DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374

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IN   REPLY   REFER  TO;
1850
CORB:003
20 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-02713

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 7 Mar 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs} accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02713 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20080715

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “bilateral elbow pain,” rated 10% each with a combined disability rating of 20%.

CI CONTENTION: “I was told the elbow injuries were severe enough that I could no longer be a Marine. Yet that wasn’t even worth a medical retirement? I dispute the claim that it is not combat related.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20080429	VARD - 20080819	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Cubital Tunnel Syndrome	8616	10%	No VA Placement	
	8616	10%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Bilateral Cubital Tunnel Syndrome. According to the service treatment record and MEB narrative summary (NARSUM), the CI was a gunner and he developed bilateral cubital tunnel syndrome after stabilizing his elbows on the gun mount for long hours while deployed to Iraq. The CI underwent right elbow ulnar nerve release and subcutaneous transposition in January 2007 and left elbow ulnar nerve release and subcutaneous transposition in August 2007. In both cases, there was extensive fibrosis noted around the ulnar nerve and there was thickened fascia at the entrance into the flexor carpi ulnaris muscle.  The tunnel was very tight around the nerve. After

surgery, the CI progressed and returned to work, but still had some residual symptoms. Since surgery his symptoms were far less, the majority of his ulnar sensory numbness had resolved, he was better with grip and manipulation of objects and his grip was stronger.

The 16 January 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of bilateral elbow and forearm pain, as well as grip weakness. He still suffered from intermittent elbow pain with occasional radiation along the ulnar nerve distribution. This went approximately halfway down his forearm and occurred once or twice a week. Physical examination showed mild tenderness over the posteromedial elbows, but there was no pain with pressure in the cubital tunnel. Neurovascular integrity was intact in the bilateral elbows, and there was no evidence of motor atrophy, or any deformity of the elbows. Bilateral range of motion (ROM) testing showed 145 degrees of flexion (normal), full pronation and full supination. Fingers and wrist also showed full ROM. There was no swelling of elbows. Grip strength on the right was 120, 90, 92 pounds with an average of 101 and left was 92% of the right in total strength.

At the 11 April 2008 VA Compensation and Pension (C&P) examination, 3 months prior to separation, the CI reported bilateral numbness and a tingling sensation with loss of sensation about 3 to 4 times a week. He also reported 4/10 bilateral elbow pain that did not radiate and was brought on by physical activities. Physical examination revealed no evidence of functional limitation, instability, inflexibility or limitation of motion. The CI was able to make a tight fist (bilaterally) without difficulty, and hand strength was normal. Bilateral elbow ROM testing showed flexion of 145 degrees, pronation of 80 degrees and supination of 85 degrees without pain in any plane of motion. Motor strength was 5/5 in the upper extremities and sensation was intact.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left and right elbow conditions 10% each, coded 8616 (neuritis). The VA did not rate the condition, and the C&P examination did not address any form of elbow condition. The panel considered the evidence and agreed that a 10% rating for each elbow was justified for tenderness with functional loss. The NARSUM and the C&P examinations indicated normal reflexes, normal motor strength, no muscle atrophy, no loss of sensation and normal ROM. There were no additional applicable codes that would result in a higher rating than the 10% adjudicated by the PEB for either elbow. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral elbow condition.

BOARD FINDINGS: In the matter of the bilateral elbow condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel 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 20170310, w/atchs 
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record