RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00500
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Intelligence Analyst, medically separated for “left (non-dominant) reflex sympathetic dystrophy,” with a disability rating of 10%.

CI CONTENTION:  “Review 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 based upon a 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 - 20051011	VARD - 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Non-Dominant) Reflex Sympathetic Dystrophy	8799-8716	10%	No VA examination in evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  	

ANALYSIS SUMMARY:  

Left Elbow Reflex Sympathetic Dystrophy.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left elbow condition began during Advanced Individual Training (AIT) in 2001 when he did a lot of pushups.  Elbow popping occurred off and on and was treated with Motrin (ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID)).  In January 2004 during a physical fitness test, an officer heard a popping sound and the CI was directed to seek medical treatment.  Radiographic (X-rays) studies of the left elbow were normal on 27 January 2004.  Subsequently, on 22 March 2004, the CI underwent an anterior transposition ulnar nerve and medial epicondylectomy (inner portion of the elbow bone removed) of his left elbow.  

Postoperatively, the CI had swelling in the fingers of the left hand and left wrist.  He dropped things occasionally and had numbness and arm shaking.  X-rays on 5 January 2005 of the left elbow showed no acute bony abnormalities, while X-rays on 24 February 2005 demonstrated a small calcification in the region of the medial epicondyle and no soft tissue abnormality.  

An orthopedic note on 31 May 2005 indicated electrodiagnostic studies in April 2005 revealed no ulnar neuropathy and the range of motion (ROM) of the left elbow was flexion of 135 degrees (normal 145) and a normal extension of 0 degrees.  The orthopedic diagnoses were left cubital tunnel syndrome, causalgia of upper limb, and ulnar nerve palsy.  Despite treatment, the left elbow condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left arm pain/nerve dysfunction” for PEB adjudication.  

At the NARSUM examination on 8 July 2005, the CI had tenderness to palpation of the left medial elbow without any swelling at the elbow, wrist, or fingers.  There was no atrophy of the muscles of the thenar or hypothenar eminences of the palm and Tinel’s sign (to determine nerve irritation) at the ulnar nerve was negative.   The CI had continued problems if he did a lot of typing, which was required in his military occupation specialty (MOS) and also had problems with his left hand twitching and numbness.  Amitriptyline (for nerve pain), tramadol (an opioid-like drug), and a brace were prescribed and non-operative treatment was recommended; however, physical therapy provided no relief.  

Occupational therapy elbow ROM measurements on 12 July 2005, were normal extension on the right and 15 degrees on the left, flexion on the right 155 degrees and left 150 degrees, supination 80 degrees bilaterally, and pronation 50 degrees bilaterally.  Grip strength on the right was 100 pounds and left 45 pounds.  There was tenderness to palpation around the margins of the incision and dorsum of the left elbow with mild atrophy of the left forearm and hypothenar atrophy.  There was normal light touch sensation of the digits of the left hand.   Pain was rated at 5/10 (10 being the worst pain) and was aggravated with driving, typing, and picking up his children.  A series of stellate ganglion blocks in the left neck at the level of C7 was given in August and September 2005 with significant, but transient benefit.  On 22 September 2005, radiofrequency denervation of the left stellate ganglion was performed.  Amitriptyline (for nerve pain), tramadol (an opioid-like drug), and a brace were prescribed.  

At the MEB examination on 14 July 2005, 6 months prior to separation, the CI reported pain in the left elbow.  The examiner noted left elbow tenderness with full flexion and decreased sensation on the dorsal surface of the left arm with decreased strength of the left arm.  There was no evidence that a VA Compensation and Pension examination was performed.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 8799-8716 code (the ulnar nerve-mild neuralgia), citing rated as mild incomplete paralysis.  Members considered whether the neuralgia was more consistent with a moderate or severe rating and took note of a 55 pound difference in the grip strength between the left and right hands.  Therefore, a 20% rating is warranted for the CI’s condition.  The absence of positive electrodiagnostic findings did not support a higher 30% rating.  The left elbow ROM measurements were non-compensable, and painful motion only warranted a 10% rating using code 5099-5003, thereby affording no additional benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left (non-dominant) reflex sympathetic dystrophy condition, coded 8799-8716.  

BOARD FINDINGS:  In the matter of the left (non-dominant) reflex sympathetic dystrophy condition, the Board unanimously recommends a disability rating of 20%, coded 8799-8716 IAW VASRD §4.124a.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left (Non-Dominant) Reflex Sympathetic Dystrophy	8799-8716	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/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, AR20160018730 (PD201500500)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA