RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04230
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20060731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Armor Crewman) medically separated for a right elbow condition.  The right elbow condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  “Chronic lateral elbow pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic right lateral elbow pain, post lateral epicondylar debridement for epicondylitis” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requests the Board consider all conditions.  His complete submission is at Exhibit A.

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:  

IPEB - Dated 20060710	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Lateral Elbow …	5099-5003	10%	Right Elbow …	5299-5211	10%	20061003	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7	
RATING: 10%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20061019 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Right Lateral Elbow Pain Post Lateral Epicondylar Debridement for Epicondylitis.  The record showed that the right hand dominant CI developed right elbow pain after changing out track pads in early 2004.  He was diagnosed with tennis elbow (lateral epicondylitis) and treated with medications, injections, duty restrictions, and occupational therapy with persistent pain.  An X-ray showed some degenerative changes and a bone scan was negative for elbow pathology.  An magnetic resonance image performed on 22 December 2004 showed minimal disease.  An arthrogram the same day was normal.  He had surgery in April 2005 with initial improvement, but subsequent recurrence of pain.  He was thought to have bursitis (inflammation of a fluid filled sac which reduces friction) and entrapment of the radial nerve.  He then had a release of the radial nerve on 24 January 2006, but had persistent pain which precluded return to full duty.  The narrative summary (NARSUM), dictated by an orthopedist was dated 14 June 2006 (7 weeks prior to separation).  It noted that the CI had an 80% improvement in his symptoms since the second surgery.  On examination, his grip strength was reduced as was the range-of-motion (ROM) which is charted below.  

At the VA Compensation and Pension (C&P) examination performed on 3 October 2006 (2 months after separation), the CI reported that he was working as a condominium manager.  He reported pain and weakness in the right hand and forearm.  He was able to do minor repairs and paperwork, but these affected his pain.  On examination the scars were noted to be well healed and without functional impairment.  Motion was painful and limited, but there was no further limitation with repetition.  There was no atrophy and the motor function was symmetric.  Some sensory loss of the right hand and forearm was present (attributed to radial and carpal tunnel syndromes).  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.

Right Elbow ROM
(Degrees)	MEB ~2 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
Flexion (145 Normal)	135	120	
Extension (0)	15	0	
Comment	Tender	Painful motion	
§4.71a Rating	0%	10%	

Right Forearm ROM
(Degrees)	MEB ~2 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
Pronation (80 Normal)	75	Normal	
Supination (85)	65	Normal 	
Comment	Tender	Painful Motion	
§4.71a Rating	0%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right elbow condition 10%, coded 5099-5003 (analogous to degenerative arthritis) citing the USAPDA pain policy.  The VA also rated the elbow condition 10%, coded 5299-5211 (analogous to impairment of the ulna).  The VA rated the CI for right radial and carpal tunnel syndromes; neither condition is within the scope of the Board.  The Board considered the evidence, but found no route to a rating higher than the 10% adjudicated by both the PEB and VA.  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 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 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 chronic right lateral 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 20141105, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 JUL 2016

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 XXXXXXXXXXXXXXXXXXXX, AR20160004467 (PD201404230)

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