RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201213
BRANCH OF SERVICE:  Army	BOARD DATE:  20130409
SEPARATION DATE:  20040107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (11B10/Infantryman) medically separated for left elbow pain with a history of left cubital tunnel syndrome (CTS) and ulnar nerve decompression in March 2003.  The CI had a long history of complaints related to his left non-dominant elbow.  After conservative therapies and surgery, as noted, he continued to have pain in his elbow and weakness and numbness in his left hand.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  Left elbow CTS and bilateral plantar fasciitis conditions were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated left elbow pain with a history of left CTS and ulnar nerve decompression in March 2003 as unfitting, rated 10% citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy and Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated with that disability rating.

CI CONTENTION:  “My disability rating awarded for right knee pain was 0%.  The pain still persists as of now and it was not just a temporary pain.  I can walk on easy terrain for short distances, but definitely I cannot walk long distances or run.  This is not just painful, but also very frustrating for me, considering my previously active life I was used to.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left elbow condition is addressed below and no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the respective Service Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20040107	VA – (~8 Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Elbow Condition	5099-5003	10%	Left Elbow Residuals S/P Ulnar Nerve Transposition Secondary to Cubital Tunnel Syndrome	8516	10%	20040304	
B/L Plantar Faciitis	Not Unfitting	No Corresponding VA Entry	
No Additional MEB/PEB Entries	Other x 7	20040304 	
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20040729 (most proximate to date of separation [DOS]).   
BVA Decision Dated 20090330 granted chronic sinusitis @ 30% retroactively to DOS, thus also raising combined rating to 40%. 

ANALYSIS SUMMARY:  

Left Elbow Pain Condition.  The CI’s left elbow symptoms began after an automobile accident.  He developed numbness and weakness in his left hand and underwent ulnar nerve decompression in March 2003, without sustained improvement.  At the MEB, the examiner recorded a history of pain with activity, and persistent pain in the elbow and weakness and numbness in the left hand.  The CI required non-steroidal medications and occasional Percocet for pain control.  Post-operative nerve conduction studies showed moderate improvement but with a continued pattern consistent with compressive neuropathy of the ulnar nerve at the left cubital tunnel.  The MEB physical exam noted tenderness to palpation of the wound at the medial aspect of the left elbow from the ulnar nerve decompression surgery.  There was a positive Tinel’s sign at the elbow both proximally and distally.  Flexion at the left elbow was 0-130 degrees (0-140 degrees on the right).  There was diminished light touch at the 4th and 5th fingers.  The left arm and forearm were slightly smaller than the right side.  The narrative summary (NARSUM) addendum indicated the CI “has noted difficulty with certain manual dexterity requirements with the use of two hands.  Specifically, he has noted difficulty opening metal cans and buttoning his clothes.”  The commander’s statement noted that the CI’s “duty performance is extremely limited due to inability to use his left arm (including his elbow and hand).  He cannot move his arm on its own or move or use his hand.”  At the VA Compensation and Pension (C&P) exam performed 2 months after separation, the physical exam showed pain on deep palpation of the medial elbow.  Painless active range of motion (ROM) of the elbow was -10 degrees full extension and flexion was from 0-135 degrees.  There was a sensory deficit to light touch noted in the last two fingers of the left hand in the ulnar nerve distribution.  No atrophy was noted but there was weakness 4/5 of the intrinsic muscles of the left hand.  Elbow flexor and extensor muscles were described as “within the range of good minus.”

The Board directs attention to its rating recommendation based on the above evidence.  The VA and the PEB used different coding strategies but arrived at the same 10% rating.  The PEB’s approach to coding the left elbow condition was analogous to 5009-5003 (degenerative joint disease) which it rated at 10% using the USAPDA Pain policy based on the pain being characterized as moderate and frequent.  The Board considered there was no elbow joint bony pathology or damage to the joint muscles or tendons, but that the CI’s principle disability was due to nerve injury as demonstrated by objective nerve testing and exams.  The Board therefore considered that absent the USAPDA pain policy, the coding of the left elbow pain and peripheral nerve deficits should have been IAW VASRD §4.124a., Schedule of ratings—neurological conditions and convulsive disorders.  The Board considered the weakness, decreased forearm size and pain in rating analogous to ulnar nerve neuralgia and/or paralysis as 8716-8516 and deliberated if the CI’s condition was closest to the “mild” (10%) or “moderate” (20%) picture of disability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.7 (higher of two evaluations), the Board recommends a disability rating of 20% for the left elbow pain condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy for rating the left elbow pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the left elbow condition, the Board unanimously recommends a disability rating of 20%, coded 8716-8516 IAW VASRD §4.124a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Left Elbow Pain	8716-8516	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120711, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	
	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB),

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130009481 (PD201201213)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA