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AF | PDBR | CY2012 | PD2012 01729
Original file (PD2012 01729.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201729
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130507
SEPARATION DATE: 20020911


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PO2/E-5 (PN2/Personnel Second Class) medically separated for a nerve condition. He had longstanding left elbow pain, which was treated with surgery, but could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The medial epicondylitis and ulnar neuropathy conditions were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated ulnar neuropathy as unfitting (Category I), rated 20%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining condition was determined to be Category II , contributing to the primary unfitting condition. The CI made no appeals, and was medically separated with a 20% disability rating.


CI CONTENTION: “I would have stayed in the Navy for 20 years if not for my left elbow. After 2 operations I could not do the required pushups for the Navy Physical Fitness, it was also very difficult for me onboard the ship (USS MONTEREY) to open and close Hatches, sleep in a rack. I have pain daily, and perform basic task like mowing the lawn aggravates my elbow even more. My VA rating is 30%.”


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 ratings for the unfitting ulnar neuropathy and contended Category II medial epicondylitis condition are addressed below, and, thus are within the DoDI 6040.44 defined purview of the Board. Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Naval Records.


RATING COMPARISON:

Service IPEB – Dated
VA - (~5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Ulnar Neuropathy
 8716 20% Left Ulnar Neuropathy... 8516 10% 20030127
Medial Epicondylitis
 Cat II P/O Scarring, Left Elbow 7804 10% 20030127
No Additional MEB/PEB Entries
 Other x 6 20030127
Combined: 20%
 Combined: 30%
Derived from VA Rating Decision , dated 200 30415 (most proximate to date of separation ( DOS )


ANALYSIS SUMMARY: The Board acknowledges the CI’s contention that suggests a higher rating should have been granted at the time of separation. Additionally, the Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him; but, must emphasize that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.

Ulnar Neuropathy with Associated Medial Epicondylitis Condition. The CI experienced onset of left hand tingling and numbness primarily of the little finger beginning in April 1998. A nerve conduction velocity (NCV) test on 30 July 1998 showed slowing of the ulnar nerve motor segments at the elbow, but was otherwise normal. He did not improve with conservative care and underwent a left ulnar nerve decompression and medial epicondylectomy on 26 October 1998. Due to slow rehabilitation and waiver for Physical Readiness Training (PRT) for three cycles he was placed on limited duty on December 1999. He continued with occupational therapy and experienced good results, being found fit for full duty on 16 May 2000. In August 2000 he reported recurrence of symptoms with decreased sensation along the ulnar aspect of the left 5th finger after doing push-ups. A NCV test showed ulnar nerve motor slowing at the elbow, but was otherwise normal. He failed to improve with conservative care and underwent a left ulnar nerve submuscular transposition and left Guyen’s canal release on 22 January 2001. Pre-operative physical examination on this date showed full active left elbow range-of-motion (ROM) associated subluxation of the ulnar nerve and pain. Post operatively service treatment records (STRs) reflect significant improvement. At a follow up evaluation with his surgeon on
8 June 2001, there were no paresthesias or numbness and the elbow felt good. There was some lateral elbow pain with push-ups, but strength was improving. Elbow ROM was full and strength was normal including grip strength. Sensation was intact and there were no symptoms on Tinel’s testing. The CI was released to full duty. The CI experienced left elbow pain in November 2001 while on ship duty diagnosed as medial epicondylitis. Initially there was no numbness or tingling, but the CI later reported recurrent numbness and tingling into the small finger. A medical note from orthopedic surgery dated 8 January 2002 recorded, “tender at medial epicondyle, full range of motion, decreased sensation small finger left. No surgical options remain for this patient’s conditions.” The CI was referred for MEB due to persisting left elbow pain with activity. At the orthopedic MEB narrative summary (NARSUM) examination
1 February 2002, the CI reported long-standing complaints of left elbow pain with numbness and tingling radiating to the small fingers of his left hand. There was left elbow pain with repetitive use such as climbing ladders, push-ups and many normal job duties. On physical examination there was tenderness over the left medial epicondyle at the left elbow and a positive Tinel’s sign at the left elbow. On a medical assessment dated 7 February 2002, the CI reported complaints as “little finger numb at times, elbow hurts at times.” The commander’s non-medical statement 15 April 2002 noted elbow pain limited the CI’s duty performance.

At the VA Compensation and Pension (C&P) examination, 3 December 2002, 3 months after separation, the examiner recorded: “Since that time the patient has continued to notice recurrent episodes of tingling and numbness about the left small finger. There is no loss in using function in his hand and he has good motion about the finger and he has no complaints about the wrist at this time. No loss of range of motion and the use of his left wrist…no impairment in use of the left hand.” On examination, the ROM of the left elbow was “full” with very slight tenderness of the scar. There was good grip strength of both hands. At the C&P examination 27 January 2003, approximately 4 months after separation, the CI reported difficulty lifting heavy objects due to left elbow pain and left ulnar neuropathy. On examination of the left elbow, there was no tenderness. Flexion was 130 degrees (normal 145) and extension 0 degrees (normal 0) limited by pain but not fatigue or lack of endurance. There was numbness of the left little finger but power was normal. Motor function (muscle strength) of the upper extremities was normal. An X-ray of the left elbow was normal.

The Board directs attention to its rating recommendation based on the above evidence. The Board noted that the MEB referred the left elbow pain (medial epicondylitis) as the primary diagnosis and ulnar neuropathy as the second diagnosis. The PEB reversed the diagnosis order listing ulnar neuropathy as the primary unfitting diagnosis rated 20% coded 8716 (neuralgia of the ulnar nerve, moderate minor) and the medial epicondylitis as a condition that contributed to the primary unfitting diagnosis. All Board members however agreed that the left elbow pain was the primary unfitting condition and not the ulnar nerve neuropathy. In fact, following the final surgery, the STRs, NARSUM examination and C&P examinations document symptoms of numbness of the left little finger without hand impairment indicating the residual left ulnar neuropathy was not the primary condition that would be considered unfitting for continued military service. Further, the Board concluded the impairment from the residual ulnar neuropathy was no greater than mild and based on the first C&P examination was associated with no impairment warranting greater than a 10% rating for mild. The Board next considered the left medial epicondylitis. There was no limitation of motion that attained a minimum rating for limitation of motion and no significant associated weakness. The Board concluded a rating of 10% was supported based on painful motion (§4.59) and functional loss (§4.40). Based on this discussion, the Board concluded that the PEB fully considered the impairments from both the ulnar neuropathy and the medial epicondylitis in its 20% rating. However, all Board members agreed that separate ratings for the conditions were more appropriate and consistent with VASRD guidelines. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a modification of the disability rating to 10% for the ulnar neuropathy condition (coded 8716) and 10% for the medial epicondylitis condition (coded 5099-5024).


BOARD FINDINGS: In the matter of the left ulnar neuropathy with associated category II left medial epicondylitis condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication total percentage, but a modification of the rating codes and percentages as noted. In the matter of the ulnar neuropathy with associated Category II left medial epicondylitis conditions the Board unanimously recommends separate disability ratings of 10%, coded 8716 IAW VASRD §4.124a and 10% coded 5099-5024 IAW VASRD §4.71a respectively. 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
Ulnar Neuropathy
 8716 10%
Medial Epicondylitis
 5099-5024 10%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120807, 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 15 Jul 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective 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:
- former USMC
- former USMC
- former USMC
 - former USN
- former USN
- former USN


                                                      xx
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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