RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04196
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Motor Transport Operator, medically separated for “rupture right (non-dominant) distal biceps” with a disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 - 20080201	VARD - 20081105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rupture Right (Non-Dominant) Distal Biceps	5305	20%	Residuals, Right Arm Distal Bicep Tendon Rupture	5305	20%	20080506	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Biceps Rupture.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI initially injured his right biceps in October 2006 while lifting ammunition, and subsequently developed constant right arm pain.  While doing push-ups in February 2007, he felt a snapping pain and noticed a right biceps deformity.  An MRI revealed a biceps muscle and tendon tear.   During the 17 August 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported a deformed right arm biceps with swelling to above the right elbow.  He could not lift his arm above the shoulder for a long time and used an arm brace at night for support.  Physical examination showed a bicipital deformity, right biceps tenderness, and right upper extremity (RUE) weakness with decreased right hand grip strength (3/5).  The 22 October 2007 MEB NARSUM examination, 7 months before separation, noted CI complaints of constant RUE pain with weakness, paresthesias, and numbness, which worsened in severity when performing regular military duties.  He took three pain medications, including a synthetic narcotic agent, with minimal pain control, and had difficulty lifting more than 30 pounds or performing push-ups.  The physical examination reflected the August 2007 MEB findings.  Average right forearm pronation was to 71 degrees (normal 80) and supination to 81 degrees (normal 85).  

At the 6 May 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported pain along the inner aspect of the right arm that mildly benefited from a synthetic narcotic agent.  He could not lift anything over 5 pounds, do housework, mow the lawn or shovel snow, and the pain also affected his sexual activities and increased the time it took to dress, groom and bath.  The pain often awoke him at night as did wearing an uncomfortable hard sling. He planned to look for a desk job because he could not perform the physical work he did in the military.  Physical examination of the RUE showed the right biceps was generally bulky and atrophied with no pain on slight palpation of the area.  There was pain in the scapular area but no atrophy of the shoulder girdle.  Measured right shoulder flexion was to 170 degrees and abduction to 160 degrees, and he was able to put his arm behind his head and back with difficulty.  Repetitive motion increased the pain and produced weakness, fatigue, lack of endurance and coordination with a ROM loss of 10 degrees.  Right forearm pronation and supination were normal and motor function was 5/5 in the dominant left arm, but 2/5 in the right arm with hand grip decreased to 3/5.  Deep tendon reflexes were 1-2+ in all extremities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right biceps condition 20%, coded 5305 (group V function:  flexor muscles of elbow: biceps), citing “strength decreased right upper extremity and grip 3/5.”  The VA also rated the right biceps condition 20%, coded 5305, based on the C&P examination, citing moderately severe muscle disability.  Panel members first determined that the C&P examination was more probative than the NARSUM due to its proximity to separation and completeness.  While the physical examination showed biceps atrophy and deformity with a weakened hand grip, right forearm pronation and supination were full, and the CI was able to manage personal grooming, albeit more slowly; medication provided some benefit.  The panel agreed that the condition most closely met criteria for a moderately severe level of disability, but no higher, under code 5305 and IAW VASRD §4.56 (muscle injury evaluation).  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 biceps condition.  

BOARD FINDINGS:  In the matter of the right biceps condition and IAW VASRD §4.73, 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:

AR20200000657, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX:

	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.