lasted 10 minutes.  He reported difficulty opening things, lifting, and no hand strength.  On examination there was normal left elbow range-of- motion.  There was no limitation of motion due to pain, fatigue, weakness, lack of endurance, or incoordination.  The neuromuscular examination demonstrated decreased sensation and normal motor function.  
The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA rated the left ulnar neuritis at 20%. The PEB coded the condition 8616 (ulnar nerve neuritis moderate).  VA coded the condition 8515 (median nerve paralysis); however the VA listed left ulnar neuritis; which is VASRD coded 8616.  The Board considered whether the evidence supported a higher than 20% rating.  The Board noted no evidence of hand muscle atrophy, motor deficits, or sensory deficit demonstrative of severe incomplete paralysis of the ulnar nerve.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left ulnar neuritis.  

BOARD FINDINGS:  In the matter of the left ulnar neuritis condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140702, 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-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160005138 (PD201403387)

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
( ) OVA