RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01957
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20021105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Boatswain's Mate, medically separated for “status post left elbow fracture dislocation” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20021003	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Left Elbow Fracture Dislocation	5206-5010-5003	10%	No VA Examination in Evidence	
Status Post Left Elbow Anterior, and Posterior Capsulectomies Times Two	Cat II		
Status Post Left Elbow Radial Head Replacement	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Status Post Left Elbow Fracture Dislocation.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI’s left elbow condition began in January 2001 after a dislocation with comminuted radial head fracture while skiing.  He underwent multiple surgeries including a left radial head replacement with a metal prosthesis in Jan 2001, and two revision surgeries in August 2001 and 30 January 2002 for continued pain and stiffness.  

At the 21 May 2002 post-surgical release follow-up evaluation the CI was considered fairly stable.  He had “about 110 degrees of flexion” and stated he could get more with working out.  He lacked 25-30 degrees of extension (normal 0) and had full forearm rotation.  

The 29 July 2002 MEB NARSUM orthopedic examination, 3 months before separation, noted left elbow stiffness and pain.  Physical examination showed well-healed surgical incisions and painful motion with flexion was to 110 degrees (normal 145) and lacking 20 degrees of terminal extension.  Pronation and supination were “relatively full and about 80 degrees.”  The examiner stated the CI had “a functional range of motion and is able to bring his elbow into maximal flexion and reach his face (for purposes of hygiene and feeding) and is able to dress himself.”  X-rays from 16 July 2002 indicated a small amount of heterotrophic ossification with the prosthetic radial head appearing stable.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left elbow condition 10%, coded 5206-5010-5003 (limitation of flexion of forearm-traumatic arthritis-degenerative arthritis).  The PEB also listed “status post left elbow anterior, and posterior capsulectomles times two” and “status post left elbow radial head replacement” as related Category II conditions (contribute to the primary unfitting condition but not separately ratable).  The impairment from both Category II conditions (surgeries) were properly subsumed under the overall rating for the status post left elbow fracture dislocation IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion, extension, pronation or supination (5206, 5207, 5208, or 5213).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no ankyloses (5205); deformity, non-union, malunion, flail false joint, or flail elbow joint (5209, 5210, 5212) to support rating under those codes.  The panel deliberated over whether the CI’s condition more closely approximated an elbow replacement (prosthesis) disability picture for a minimum 20% rating using code 5052.  However, members noted only the radial head was replaced and there was no humerus or ulnar component to the prosthetic to be considered an elbow replacement.  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left elbow condition.  

BOARD FINDINGS:  In the matter of the left elbow condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20150714, w/atchs
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
	XXXXXXXXXXXXXXXXXXX  					
         Acting