DEPARTMENT OF THE AIR FORCE
WASHINGTON DC

Office of the Assistant Secretary

SAF/MRBD (PDBR)
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435
MEMORANDUM FOR THE ASSISTANT SECRETARY OF THE NAVY, MANPOWER AND RESERVE AFFAIRS

SUBJECT: Physical Disability Board of Review Recommendation on Case Number PD-2017-04593

In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual from the United States Navy. After carefully reviewing the application and medical separation case file, the PDBR recommended no re-characterization of the separation or modification of the disability rating previously assigned. I recommend you accept this proposed decision.

The covered individual (CI) was an active duty E4, Hospital Corpsman, medically separated for “medial instability, left elbow” with a disability rating of 20%. The PEB analogously coded this condition 5299-5209 (other impairment of the elbow). The PEB also rated the “status post (s/p) left ulnar nerve transposition for ulnar neuritis most likely related to the mild instability of the elbow” as a related Category II diagnosis contributing to the disability in this case and the PEB determined that the s/p malunion, left supracondylar humerus fracture, and union of left both bone forearm fracture existed prior to service (EPTS). The VA rated the left elbow condition 0%, also coded 5299-5209, based on the Compensation and Pension examination, citing that “the current exam does not demonstrate marked cubitus varus or cubitus valgus deformity.” The panel noted there was no limitation of motion which supported a rating under the diagnostic codes for elbow flexion or extension (5206, 5207, 5208) or forearm pronation or supination (5213). However, there was evidence of painful motion of the elbow at the post-separation orthopedic examination and resolution of reasonable doubt in the CI’s favor supports a 10% rating for the elbow (based on §§4.59, 4.40 and 4.45), coded 5299-5206 (analogous to limited elbow flexion). Although the CI apparently had a history of malunion of a humeral fracture as a child, the PEB adjudicated the humeral condition as EPTS and did not rate it separately, however, the PEB used code 5209 and rated the unfitting condition 20% for deformity or un-united fracture of the radius.  There was no nonunion of the radius or ulna (5210, 5212) or malunion of the ulna (5211) for consideration of rating under these codes. There was therefore no higher than a 10% rating supported with any applicable VASRD elbow code.

In the matter of the Category II ulnar nerve condition the panel’s first charge is to assess whether the condition can be reasonably justified as separately unfitting for rating consideration. The condition was listed on the limited duty form and a nerve condition was forwarded by the MEB. The non-medical assessment noted the CI’s physical limitations as impairing duty

performance and did not specifically identify the CI’s contributing medical conditions. The panel concluded that the Category II condition was reasonably considered separately unfitting and eligible for rating. There was evidence to support a 10% rating for mild neuritis of the ulnar nerve. The CI reported continued radiating pain and paresthesia of the left upper extremity. The muscles innervated by the ulnar nerve were noted to have normal strength (wrist flexors and extensors and fingers). At the narrative summary (NARSUM) and VA examinations, intact sensation was noted, but at the orthopedic examination, limited decreased sensation of the ulnar aspect of the forearm was noted. Panel members agreed the neuritis could not be characterized as moderate for higher rating. After deliberations the panel found its rating recommendation of 10% for status post ulnar nerve transposition coupled with the 10% for the left elbow medial instability resulted in the same combined 20% rating as that of the PEB. Therefore no change to the PEB’s adjudication is recommended.

In the matter of the contended humeral malunion condition which the PEB determined was EPTS based on CI’s history of a humeral fracture and fracture of the radius and ulna at age 9 while doing gymnastics, the panel found no evidence to indicate this was not correct. The prior humeral fracture healed with a degree of malunion, per the CI’s treating orthopedic surgeon (also author of the MEB NARSUM). The panel next considered whether or not there was evidence of service aggravation. A presumption of service aggravation may only be overcome by a preponderance of competent medical evidence and accepted medical principles that the natural progression of a pre-existing condition was clearly unaltered by any consequence of military service. Following the CI’s left upper extremity injury during boot camp, elbow X-rays did not show any fracture. A subsequent arthrogram, prior to her ulnar nerve surgery, showed a medial collateral ligament tear. Elbow X-rays at the post-separation VA examination were reported as normal. There was no aggravation of the prior malunion of the humeral fracture. The panel agreed the serial elbow imaging evidence supported to a virtual certainty there had been no humeral fracture during active duty which worsened the CI’s degree of malunion of humerus and therefore no additional disability rating is recommended.

2	PD-2017-04593

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
10 Sep20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno 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.