RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04083
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070917

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Petroleum Supply Specialist, medically separated for “post-traumatic arthritis of the right elbow” with a disability rating of 10%. 

CI CONTENTION:  The rating should have been higher and anxiety was misdiagnosed.  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 - 20070620	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthritis of the Right Elbow	5010	10%	 No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right (Dominant) Elbow.  According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured his elbow playing flag football on 29 August 2003 and underwent an open reduction internal fixation for a comminuted fracture of the olecranon (the bony tip of the ulna bone at the elbow)/proximal ulna in September 2003 with additional corrective surgery in November 2003.  The hardware was removed in April 2004 and his arm function improved however, pain worsened during deployment according to a referral note dated 30 October 2006.  The chronic elbow pain was associated with lifting and carrying while performing as a petroleum supply specialist.  X-rays of the right elbow dated 22 November 2006 demonstrated no residual complication following hardware removal.  On 30 March 2007 the CI reported right elbow pain was 4/10 even with tramadol (an opioid-like medication).  A nonsteroidal anti-inflammatory drug was prescribed to alleviate the pain. 

During the 14 February 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported right elbow pain and slight loss of range of motion (ROM).  Physical examination showed tenderness over the olecranon and joint line.  Full extension increased the pain.  At the 25 April 2007 physical therapy (PT) ROM study, flexion was 142 degrees (normal 145) and extension was 14 degrees (normal 0).  Right elbow extension failed to reach neutral and right elbow extension reproduced pain.  Limitation was partially due to pain and possible mechanical restriction.  Supination was 79 degrees (normal 85) and pronation 80 degrees (normal).  

The 27 April 2007 MEB NARSUM examination, 5 months prior to separation, noted the complaint of right elbow pain.  According to an orthopedic surgeon, the CI had reached maximum improvement and had no surgical options.  The examiner referenced a 13 February 2007 focused orthopedic physical examination that showed ROM of 5-130 (normal 0-145) with pain at the end of motion.  Supination and pronation were 90 degrees each.  There was no edema and sensation was intact.  X-rays revealed a healed fracture in good alignment status post hardware removal.  Reference to the 25 April 2007 PT ROM measurements indicated pain was limited during active extension starting at 19 degrees; limitation of further motion due to bony restriction started at approximately 10 degrees.  Supination and pronation were reported as normal by PT and orthopedics, however, a fair amount of supination was achieved by the hand and wrist, not by the elbow.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right elbow condition 10%, coded 5010 arthritis, due to trauma, substantiated by X-ray findings, citing loss of motion of one joint, which would be non-compensable under code 5207 (limitation of forearm extension).  The panel considered other VASRD elbow and analogous codes, but all were less applicable and not advantageous for rating.   The panel noted use of an elbow code was not applicable in the absence of elbow ankylosis (5205), forearm limitation of flexion and/or extension (5206, 5207, or 5208), elbow, other impairment of flail joint (5209), radius and/or ulna nonunion or impairment (5210, 5211, and 5212), or impairment of supination and pronation (5213).   Furthermore code 5010 is rated as arthritis, degenerative (5003), which states “[w]hen however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10% is for application for each such major joint or group of minor joints affected by limitation of motion.”  Therefore, a rating higher than 10% is not achievable.  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 right elbow condition.  

BOARD FINDINGS:  In the matter of the right elbow condition and IAW VASRD §4.71a, 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:

AR20180016622, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has been provided to the counsel you listed on your application, Disabled American Veterans (DAV),