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AF | PDBR | CY2012 | PD2012 01018
Original file (PD2012 01018.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE NUMBER: PD120 1018
BRANCH OF SERVICE: Army   BOARD DATE: 2013 0514
Separation Date: 20030514


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B10/Infantryman) medically separated for post-traumatic degenerative arthritis of the right elbow, which existed prior to service (EPTS), but was permanently service aggravated (PSA) during Operation Anaconda. The CI reported he had a healed right elbow injury during his childhood. While in Afghanistan, the CI fell and struck his right elbow and developed increased pain and intermittent locking. Despite right elbow arthroscopic surgery, physical therapy (PT), orthopedic evaluations, occupational therapy (OT), narcotic medications, and nonsteroidal anti-inflammatory drugs (NSAIDs), the CI failed to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. The CI was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded post-traumatic degenerative changes (EPTS by history) to the Physical Evaluation Board (PEB) IAW AR 40-501, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The MEB submitted no other conditions. The PEB adjudicated “Post Traumatic Degenerative Arthritis, Right Elbow,” rated 10%. On DA Form 199, the PEB noted that there was sufficient evidence to support a finding that the current impairment was EPTS, and was subsequently aggravated by such service and rendered the CI unfit. The CI made no appeals and he was medically separated with 10% disability rating.


CI CONTENTION : “My benefits should be increased for the following reasons: 1. I was medically discharged in 2003 before the military put an emphasis on combat related injuries. 2. I was diagnosed with post traumatic degenerative joint disease. Because of this diagnosis, my elbow will only get worse as I get older. My arm is not straight, I’ve lost the ability to rotate my elbow, and I deal with inflammation flare ups daily. 3. In comparison of my fellow soldiers I feel that the 10% disability rating I receive does not fit the injury I received in combat operations.”


 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 posttraumatic degenerative arthritis of the right elbow condition is addressed below. 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 20030411
 VA - Based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Posttraumatic Degenerative Arthritis of the Right Elbow
 5010 10% Degenerative Joint Disease, Right Elbow (Major) 5010-5206 10% Service Treatment Record (STR)
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VARD) dated 20030612 (most proximate to date of separation [DOS]). invalid font number 31502

ANALYSIS SUMMARY : The Board acknowledges the sentiment expressed in the CI’s application, that the gravity of his condition and predictable consequences which merit consideration for a higher separation rating. The Board utilizes VA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of Disability Evaluation System ( DES ) fitness determinations and rating decisions for disability at the time of separation. Post-separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implicati ons at the time of separation.

Posttraumatic Degenerative Arthritis of the Right Elbow Condition . There were range - of - motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Right Elbow ROM
(Degrees)
 OT ~ 3.5 Mo. Pre-Sep PT ~ 2.43 Mo. Pre-Sep MEB ~ 1.90 Mo. Pre-Sep
Flexion (145 Normal)
 140 140 135 (133)
Extension (0)
 25 -20 20
Pronation (80)
 45 45 45
Supination (85)
 45 80 80
Comment
 Crepitus; decreased pronation, supination; “still locking in flexion” “pain with extension” Tenderness; crepitus ; grip strength 120 lbs on left and 80 lbs on right Surgical incision well healed; no evidence instability on valgus, varus stressing medially or laterally; motor strength 5/5 and reflexes 2/4; “chronic pain”, “catching”
§4.71a Rating
 10 % 10% 10 %

The CI complained of locking and stiffness in the right elbow after his injury in February 2002. A pre-operative right elbow X - ray revealed int ra articular ossific bodies in the elbow joint. The o rthopedist indicated that the CI reported he had injured his elbow at age 14 while playing football that resulted in a crooked elbow and X -rays performed at that time revealed a healed fracture. H owever , there is no documentation of this injury on the SF 88 Report of Medical Examination at the time of his enlistment or any treatment related to this condition prior to his injury in February 2002 . The CI reported pain and locking in the elbow that interfered with push-ups, certain activities required by his MOS and the elbow would lock sometimes in a flexed or extended position during the day. The physical exam findings showed the elbow carrying angle to be symmetrical, tenderness in the medial and lateral aspects of the joint, and limited ROM. The CI underwent a diagnostic surgical right elbow arthroscopy with removal of loose bodies and a partial synovectomy in November 2002 . Post operatively the CI was given an elbow pad appliance. The CI was seen in follow-up by Orthopedics with complaints of popping, locking, stiffness, and crepitus. The CI was seen 2 months later for reevaluation and was found to have popping with minimal activity, locking with pushups, crepitus with mild pain on flexion , and limited ROM (pronation limited to 45 degrees) with pain reproduced on resistance. The CI was given a permanent U 3 Profile for right elbow pain secondary to chronic instability and dege n erati ve joint disease (DJD) /arthritis. The c ommander’s s tatement noted that the CI’s disability directly interfered with his MOS duty performance. The MEB n arrative s ummary (NARSUM) exam approximately 2 months prior to separation noted frequent chronic right elbow pain and catching aggravated by push-ups, repetitive lifting , and various activities in his MOS. The CI was noted to have restrictions of firing his rifle due to discomfort; lifting restricted to thirty-five pounds with the right hand, physical training limited to a two mile run; and sit-up modifications required due to the fixed flexed position that aggravated his symptoms on repetitive use. X - ray findings of the right shoulder revealed marked degenerative changes and osteophytic changes anteriorly to the radiocapitellar (elbow) joint were noted prior to surgery. These findings were confirmed with marked chondromalacia seen during the arthroscopy . The examiner further documented that the condition was permanently aggravated by service. The MEB NARSUM physical exam findings are summarized i n the chart above. Physical examination findings from OT and PT are also recorded in the chart above and all show decreased ROM at the elbow. Although the PT exam records a negative value for extension and the others are positive, it is clear from the examination reports that all values represent lack of full extension and not hyperextension. There was no VA Compensation and Pension (C&P) examination completed .

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the p ost - traumatic d egenerative a rthritis of the r ight e lbow condition 5010 a rthritis, due to trauma, substantiated by X -ray findings rated 10 % . The PEB noted that there was sufficient evidence to support a finding that the current impairment had existed prior to service but was subsequently aggravated by such service, and rendered the CI unfit. No impairment at entry was noted and therefore no deduction from the disability rating at separation is required. The VA coded the DJD , r ight e lbow ( m ajor) condition as 5010 with 5206 , f orearm, limitation of flexion of , based on the STR noting continued pain with ROM limited form 20 to 133 degrees . The PEB and the VA chose different coding options but this did not bear on the rating. The right elbow condition could not be reasonably rated higher than 10% using any exam proximate to separation or any alternate coding schema. There was ample documentation throughout the STR of right elbow pain with activities, locking, popping, and crepitus. M arked degenerative changes and osteophytic changes anteriorly to the radiocapitellar joint were noted on X -ray and at arthroscopy . After due deliberation, considering all of the evide nce and mindful of VASRD §4.3 (r easonable doubt ) and §4. 59 ( p ainful motion ) , the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the p ost- traumatic d egenerative a rthritis of the r ight e lbow 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. In the matter of the p ost- traumatic d egenerative a rthritis of the r ight e lbow condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


 RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Posttraumatic Degenerative Arthritis Of The Right Elbow
5010 1 0%
COMBINED
 1 0%



The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 120602 , w/atchs
Exhib it 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 AR20130011073 (PD201201018)


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 and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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