RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

                                                     BRANCH OF SERVICE:  NAVY 
SEPARATION DATE:  20040630 

 
NAME:  XXXX 
CASE NUMBER:  PD1200145 
BOARD DATE:  20121023 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty Sailor, FC3/E-4 (Fire Controlman serving as Leave/TAD 
Clerk),  medically  separated  for  left  elbow  pain.   The  CI  sustained  a  displaced  left  radial neck 
fracture  in  September  2001  that  required  an  open  reduction  and  internal  fixation.    She 
developed a posttraumatic contracture that required further surgery and removal of hardware 
in January 2003.  The CI continued to have pain and stiffness and subsequently developed pain 
and  paresthesias  in  the  ulnar  nerve  distribution.    This  required  ulnar  nerve  transposition 
surgery in December 2003.  Although her symptoms did improve they remained significant and 
she  was  unable  to  meet  the  physical  requirements  of  her  rating  or  satisfy  physical  fitness 
standards.    She  was  placed  on  limited  duty  [LIMDU]  and  referred  for  a  Medical  Evaluation 
Board (MEB).  The MEB forwarded left elbow pain, left elbow post traumatic arthropathy, and 
left  elbow  cubital  tunnel  syndrome,  status  post  ulnar  nerve  transposition  as  medically 
unacceptable IAW SECNAVINST 1850.4E.  The MEB forwarded no other conditions for Physical 
Evaluation Board (PEB) adjudication.  The PEB adjudicated the left elbow pain as unfitting, rated 
20%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The PEB 
adjudicated  the  left  elbow  posttraumatic  arthropathy  and  the  left  elbow  cubital  tunnel 
syndrome, status ulnar nerve transposition as Category II diagnoses.  A Category II diagnosis is 
related to the unfitting condition and is not separately unfitting.  The CI made no appeals, and 
was medically separated with a 20% disability rating.   
 
 
CI CONTENTION: The CI states: “PEB only rated @ 20%--VA determination & medical records & 
physical/ortho exams performed while still on active duty by both VA & the Naval Hospital.”  
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (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 Category II conditions outlined in the chart below as requested for consideration 
meet the criteria prescribed in DoDI 6040.44 for Board purview and are addressed below, in 
addition to a review of the ratings for the unfitting condition.  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 Board for Correction of Naval Records.   
 
 
 
 
 
 
 
 

 

RATING COMPARISON:   
 

Service PEB – Dated 20040401 

VA (3 & 4 Mos. Pre-Separation) – All Effective Date 20040701 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Left Elbow Pain 

5099-5003-

8616 

20% 

Left Elbow Cubital Tunnel 
Syndrome, S/P Ulnar 
Nerve Transposition 
Left Elbow Post Traumatic 
Arthropathy 

Category II 

Category II 

↓No Additional MEB/PEB Entries↓ 

Left Elbow Arthritis, S/P L Elbow 
Proximal Radius Fracture, Open 
Reduction & Internal Fixation, 
Hardware Removal & 
Contracture Release 
Left Ulnar Neuropathy (Claimed 
as Cubital Tunnel Syndrome, L 
Arm and Hand Loss of  Motion, 
Pain and Numbness 
Tinnitus 
IBS & Gastroesophageal Reflux 
Disease 
Left Forehead Scar 

5010-5212 

20% 

20040304 

8516 

30%* 

20040304 

6260 

7319-7346 

7800 

10% 
10% 
10%* 

20040227 
20040226 
20040226 
20040304 

Combined:  20% 

0% X 4 others / Not Service-Connected x 7 

Combined: 60%* 

*8516 increased from 20% to 30% and 7800 increased from 0% to 10%, increasing combined to 60%, all effective 20040701. 
 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application, 
i.e., that the gravity of her condition and predictable consequences merit consideration for a 
higher  separation  rating.    The  Board  wishes  to  clarify  that  it  is  subject  to  the  same  laws  for 
service  disability  entitlements  as  those  under  which  the  Disability  Evaluation  System  (DES) 
operates.  While the DES considers all of the member's medical conditions, compensation can 
only be offered for those medical conditions that cut short a member’s career, and then only to 
the  degree  of  severity  present  at  the  time  of  final  disposition.    However  the  Department  of 
Veterans’ Affairs (DVA), operating under a different set of laws (Title 38, United States Code), is 
empowered to compensate all service-connected conditions and to periodically reevaluate said 
conditions  for  the  purpose  of  adjusting  the  Veteran’s  disability  rating  should  the  degree  of 
impairment vary over time.  The Board utilizes DVA evidence proximal to separation in arriving 
at 
interval  for  special 
consideration to post-separation evidence.  The Board’s authority as defined in DoDI 6040.44, 
however, resides in evaluating the fairness of 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  implications  at  the  time  of 
separation. 
 
Left Elbow Pain.  There were four goniometric 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.  The CI is right-handed. 
 

its  recommendations;  and,  DoDI  6040.44  defines  a  12-month 

 

   2                                                           PD1200145 
 

Left Elbow ROM 

Flexion (0-145⁰) 
Left Forearm ROM 
Pronation (0-80⁰) 
Supination (0-85⁰) 

MEB ~6 Months 
Pre-Separation 

30°-135⁰ 

 

60⁰ 
60⁰ 

Tenderness to palpation 
and crepitation of 
radiocapitellar joint; no 
tenderness at medial or 
lateral epicondyles. 
Negative Tinel on ulnar 
nerve. Paresthesias in 
left 4th and 5th digits but 
neurovascularly intact on 
exam with two-point 
discrimination at 5mm in 
all digits. No intrinsic 
atrophy. X-rays 
document post-
traumatic arthritis. 

 

10% 
10% 

Comment 

§4.71a Rating 
5010/5003 

8616 

PT ~6 Months 
Pre-Separation 

30°-135⁰ 

 

20⁰ 
20⁰ 
Tender to 
palpation. Grip is 
reduced on left 
compared to 
right secondary 
to elbow pain. 
“Has met goals of 
ortho doc.” Will 
continue ADL’s 
and ROM but will 
stop PT. 
Pronation and 
Supination may 
have been 70 and 
70 (90-20=70). 

 

10% 

Incomplete exam 

VA C&P ~4 Months 

Pre-Separation 

VA C&P ~13 Months 

Post-Separation 

30°-120⁰ 

 

None 
Full 

30°-120⁰ 

 

None 
Full 

Pain and weakness on 
elbow ROM exam; 
numbness of 4th and 5th 
digits. Left hand grip is 
good. Atrophy of muscle 
from lateral epicondyle; 
Left arm circumference 
is 9.5 inches and right is 
10 inches; forearms are 
both 8 inches. Marked 
lack of endurance and no 
lack of coordination of 
left elbow. Left hand has 
lack of coordination but 
no lack of endurance. 

 

Mild pain and mild 
weakness throughout ROM. 
Limited pronation interferes 
with driving. Numbness of 
4th and 5th digits with 
normal intrinsic muscle 
function. Right forearm is 
9.25 inches, left is 9 inches; 
right arm is 10.5 inches, left 
is 10 inches. No objective 
weakness. “Marked lack of 
endurance and mild lack of 
coordination with marked 
restriction of repetitive use 
of the left elbow and hand.” 

 

10% (VA rated 20%) 
10% (VA rated 20%) 

10% (VA rated 20%) 
10% (VA rated 30%) 

 
The PEB applied a 20% for left elbow pain coded as 5099-5003-8616.  This rating appears to 
have included both traumatic arthritis and radiculopathy.  The VA rated the elbow joint as left 
elbow  arthritis,  status  post  left  elbow  proximal  radius  fracture,  open  reduction  and  internal 
fixation,  hardware  removal  &  contracture  release  using  code  5010-5212.    The  VA  rating 
decision stated the left elbow arthritis condition warranted a 10% rating for painful motion and 
an additional 10% “because it also causes a lack of endurance in your elbow.”  This resulted in a 
20% rating for the elbow arthritis.  The VA initially rated the radiculopathy at 20% based on the 
March 2004 examination.  As shown above this examination did not note any objective loss of 
muscle  strength  and  sensory  and  reflex  examinations  were  not  completed.    The  CI  reported 
paresthesias  and  numbness  in  left  4th  and  5th  digits.    The  VA  interpreted  this  as  moderate 
incomplete paralysis of the ulnar nerve on the non-dominant side.  However, the CI submitted a 
notice of disagreement and the VA requested a re-examination by the same physician in July 
2005.    After  this  examination,  the  VA  increased  the  rating  to  30%  for  severe  incomplete 
paralysis with the original effective date of 1 July 2004.  The July 2005 examination noted no 
objective  changes  from  the  previous  examination.    However,  the  examiner  noted  limited 
pronation interfered with driving and stated the CI had marked restriction of repetitive use of 
the left elbow and hand.  
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  combined  elbow  pain,  ulnar  radiculopathy,  and  traumatic  arthritis  as  a  single  unfitting 
condition, coded analogously to 5003 and 8616 and rated 20%.  The Board must apply separate 
codes  and  ratings  in  its  recommendations  if  compensable  ratings  for  each  condition  are 
achieved  IAW  VASRD  §4.71a.    If  the  Board  judges  that  two  or  more  separate  ratings  are 
warranted  in  such  cases,  however,  it  must  satisfy  the  requirement  that  each  “unbundled” 
condition was unfitting in and of itself.  Not uncommonly this approach by the PEB reflects its 
judgment  that  the  constellation  of  conditions  was  unfitting,  and  that  there  was  no  need  for 
separate fitness adjudications, not a judgment that each condition was independently unfitting.  
Thus  the  Board  must  exercise  the  prerogative  of  separate  fitness  recommendations  in  this 
circumstance, with the caveat that its recommendations may not produce a lower combined 
rating than that of the PEB.  

   3                                                           PD1200145 
 

The Board first considered if left ulnar neuropathy, having been de-coupled from the combined 
PEB adjudication, remained independently unfitting as established above.  Board precedent is 
that  a  functional  impairment  tied  to  fitness  is  required  to  support  a  recommendation  for 
addition  of  a  peripheral  nerve  rating  at  separation.    No  examinations  note  objectively 
decreased muscle strength.  The CI complained of paresthesias and numbness in her left 4th 
and 5th digits but no objective testing documented any actual decreased sensation.  However, 
the CI did report significant paresthesias which were painful and caused her to drop things and 
have a limited ability to lift and carry things.  The VA examiner noted this as lack of coordination 
and endurance.  All members agreed that left ulnar nerve neuropathy, as an isolated condition, 
would have rendered the CI incapable of continued service within her Rating, and accordingly 
merits  a  separate  rating.    However,  no  examinations  support  a  rating  greater  than  10%  for 
traumatic  arthritis  manifested  by  pain-limited  motion  or  a  rating  greater  than  10%  for  ulnar 
radiculopathy manifested by paresthesias without objective decreased strength or sensation or 
alteration  of  reflexes.    These  ratings  combine  to  result  in  an  overall  rating  of  20%  with  no 
benefit to the CI.  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 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.  In the matter of the left 
elbow pain condition and IAW VASRD §4.71a and §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:   
 

VASRD CODE 

5099-5003-8616 

COMBINED 

RATING 

20% 
20% 

Left Elbow Pain 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120130, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXX 
           President 
           Physical Disability Board of Review 

   4                                                           PD1200145 
 

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 7 Nov 12 

 

      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: 
 
                  -    former USN  
-    former USN  
-    former USMC 
-    former USN   
-    former USMC 
-    former USMC 
-    former USMC 
-    former USN  

 

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

  
  Assistant General Counsel 
  (Manpower & Reserve Affairs) 

   5                                                           PD1200145