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AF | PDBR | CY2012 | PD2012 01563
Original file (PD2012 01563.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XX         BRANCH OF SERVICE: MARINE CORPS
CASE NUMBER: PD1201563   SEPARATION DATE: 20020715
BOARD DATE: 20130411


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty GySgt/E-7 (3529/Motor Transportation Maintenance Chief), medically separated for post-operative neuroma versus scar neuritis of the right medial antebrachial cutaneous nerve with loss of pronation. The CI injured his right distal biceps tendon in September 1999. He did not respond adequately to operative and rehabilitative treatment to meet the physical requirements of his (MOS) or satisfy physical fitness standards. He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB). “Most consistent with postoperative neuroma versus scar neuritis of the right medial antebrachial cutaneous nerve” was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW SECNAVINST 1850.4E. There were no other conditions on the MEB submission. The Physical Evaluation Board (PEB) adjudicated the post-operative neuroma versus scar neuritis of the right medial antebrachial cutaneous nerve with loss of pronation conditions as unfitting, rated 20%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI appealed to the Formal PEB (FPEB), which affirmed the Informal PEB (IPEB) rating but changed the VASRD code. The CI also filed a petition for relief to the Navy Council of Personnel Boards to be placed on the temporary disability retirement list (TDRL), but was denied and separated with a 20% disability rating.
CI CONTENTION: “As explained while still on Active Duty, I would qualify for a TDRL due to my deteriorated biceps tendons. I have maintained a good state of physical condition and am requesting to be reevaluated for retirement. My status was determined to be separated and not retired. I feel that due to my service connected disability, I was not able to fully complete my years for a full retirement. I would like to be reconsidered for retirement or disabled and retired with full benefits. I served my country honorably and deserve to be retired w/ benefits after having served 20 years!”


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. The unfitting post-operative neuroma versus scar neuritis of the right medial antebrachial cutaneous nerve with loss of pronation condition meets the criteria prescribed in DoDI 6040.44 for Board purview, and is accordingly addressed below. The contended right bicep tendon is considered by the Board only with regard to rating the unfitting post-operative neuroma versus scar neuritis of the right medial antebrachial cutaneous nerve with loss of pronation condition and is otherwise outside the scope of the Board. Any condition or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records. The Board acknowledges the CI’s opinion that he qualified for a TDRL due to his deteriorated biceps tendons. IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.


RATING COMPARISON :

Service FPEB – Dated 20010911
 VA (~15 Mos. Pre-Separation) – All Effective Date 20020716
Condition
 Code Rating Condition Code Rating Exam
P/O Neuroma Versus Scar Neuritis, R Medial Antebrachial Cutaneous Nerve 8711 20% P/O Neuroma Versus Scar Neuritis, R Medial Antebrachial Cutaneous Nerve 5305-8517 10% 20010419
No Additional MEB/PEB Entries
 Other x 10 20010419
Combined: 20%
 Combined: 50%
Derived from VA Rating Decision, dated 20030319 (Most proximate to the date of separation)


ANALYSIS SUMMARY:

Post-Operative Neuroma versus Scar Neuritis of the Right Medial Antebrachial Cutaneous Nerve with Loss of Pronation Condition. The CI is a right-hand dominant male who sustained a rupture of the right biceps tendon while lifting a tire on 15 September 1999. The CI underwent surgical repair of the ruptured tendon on 4 October 1999. His received extensive occupational therapy post-surgery, however he continued to complain of pain in the region of the right antecubital fossa adjacent to the surgical scar within the distribution of the right medial antebrachial cutaneous nerve. He was diagnosed with neuroma versus neuritis of right medial antebrachial cutaneous nerve and treated in the pain clinic with anti-inflammatory medications and injections; however this too did not alleviate his chronic pain. His treating surgeons concluded that attempts to find and excise a possible neuroma were likely to be futile and referred the CI for MEB. The MEB narrative summary (NARSUM) on 8 February 2001 (17 months prior to separation) notes that the CI reported that his pain increased with strengthening exercises that primarily involved right arm flexion. On exam, he had a well-healed tender scar with visible atrophy of the right bicep muscle. He also had tenderness to palpation at insertion of the biceps muscle at the elbow. Palpation in the elbow area produced shooting pain down the mid forearm. His elbow flexion was 140 degrees (normal 145), extension 0 degrees (normal 0), pronation 65 degrees (normal 80), and supination 75 degrees (normal 85). Biceps muscle strength was 4+/5 and strength in supination of the forearm was 4/5. Sensation was normal. An occupational therapy evaluation dated 20 February 2001 recorded CI complaint of increased soreness and swelling after approximately 30 minutes of trowling mortar during a tile installation project. On examination right elbow circumference was 29.8 centimeters and left elbow circumference 30.2 centimeters. His right elbow extension was 0 degrees and flexion 140 degrees and pronation and supination were noted as normal. His pain was worse with holding a weight and his grip strength was decreased. The occupational therapist noted he had not significantly improved over the preceding 6 months.

At the VA Compensation and Pension (C&P) exam on 19 April 2001 (15 months prior to separation), the surgical scar in the right antecubital fossa was non-tender. There appeared to be evidence of a small neuroma in the right antecubital fossa with tenderness in the area. Right elbow active flexion was 145 degrees, extension 0 degrees, supination 85 degrees, and pronation 80 degrees. The range-of-motion (ROM) of the right elbow was not limited by pain, fatigue, weakness, lack of endurance or repetitive use. The examination of the right elbow revealed no evidence of heat, redness, swelling, effusion, instability, weakness, drainage or abnormal movement. Strength in right upper extremity was 4/5 secondary to pain in the antecubital fossa and shoulder. The CI could make a fist without difficulty and his hand strength was assessed as normal. Sensation was intact. Reflexes were normal. At the FPEB hearing, 11 September 2001, the CI “demonstrated excellent flexion and extension as well as excellent supination and pronation”. During testimony, the CI “made clear that it was pain which interfered with his inability [sic] to pull or lift with his right arm”, and also stated there was also “a sense of weakness”.

The Board directs attention to its rating recommendation based on the above evidence. Both the IPEB and the FPEB rated the right elbow pain condition 20% but used different codes. The IPEB used the code for limitation of supination and pronation (5213), however there was not limitation of supination or pronation that attained a minimum rating. There was also no limitation of flexion or extension that warranted a minimum rating under the respective codes (5206, 5207, 5208). The FPEB, citing the primary problem was nerve pain and used the code for neuralgia of the upper radicular group (8711). However the upper radicular group refers to cervical spine nerve root impairment which the CI did not have. The CI had a neuralgia involving a peripheral nerve at the surgical site in the left antecubital fossa. In its 10% rating, the VA utilized a peripheral nerve code that most nearly approximated the CI’s impairment, the musculocutaneous nerve (8517) which includes weakness of elbow flexion and supination. Ratings under 8517 for the dominant/major extremity are for incomplete paralysis: mild 0%, moderate 10% and severe 20%. The Board concluded impairment most nearly approximated a moderate degree and agreed the C&P examination considered alone more nearly approximated mild impairment. The Board also considered the rating under the muscle code 5305 (Group V muscle injuries; flexion of the elbow and supination). All members agreed the disability more nearly approximated the moderate (10%) and did not approach the moderately severe (30%) based on examination findings of mild weakness and in view of the fact that the weakness was mostly attributed to the neuralgia pain condition rather than a muscle condition. The Board could find no route to a higher rating. The Board’s charge is to consider the permanent rating for unfitting conditions at separation and does not recommend TDRL. However, the Board notes that the condition did not meet the criteria for placement on TDRL which include a rating of at least 30% and an unstable condition expected to appreciably change within a short period of time. The Board concluded the rating did not attain a 30% level and noted the CI’s condition to have been stable for some time prior to separation and not expected to change (post separation evidence also indicated the condition to be stable). Thus, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the post-operative neuroma versus scar neuritis of the right medial antebrachial cutaneous nerve with loss of pronation 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 post-operative neuroma versus scar neuritis of the right medial antebrachial cutaneous nerve with loss of pronation condition and IAW VASRD §4.124a, 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
Post-Operative Neuroma versus Scar Neuritis of the Right Medial Antebrachial Cutaneous Nerve with Loss of Pronation 8711 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120816, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         XX
         Director of Operations
         Physical Disability Board of Review


 MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 31 May 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- X former USMC
- X former USN
- X former USMC
- X former USN
- X former USN
- X former USN



                                                     
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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