RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03401 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060830

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Hospital Corpsman, medically separated for “left elbow fracture” with a disability rating of 20%.

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 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 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 - 20060727	VARD - 20070719	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Left Elbow Fracture with
Subsequent Decreased ROM…	5208	20%	S/P Left Elbow Fracture Due to GSW
with Limited Extension and Flexion	5208	20%	20070405	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Left Elbow Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained a gunshot wound to the left elbow and initially underwent incision and debridement of the open wound and left distal humerus, supracondylar humerus, and lateral condyle comminuted fractures on 22 August 2005. This procedure was followed by an open reduction internal fixation on 30 August 2005, at which time a large piece of the flexor mass of muscle was noted to be missing and after closure a drain was placed in the void. He went on to develop nonunion and decreased range of motion (ROM) and underwent a bone graft procedure and capsular release on 18 January 2006. At an occupational therapy clinic visit on 9 March 2006, the left elbow ROM was -54-130 degrees (normal 0-145) with a 21% decrease in left grip strength. Treatment consisted of a dynamic splint and continued occupational therapy. Finally, he underwent a capsular release and manipulation on 13 June 2006.

The 26 June 2006 MEB NARSUM examination, 2 months prior to separation, noted the complaint of decreased ROM shorter than a functional range. Physical examination showed a small open wound, approximately 2 mm at the tip of the olecranon, which was healing well through

secondary intention without any signs of infection. Left elbow ROM was 35-100 degrees. The left upper extremity was neurovascularly intact in both sensory and motor functions. X-rays showed a healed left elbow fracture and mild heterotopic ossification.

At the 5 April 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported chronic daily pain in the left elbow following a fracture and multiple surgical procedures. Physical examination showed left elbow ROM from 30-100 degrees due to painful motion and incoordination. Supination was full at 85 degrees (normal 0-85) and pronation was full at 80 degrees (normal 0-80). With repetition, there was no loss of motion. Multiple scars were present on the left elbow with hypersensitivity and pain with two of the scars. X-rays of the left elbow dated 5 April 2007 showed hardware maintaining anatomic alignment of prior fracture of the distal humerus. Numerous tiny and small radio-opaque shrapnel fragments remained.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and the VA both rated the left elbow condition 20%, coded 5208 (forearm, flexion limited to 100 degrees and extension to 45 degrees). The VA based the rating on the C&P examination, citing limited flexion and extension of the forearm.

The panel noted that the limited flexion of the elbow to 100 degrees warrants a 10% rating using code 5206, but extension of 35 degrees achieves only a 0% rating using code 5207. However, the PEB and VA assigned a 20% rating using code 5208, which encompassed the limitations of flexion and extension, although not exactly with the measured extension ROM. No other elbow codes including 5205 (ankylosis), 5209 (flail joint), 5210 (radius and ulna, nonunion), 5211 (ulna impairment), 5212 (radius impairment), and 5213 (supination and pronation impairment) offer a rating higher than 20% nor does the shoulder and arm code 5202 (humerus, other impairment of). However, since the CI sustained a high velocity gunshot wound resulting in loss of a large piece of the flexor mass of muscle, it is appropriate and reasonable to use VASRD code 5305 (Group V. Function: Elbow supination (1) (long head of biceps is stabilizer of shoulder joint); flexion of elbow (1, 2, 3). Flexor muscles of elbow: (1) Biceps; (2) brachialis; (3) brachioradialis) . The panel members then had a long, detailed discussion related to VASRD §4.56 (evaluation of muscle disabilities), which states, “An open comminuted fracture with muscle or tendon damage will be rated as a severe injury of the muscle group involved unless, for locations such as in the wrist or over the tibia, evidence establishes that the muscle damage is minimal.”

After extensively reviewing guidance, correlation of symptoms, and objective findings, including but not limited to loss of muscle mass, incoordination, decreased grip strength, and limitation of motion of the elbow, the panel majority determined that a rating of 30% for a severe disability using code 5305 was warranted. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 30% for the left elbow fracture condition, coded 5305.

BOARD FINDINGS: In the matter of the left elbow fracture condition, the panel majority recommends a disability rating of 30%, coded 5305 IAW VASRD §§4.56 and 4.79. The single voter for dissent recommends no change and no re-characterization and did not elect to submit a minority opinion. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Elbow Fracture	5305	30%	

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB:003 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 

PHYSICAL DISABILITY BOARD OF REVIEW {PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 23 Dec 19
(b)	

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

2.	On 5 October 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 20 to 30 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command, for correction of your records as stated above.	You will be notified once those changes are complete.
1.