RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00612
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20021231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Avenger Crewmember, medically separated for “chronic pain, left elbow” and “status post open reduction internal fixation of right ankle fracture,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  The CI requests consideration of 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 - 20020926	VARD - 20060607	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Elbow	5099-5003	10%	Left Elbow Condition	5206	20%	20060504	
S/P ORIF Right Ankle Fracture	5271	10%	Right Ankle Condition	5270	30%	20060504	
#8 and #9 Tooth Avulsion	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Left Elbow pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI obtained a distal humerus (elbow) fracture secondary to a motor vehicle accident (MVA) in early 2001.  He underwent surgical fixation of the fracture in April 2001 and a re-fixation in September 2001 for a failed union of new bone.  Despite post-surgical therapy, 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 open elbow with open distal humerus fracture” for PEB adjudication.  
The MEB NARSUM examination on 30 August 2003, 4 months prior to separation, noted the CI was unable to lift more than 5 pounds due to elbow pain.  His physical examination (PE) revealed tenderness over the left elbow.  There was decreased and painful range of motion (ROM) present; flexion to 110 degrees (normal 145) and extension was limited to 35 degrees (normal 0).  He could supination to 70 degrees and pronate to 85.  The VA Compensation and Pension (C&P) evaluation was performed 3 years after separation and therefore, outside the 12 month consideration of this Board’s review.  This Boards final rating recommendation was based upon the STR and MEB NARSUM documentation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left elbow condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the same condition at 20% effective November 2005 coded 5206 (forearm, limitation of flexion), based on the VA C&P examination over 3 years after separation, citing flexion limitation of motion.  Absent limitation of motion which supported a rating under the diagnostic codes for limitation of flexion, extension (5206, 5207) or supination and pronation (5213), Board members agreed that the evidence of painful motion with functional loss supported a 10% rating (based on §4.59, §4.40 and §4.45).  The Board also considered alternative VASRD elbow and analogous codes, but all were not applicable and or not advantageous to the PEB’s current rating.  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’s adjudication for the left elbow condition.

Right Ankle Pain.  Subsequent to the previously described MVA, the CI also fractured his right ankle.  The NARSUM noted that the CI’s surgical history included surgical fixation of the right ankle fracture.  The CI endorsed the inability to run secondary to persistent right ankle pain.  His PE revealed painful and limited ROM of the right ankle.  Dorsiflexion was measured at 10 degrees (normal 20) and plantar flexion was 20 (normal 45).  The provider assessed the CI’s pain as “slight” and “frequent”.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (ankle, limitation of motion), citing moderate limitation of motion.  The VA rated the same condition at 30% effective November 2005 coded 5270 (ankle, ankylosis), based on the VA C&P examination over 3 years after separation, citing limited dorsiflexion.  Board members first agreed that the MEB NARSUM examination, proximate to separation, sufficiently documented painful motion causing functional loss and thus in support of the PEB’s 10% rating (based on §4.59, §4.40 and §4.45).  The Board also considered code 5271, with its ratings of 10% (moderate) and 20% (marked) impairment ratings and concluded that the parameters of limited ankle motion did not support that above ‘moderate” impairment and its 10% rating.  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 ankle condition.  

Contended PEB Condition:  #8 and #9 Tooth Avulsion.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended tooth avulsion condition was not unfitting.  The condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the teeth avulsion condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left elbow condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended #8 and #9 tooth avulsion condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, 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-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170000281 (PD201500612)

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