RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-04139
BRANCH OF SERVICE:  NAVY		SEPARATION DATE:  20081212  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1, (Navy Recruit) medically separated for “persistent right elbow pain,” with a disability rating of 0%.  

CI CONTENTION:  “Please consider all conditions.”  The CI’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 Physical Evaluation Board (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 - 20081024	VARD - 20090207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Right Elbow Pain 	5207	0%	Fracture of Olecranon Process of the Ulna Status Post ORIF of Right Olecranon	5299-5206	10%	20081001	
			Right Elbow Scar	7805	0%	20081001	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Persistent Right Elbow Pain.  The service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) noted a proximal forearm fracture (displaced and comminuted olecranon fracture) that occurred after falling in the shower in July 2008 during basic training.  Surgical correction (open reduction and internal fixation) occurred the next day.  At the postoperative orthopedic visit on 18 September 2008, 3 months before separation, the physical examination showed mild tenderness at the distal triceps muscle insertion point, mild posterior pain with resisted extension, range of motion of 10-140 degrees (normal 0-145) with no pain, and full supination and pronation (normal).  Radiographic evaluation documented a healed fracture and good positioning of the hardware.  With the need for extensive physical therapy at the onset of training, the left elbow condition could not be immediately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “pain in joint involving upper arm” and “fracture of olecranon process of ulna, closed” for PEB adjudication.  

At the MEB NARSUM examination on 29 September 2008, 2 months before separation, the CI reported continued pain with resistance exercises and inability to perform pushups.  The examiner referred to the previous orthopedic physical examination performed in September 2008.  

At the 1 October 2008 VA Compensation and Pension (C&P) examination, performed 2 months after separation, the CI reported pain with resisted extension.  The orthopedic examination (performed the same day) documented normal extension with 15 degrees of hyperextension (normal 0); flexion of 135 degrees (normal 145) with normal supination and pronation.  There was no crepitus, popping, tenderness, or instability.  Triceps muscle contraction was weak (4/5 strength) and painful (with resisted extension).  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the “persistent right elbow pain status post open reduction with internal fixation of the comminuted intra articular olecranon fracture,” coded 5207 (forearm, limitation of extension).  The VA rated 10% for the “fracture of olecranon process of the ulna status post open reduction with internal fixation of the right olecranon,” coded 5299-5206 (forearm, limitation of flexion), citing painful motion and the “chronic nature of the condition.” The VA also assigned a separate 0% rating for painful scar.  The Board does not recommend separation rating for scars unless their presence imposes a direct limitation on fitness.  The Board reviewed the STR and did not find evidence that a tender or painful scar separately interfered with duty and therefore a separate rating was not recommended.  
 
Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of painful motion IAW VASRD §4.59, §4.40, and §4.45 as reported on the MEB and VA C&P examinations.  The Board considered alternative VASRD codes and analogous codes, but all were less applicable and not advantageous to rating.  There was no STR documentation before separation of flexion limited to 90 degrees in support of a higher rating under code 5206.  There was no STR documentation of extension limited to 75 degrees in support of a higher rating under code 5207.  Rating under 5208 was also not supported.  There was no evidence of false or flail joint for rating under 5210 and no evidence of marked cubitus varus or valgus deformity or ununited fracture for a higher rating under code 5209.  There was no evidence of elbow ankylosis (5205) or nonunion in the upper half of the ulna with false movement or loss of bone substance and marked deformity (5211).  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 right elbow condition.  

BOARD FINDINGS:  In the matter of the right elbow condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5207 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Persistent Right Elbow Pain 	5299-5207	10%	

The following documentary evidence was considered:

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

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 22 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 26 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (j) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 0 percent) effective date of discharge.

     b. former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     c. former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     d. former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

     e. former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     f. former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge. 

     g. former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     h. former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     i. former USN: Placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.