RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-04251
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20051108

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E7, Light Wheeled Vehicle Mechanic, medically separated for “chronic right elbow pain” with a disability rating of 0%.

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’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 – 20051013	VARD - 20051122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Elbow Pain	5099-5003	0%	Right Elbow Tendonitis, Postoperative	5099-5024	10%	20050823	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right Elbow Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his right (dominant) elbow on a bulldozer blade in December 2003 while deployed. He underwent surgery for lateral epicondyle and tendon debridement with reattachment in June 2004, and an MRI showed changes compatible with lateral epicondylitis. The 13 April 2005 orthopedic evaluation, 6 months prior to separation, noted complaints of continued right elbow pain and weakness, especially with lifting. Physical examination showed full range of motion (ROM) of the elbow symmetric to the left side, as well as normal pronation/ supination and wrist ROM. There was right elbow tenderness with a 1 cm palpable defect at the insertion to the lateral epicondyle, mild weakness with external rotation, and pain at the elbow

with resisted external rotation. An MRI revealed obvious tendon degeneration with an area of the capsule and the extensor tendon that had not healed down (to the bone). The surgeon discussed the benefits and risks of reconstruction of the extensor tendon mechanism (using repeat debridement and tacking it down to bone) with a 60%-70% probability of success.

The 8 August 2005 MEB NARSUM examination, 2 months before separation, noted CI complaints of right elbow pain which significantly limited forceful gripping for carrying and lifting items. Physical examination revealed tenderness to the right elbow at the lateral epicondyle and common extensor origin, and forced extension of the fingers and wrist reproduced pain in that area. Right elbow ROM was normal and symmetric to the left, and the examiner diagnosed lateral epicondylitis. During the 22 August 2005 MEB examination (recorded on DD Forms 2807- 1 and 2808), the CI reported right elbow pain which was reproduced during physical examination.

At the 23 August 2005 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI reported right elbow pain and weakness, which was worse with lifting. Physical examination of the right elbow showed a well-healed scar without swelling or deformity. The examiner stated “DeLuca: Pain in the right elbow limits functional ability.” An addendum on 25 October 2005 recorded pain which limited function and muscle fatigue following repetition with a loss of 15 degrees of elbow flexion secondary to weakness. A second addendum on 2 November 2005 answered a request for complete DeLuca criteria, and recorded a loss of 5 degrees of flexion and 10 degrees of pronation due to pain (no loss in supination), and a loss of 5 degrees of flexion secondary to weakness.  An X-ray showed a small olecranon spur.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right elbow condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency pain policy. The VA rated the right elbow condition 10%, analogously coded 5099-5024 (tenosynovitis), based on the C&P examination, citing painful or limited motion of a major joint. Panel members agreed that there was no compensable limitation of elbow motion or malunion which supported a rating under codes 5205 through 5213. However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) based on the pre-separation VA examination. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right elbow condition, coded 5099-5024.

BOARD FINDINGS: In the matter of the right elbow condition, the panel recommends a disability rating of 10%, coded 5099-5024 IAW VASRD §4.71a. 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, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Elbow Pain	5099-5024	10%	

The following documentary evidence was considered:

	PD-2017-04251

AR20190012699, XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

	PD-2017-04251