RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01019
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Security Forces Craftsman, medically separated for “chronic right elbow pain” with a disability rating of 10%.   

CI CONTENTION:  “Review all conditions.”  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 - 20040707	VARD - 20041007	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Elbow Pain	5306	10%	Ulnar Neuritis, Right Elbow…	8599-8516	10%	20040707	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Elbow Pain.  The CI is right-hand dominant.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s elbow pain condition began suddenly in April 1994 upon throwing a baseball.  Initial x-rays were negative.   An MRI of the right elbow in June 2003 was unremarkable.  An EMG performed on 19 November 2003 revealed an ulnar neuropathy due to entrapment at the right elbow.  On 17 December 2003, the CI underwent surgical transposition of the right ulnar nerve.  Post-operative rehabilitation did not completely resolve his painful symptoms and he was referred to a MEB.        

The 5 May 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of a limited ability to grip, climb, and lift due to his elbow condition.  Additionally, the CI could not legibly write his name.  There was no actual physical examination (PE) performed on this date for the “Member was not available for direct physical exam.”  The provider did list the physical findings of the CI’s Occupational Therapist (OT) progress report conducted on 26 February 2004, 2 months prior to the NARSUM report.  The CI’s right elbow range of motion (ROM) was measured as flexion of 135 degrees (normal = 145) and extension of -10 degrees (normal = 0).  The CI’s grasp strength of the right upper extremity was significantly decreased in comparison to the unaffected left side (40 pounds vs 118 pounds).  The listed diagnostic impression was, “ongoing right elbow functional limitations severe enough to prevent performance of duties in security at present.”  

At the 7 July 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported right elbow swelling, increased sensitivity along the surgical scar, decreased grip strength and painful motion.  His PE revealed numbness about the right elbow with increased sensitivity along the surgical scar.  Right elbow ROM was decreased with flexion to 117 degrees and extension to -19 degrees.  Although improved, his comparison grip strength remained decreased (right at 60 pounds vs. left at 110).  His listed diagnosis was ulnar neuritis, right elbow.     

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right elbow pain condition at 10%, coded 5306 (muscle group VI function), whereas the VA rated the right elbow neuritis condition at 10%, analogously coded 8599-8516, (ulnar nerve; neuritis), based on the C&P examination 2 months before separation, citing incomplete paralysis of finger and wrist movements.  All panel members first agreed that in light of surgical findings, clinical examination findings, and electro-diagnostic criteria, the identified ulnar nerve was clearly the etiologic pathology in this case and therefore, a rating under such a nerve code as used by the VA seemed most appropriate.  However, the residual weakness in the right upper extremity as demonstrated by grip/grasp strength testing was directly a function of muscle power and therefore, a rating under such muscle group as used by the PEB was also appropriate.  In consideration of both rating schemes, panel members focused their attention on the various rating levels.  The ulnar nerve code ratings for the dominant extremity are 20%, 40%, and 50% corresponding to mild, moderate, and severe impairment; whereas, the appropriate muscle group ratings are 0%, 10%, 30%, or 40% corresponding to slight, moderate, moderate-severe, and severe impairment.  Members then deliberated and agreed that when comparing the residual findings in this case, the muscle weakness was more prominent when compared to the degree of altered nerve-related deficits and therefore, concluded that a rating under a muscle code of 5306 was most appropriate.  Panel members agreed that the degree of weakness prior to separation was clearly above “slight” (0%) and below that of a “severe” (40%) impairment and thus deliberated over its rating of either “moderate” (10%) or “moderate-severe at 30%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that nearly a 50% loss of grip/grasp strength in the dominant upper extremity (60 vs 110 pounds) near the time of separation would support a moderate-severe (30%) impairment.     

BOARD FINDINGS:  In the matter of the right elbow condition, the panel unanimously recommends a disability rating of 30%, coded 5306 IAW VASRD §4.73.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation: 

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Elbow Pain	5306	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160920, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01019.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities. The Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay
I carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding, accept their recommendation and determined that your records should be corrected. The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP). Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election. If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings