RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
SEPARATION DATE: 20021024
NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY
CASE NUMBER: PD1200670
BOARD DATE: 20121207
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty Soldier, SGT/E‐5 (77F/Petroleum Supply Specialist),
medically separated for left elbow pain. The CI injured his left elbow in 2001, and experienced
persistent elbow pain despite non‐operative management. The condition could not be
adequately rehabilitated and the CI did not improve adequately to meet the physical
requirements of his Military Occupational Specialty (MOS). He was issued a permanent U3
profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded left elbow loose
bodies status post dislocation as medically unacceptable IAW AR 40‐501. The MEB forwarded
no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the
pain left elbow, as unfitting, rated 0% with application of the US Army Physical Disability Agency
(USAPDA) pain policy. The CI made no appeals, and was medically separated with a 0%
disability rating.
CI CONTENTION: The CI states: “Left elbow fracture of coronoid process with loose joint
fragments. I gave the military 12 years and a [sic] elbow and that was worth 0%. I wear a
elbow brace everyday and tired of fighting them. How could the PEB grant me 0% but the
hospital in Landstuhl Germany grant me 10% without the physical. I was unable to attend the
physical because I was place on 24 hour staff duty the day before. The physical was scheduled
during my clearing process and I could not reschedule. If I could have attended the physical I
know I should have at least been granted 30%. I had a wife and 3 children to worry about and
put their needs first. I trust this board will make the right decision and grant me and my family
what we justly deserve.” [sic]
SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI
6040.44, (Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined
by the PEB to be specifically unfitting for continued military service; or, when requested by the
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings
for unfitting conditions will be reviewed in all cases. 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 Army Board for Correction of Military Records.
RATING COMPARISON:
*Service Treatment Record
**VA decisions on 20050928 and 20120125 increased two non‐PEB conditions to 10% and 30%, effective 20050413 and
20100713; combined 20%, then 40%
Service PEB – Dated 20020808
Condition
Code
Pain Left Elbow
5099‐5003
Rating
0%
↓No Addi(cid:415)onal MEB/PEB Entries↓
Combined: 0%
VA – All Effective Date 20021025
Condition
Code
Left Elbow Coronoid Process
Fracture w/Loose Fragments
5099‐5024
0% X 1 / Not Service‐Connected x 0
Combined: 10%**
Rating
10%
Exam
STR*
STR
ANALYSIS SUMMARY:
Left Elbow Condition. The CI injured his non‐dominant left elbow on 31 March 2001 when he
fell backwards while playing with his son. Evaluation revealed an avulsion fracture of the
coronoid process of the elbow joint. Although it was not evident at the initial emergency room
visit, the description of the injury was thought to be consistent with an elbow dislocation, which
spontaneously reduced. The
injury was treated with casting followed by aggressive
occupational therapy, and full range‐of‐motion (ROM) was regained. Pain, particularly with full
extension, continued. A CT scan performed in March 2002 showed multiple loose bodies about
the elbow joint. The CI declined a surgical option, since the benefit was considered by the
orthopedist to be uncertain.
in evidence, with
documentation of additional ratable criteria, which the Board weighed in arriving at its rating
recommendation, as summarized in the chart below.
There were two ROM evaluations
Left Elbow ROM
Flexion (0‐145⁰)
Pronation (0‐80⁰)
Supination (0‐85⁰)
Ortho ~9 Mos. Pre‐Sep
Ortho ~4 Mos. Pre‐Sep
0‐135⁰
Not specified
0‐140⁰
“Full”
Comment
+Tenderness, painful motion
+Tenderness
§4.71a Rating
10%
10%
The narrative summary (NARSUM) examiner indicated that the elbow pain was occasionally
accompanied by a catching sensation. Firing a weapon from a prone position, heavy lifting,
climbing into military vehicles, carrying a rucksack and doing pushups was difficult. Physical
examination showed full pronation and supination of the elbow and tenderness at the lateral
ulno‐humeral joint. Loose bodies were not palpable. The first VA Compensation and Pension
(C&P) exam was performed over 2‐1/2 years after separation. The CI complained of painful
motion associated with a popping sensation in the elbow. Pain prevented lifting, pushing and
some sports participation. He denied locking. Examination revealed a prominence at the left
radial head. Extension and flexion was 0‐170 degrees, and pronation and supination were full.
Repetition of motion produced an audible and palpable click. There was no instability.
The Board directs attention to its rating recommendation based on the above evidence. The
PEB’s DA Form 199 reflected application of the USAPDA pain policy for rating. The presence of
non‐compensable limitation of motion, as well as sufficient evidence of functional loss (§4.40)
and painful motion (§4.59), supported a 10% rating under §4.71a standards. The Board could
find no support for rating higher than 10% under alternate elbow or forearm codes. After due
deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the
Board recommends a disability rating of 10% for the left elbow 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. The Board did not
surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD
were exercised. As discussed above, PEB reliance on the USAPDA pain policy for rating the
elbow pain was operant in this case and the condition was adjudicated independently of that
policy by the Board. In the matter of the pain left elbow condition, the Board unanimously
recommends a disability rating of 10%, coded 5099‐5003 IAW VASRD §4.71a. 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:
2 PD1200670
VASRD CODE RATING
5099‐5003
COMBINED
10%
10%
Pain Left Elbow
UNFITTING CONDITION
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20120606, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record
SFMR‐RB
XXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD‐ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202‐3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXX, AR20120022747 (PD201200670)
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 10% 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
XXXXXXXXXXXX
Deputy Assistant Secretary
(Army Review Boards)
3 PD1200670
CF:
( ) DoD PDBR
( ) DVA
4 PD1200670
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