Citation Nr: 0001342 Decision Date: 01/14/00 Archive Date: 01/27/00 DOCKET NO. 92-06 521 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to a compensable evaluation for a right elbow disability for the period of June 1, 1988 to May 24, 1995. 2. Entitlement to a compensable evaluation for a right elbow disability from May 25, 1995. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Michael J. Skaltsounis, Associate Counsel INTRODUCTION The veteran had active service from May 1983 to May 1988, and had nearly 21 years of active service prior to that. This matter is currently before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 1994 and October 1996, the Board remanded this issue to the RO for additional development. In January 1998, the Board upheld the RO's denial of the veteran's claim. The veteran filed a timely appeal to the United States Court of Appeals for Veterans Claims (previously known as the United States Court of Veterans Appeals prior to March 1, 1999, hereafter "the Court"). In July 1998, the General Counsel for the Department of Veterans Affairs (General Counsel) and the veteran's attorney filed a joint motion to vacate the Board's decision and to remand this matter for development and readjudication. The Court then granted the joint motion that month, vacating and remanding the case to the Board, and pursuant to the Court's July 1998 order, the Board remanded this matter in December 1998. In its December 1998 remand, the Board summarized the action requested by the July 1998 joint motion, which found that the VA examinations performed at the Board's request in both May 1994 and October 1996 were inadequate for rating purposes. The parties of the joint motion indicated that those evaluations did not meet the requirements of the Court in DeLuca v. Brown, 8 Vet. App. 202, 205-208 (1995). Specifically, the joint motion noted that 1995 examination reported flexion was to 130 degrees, instead of the 145 degrees provided in 38 C.F.R. § 4.71, Plate I. Therefore, the joint motion found that the 1997 VA examination (which noted a "full range of motion" in pronation, supination, flexion and extension) was not adequate because it failed to record such motion "in degrees" or to indicate whether such motion was limited by pain and to what extent. Consequently, the Board directed the RO to obtain any additional pertinent outstanding medical records, and to thereafter, afford the veteran with a new VA medical examination that was to be conducted in accordance with the requirements noted above. This matter has now been returned to the Board for final disposition. The Board finds that the RO has carried out the action requested in the previous remand to the extent possible, and that the claim on appeal is ready for appellate consideration. The Board further notes that pursuant to the case of Fenderson v. West, 12 Vet. App. 119 (1999), the Board will review the appropriateness of the evaluation for the veteran's right elbow disability from the effective date of the initial rating of June 1, 1988. In view of the Board's decision to grant an increased "staged" rating from May 25, 1995, the Board has divided the claim on appeal into two separate issues. FINDINGS OF FACT 1. During the period of June 1, 1988 to May 24, 1995, the veteran's right elbow disability was manifested by full range of motion and tenderness, which did not more nearly approximate bursitis or arthritis, malunion of the radius with bad alignment, limitation of flexion at 100 degrees, or limitation of extension of the forearm to 45 degrees. 2. From May 25, 1995, the veteran's right elbow disability has been manifested by bone spurring with full range of motion and evidence of pain, which is not productive of malunion of the radius with bad alignment, limitation of flexion at 100 degrees, or limitation of extension of the forearm to 45 degrees, but does more nearly approximate bursitis with evidence of pain on functional use. CONCLUSIONS OF LAW 1. The schedular criteria for a compensable evaluation for a right elbow disability for the period of June 1, 1988 to May 24, 1995, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71, Plate I, 4.71a, Diagnostic Codes 5003, 5010, 5019, 5206, 5207, 5211 and 5212 (1999). 2. The schedular criteria for a 10 percent evaluation, but not higher, for a right elbow disability from May 25, 1995, have been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71, Plate I, 4.71a, Diagnostic Codes 5003, 5010, 5019, 5206, 5207, 5211 and 5212. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Entitlement to a Compensable Evaluation for a Right Elbow Disability for the Period of June 1, 1988 to May 24, 1995 Background The Board notes that the claim is well grounded and adequately developed. 38 U.S.C.A. § 5107(a); Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board again notes that the RO complied with the requests for medical development contained within the Board's remand of December 1998 to the extent possible, and that the further remand of the claim on appeal is not warranted. Disability evaluations are determined by the application of a schedular rating which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The normal range of motion of the elbow is from 0 degrees of extension to 145 degrees of flexion. Full forearm pronation is from 0 to 80 degrees and full forearm supination is from 0 to 85 degrees. 38 C.F.R. § 4.71, Plate I. Limitation of flexion of either the major or minor forearm to 100 degrees warrants a 10 percent evaluation; limitation of flexion of either forearm to 90 degrees warrants a 20 percent evaluation; limitation of flexion of the major forearm to 70 degrees warrants a 30 percent evaluation; limitation of flexion of the major forearm to 55 degrees warrants a 40 percent evaluation; and limitation of flexion of the major forearm to 45 degrees warrants a 50 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5206. Limitation of extension of either the major or minor forearm to 45 or 60 degrees warrants a 10 percent evaluation; limitation of extension of either forearm to 75 degrees warrants a 20 percent evaluation; limitation of extension of the major forearm to 90 degrees warrants a 30 percent evaluation; limitation of extension of the major forearm to 100 degrees warrants a 40 percent evaluation; and limitation of extension of the major forearm to 110 degrees warrants a 50 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5207. A 20 percent evaluation is warranted for residuals of fracture of the elbow of the joint of either upper extremity when there is marked cubitus varus or cubitus valgus deformity or when there is an ununited fracture of the head of the radius. A flail elbow joint warrants a 60 percent evaluation when the major upper extremity is involved. 38 C.F.R. 4.71a, Diagnostic Code 5209 (1999). Nonunion of the radius and ulna, with a flail false joint, warrants a 50 percent evaluation when the major upper extremity is involved. 38 C.F.R. 4.71a, Diagnostic Code 5210 (1999). Under 38 C.F.R. § 4.71a, Diagnostic Code 5211, a 10 percent evaluation is warranted for nonunion of the ulna with bad alignment. A 20 percent evaluation requires nonunion of the ulna of the major or minor upper extremity in the lower half. A 30 percent evaluation requires nonunion in the upper half of the major extremity with false movement and without loss of bone substance or deformity, and a 40 percent evaluation requires loss of bone substance (1 inch (2.5 centimeters) or more) and marked deformity. 38 C.F.R. Part 4, Diagnostic Code 5211. Under 38 C.F.R. § 4.71a, Diagnostic Code 5212, a 10 percent evaluation is warranted for nonunion of the radius with bad alignment. A 20 percent evaluation requires nonunion of the radius of the major or minor upper extremity in the upper half. A 20 percent evaluation is also provided for nonunion in the lower half with false movement and without loss of bone substance. A 30 percent evaluation requires nonunion in the lower half with false movement with loss of bone substance or deformity. 38 C.F.R. Part 4, Diagnostic Code 5212. Limitation of supination of either forearm to 30 degrees or less warrants a 10 percent evaluation. Limitation of pronation of the forearm of the major upper extremity warrants a 20 percent evaluation if motion is lost beyond the last quarter of the arc and the hand does not approach full pronation. Bone fusion with loss of supination and pronation of the forearm of the minor upper extremity warrants a 20 percent evaluation if the hand is fixed near the middle of the arc or in moderate pronation. A 30 percent evaluation requires that the hand be fixed in hyperpronation or supination. 38 C.F.R. 4.71a, Diagnostic Code 5213 (1999). Disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence of part or all of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40. As regards the joints, the factors of disability reside in reductions of their normal excursion of movements in different planes. Some factors considered include pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. 38 C.F.R. § 4.45. The veteran's right elbow disability is currently evaluated as noncompensable under Diagnostic Code 5010 for traumatic arthritis which is rated on limitation of motion of the affected part. Bursitis is rated as degenerative arthritis. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5019. Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate Diagnostic Codes for the specific joint involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate Diagnostic Codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under the Diagnostic Code 5003. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The history of this disability shows that a February 1989 rating decision granted service connection for a right elbow disorder, and a noncompensable evaluation was assigned. This decision was based on the veteran's service medical records, and a September 1988 VA examination. Service medical records reflect that in September 1981, the veteran complained of a sore right elbow which was reportedly struck five to ten months earlier. Examination revealed that the ulna was slightly tender and X-rays were interpreted to reveal a bone spur with tenderness from the olecranon into the triceps area. The assessment was bone spur right elbow. An orthopedic consultation in March 1983 indicated that the veteran continued to have pain on motion and X-rays were interpreted to reveal a large arthritic spur over the olecranon and also one over the anterior articular surface of the ulna. The diagnosis was traumatic arthritis of the right elbow. There were additional assessments of traumatic arthritis in October and November 1983, and in December 1983, it was noted that the right elbow had worsened since March 1983. At this time, the impression was bony spur of the right olecranon, and it was indicated that this could be easily excised and might resolve most of the veteran's symptoms. A history of tenderness and pain on use was noted. Physical examination revealed a bony mass over the tip of the olecranon, which was mildly tender to deep palpation. X-rays were interpreted to reveal a bony spur that was in the extensor tendon and appeared to have a little crack through the base of the spur. Additional service medical records from January 1984 reflect a history of injury to the right elbow as a result of a fall on ice three years earlier. The assessment was bone spur. A subsequent January 1984 record reflects that the veteran was four days status post excision of an olecranon spur. The assessment was normal status post excision of an olecranon spur. In September 1984, X-rays were interpreted to reveal negative findings. At the time of a retirement examination in December 1987, the examiner noted the history of a fracture of the right elbow in 1981, secondary to falling on ice, and that the veteran was right-handed. It was also noted that the veteran underwent surgical removal of a bone chip in 1984, which left a 5 centimeter scar on the right elbow, that the veteran was hospitalized for two days, that there was full strength, that there was arthritis secondary to bone spur on the right elbow, and that the veteran still had pain for which he had not sought medical help. A September 1988 VA examination showed the veteran complained that the elbow was sensitive and squeezing produced pain. On examination, there was no tenderness and a full range of motion, with a range of 0 to 150 degrees both right and left, and supination and pronation of 0 to 80 degrees bilaterally. Diagnosis included right elbow fracture with spur removal and (or without, the abbreviation is unclear) pain residuals. X- rays of the right elbow were interpreted to reveal no fracture or dislocation, and negative findings with respect to the bone, soft tissue and joint. The veteran filed a NOD with the noncompensable evaluation of his service-connected right elbow disorder in February 1990, and submitted a substantive appeal (Form 9) in June 1990, perfecting his appeal. In a February 1990 statement, he indicated his elbow at times was fine and at other times was stiff and sore, especially if he did hard work or a lot of lifting. In May 1994, the Board remanded the veteran's case to the RO for further development. Analysis The Board has reviewed all pertinent evidence of record with reference to the period of June 1, 1988 to May 24, 1995, and recognizes the right elbow disability involves the veteran's major upper extremity, and that it is currently evaluated as noncompensable under Diagnostic Code 5010 which is rated on limitation of motion of the affected part. 38 C.F.R. § 4.71a, Diagnostic Code 5010. As was noted above, at the VA orthopedic examination in September 1988, examination of the right elbow revealed no tenderness and full range of motion from 0 to 150 degrees, bilaterally, and with supination and pronation of 0 to 80 degrees bilaterally. A 10 percent rating based on loss of forearm flexion would still require flexion to be limited to 100 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5206. A 10 percent evaluation based on loss of forearm extension would require extension to be limited to at least 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5207. Thus, neither Diagnostic Code 5206 nor 5207 would afford the veteran a basis for a compensable evaluation for the period of June 1, 1988 and May 24, 1995. As the veteran also did not have forearm flexion limited to 100 degrees and extension limited to 45 degrees for this period, a 20 percent rating is also not available under 38 C.F.R. § 4.71a, Diagnostic Code 5208 (1999). In addition, Diagnostic Codes 5205, 5209, 5210, and 5213 would not provide a basis for a compensable evaluation for the period of June 1, 1988 to May 24, 1995 since there has been no medical evidence of elbow ankylosis, marked cubitus varus or cubitus valgus deformity, ununited fracture of the head of the radius, nonunion of the radius and ulna, with a flail false joint, or bone fusion with loss of supination and pronation of the forearm of the minor upper extremity. 38 C.F.R. §§ 4.71a, Diagnostic Codes 5205, 5209, 5210, and 5213. A 10 percent rating under either Diagnostic Code 5211 or 5212 would require a finding of malunion of the ulna or radius with bad alignment. Since there is currently no medical evidence of record indicating malunion of the ulna or radius during the period of June 1, 1988 to May 24, 1995, the Board finds that the veteran is also not entitled to a compensable rating under these Diagnostic Codes. The Board has also considered 38 C.F.R. § 4.40, which provides, in essence, that functional loss may be due to pain which is supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion (See Hatlestad v. Derwinski, 1 Vet. App. 164 (1991)), and 38 C.F.R. § 4.45, which directs that the "factors of disability" affecting the joints include pain on movement and weakened movement. However, while the Board has noted lay evidentiary assertions as to the presence of pain during the period of June 1, 1988 to May 24, 1995, the Board finds that these subjective complaints are not supported by objective evidence adequate to support a compensable evaluation. The clinical findings demonstrated that squeezing the elbow produced pain, but the findings as to actual functional capacity disclosed a full range of motion and a lack of tenderness. There is nothing in the rating criteria, either under the Diagnostic Codes or the provisions relating to functional loss due to pain, to indicate that the response of the elbow to squeezing is part of the normal working movements of the body and thus a ratable functional capacity of that joint as it affects ordinary employment. Accordingly, there are no objective findings to support the subjective complaints as to functional impairment of the quality or extent that would more nearly approximate the criteria for a 10 percent evaluation under Diagnostic Codes 5206 or 5207 for limitation of flexion or extension. 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5206 and 5207. As the weight of the evidence is plainly against the award of a compensable rating for this period, there is no basis for such an award under the doctrine of reasonable doubt. 38 C.F.R. § 5107. The Board would like to point out that while service medical records clearly evidence findings of arthritis associated with the bone spur or spurs demonstrated in service, it is also clear that the veteran underwent the successful excision of these spurs in service in 1984. Moreover, the Board finds that X-rays following the surgery in September 1984 were negative for any abnormality, and this was again the case postoperatively, in September 1988. Thus, arthritis confirmed by X-ray was not present during the period from separation from service to May 25, 1995. Consequently, there was no basis in the record for a minimum 10 percent rating for traumatic arthritis under Diagnostic Code 5010 for this period. Moreover, as was noted previously, the evidence during this period does indicate a lack of objective evidence of tenderness and significant limitation of function due to pain, which would further negate application or consideration of a minimum rating under Diagnostic Code 5010 for traumatic arthritis for the period of June 1, 1988 to May 24, 1995. II. Entitlement to a Compensable Evaluation for a Right Elbow Disability from May 25, 1995 Background Although right elbow X-ray findings following the veteran's right elbow surgery to May 24, 1995, revealed negative findings, X-ray findings subsequent to May 24, 1995 begin to demonstrate findings of new spurring in the right elbow. May 25, 1995 VA X-rays of the right elbow were interpreted to reveal mild irregularity and residual spur at the olecranon process. The impression was minimal spurring of the right olecranon process. During a May 27, 1995, VA examination, performed in conjunction with the May 1994 remand, the veteran related that he injured his right elbow in December 1980. After experiencing persistent pain in the elbow for approximately nine months, the veteran sought medical treatment. A bone spur of the right elbow was diagnosed. The veteran reported that his elbow locked with range of motion, which was believed to have been caused by "a loose body." Surgery was performed to remove a presumed loose body, and a bone spur. The veteran related that the surgery was successful, and indicated that he no longer experienced episodes of locking. He stated that he occasionally experienced tenderness, but only when he hit or bumped the elbow in an abnormal way. Physical examination revealed significantly prominent proximal ulna bilaterally and his olecranon was fairly sizable bilaterally. He had full range of motion and full extension, to 130 degrees of flexion. Pronation was to 90 degrees, and supination was to 90 degrees. The ulnar nerve was slightly tender to touch. X-rays of the right elbow showed mild irregularity, and residual spur at the olecranon process. No other bone or joint abnormalities were noted. The diagnostic impression was moderate spurring at the insertion of the tendons about the elbow. The examiner noted that this was causing "minimal disability." Based on this evidence, a January 1996 rating decision continued the noncompensable evaluation of the veteran's service-connected right elbow disorder. In October 1996, the Board again remanded the veteran's case to the RO for additional development. During a January 1997 VA examination, the veteran related that he sustained substantial trauma to his right elbow in December 1980. Initially he was treated conservatively, but in 1983 he underwent an operation for removal of bone chips in the right elbow. The veteran reported that he had experienced intermittent pain in his right elbow since that time. This pain was reportedly precipitated by increased movement, increased weight lifting, or trauma to the ulnar region itself. Treatments with aspirin were ineffective. The veteran described his right elbow pain as "a deep ache." If he had mild trauma, particularly to the tip of the ulnar region, he experienced marked pain that limited his future use of the elbow for several hours. He reported that if he were very active, such as painting his house, he would experience generalized, dull pain and stiffness in the elbow for days to weeks. He denied any other current underlying morning stiffness that lasted more than five minutes. In addition, he denied any current joint swelling. Physical examination revealed a full range of motion of the right elbow with full pronation and supination on passive motion, in addition to full flexion and extension. There was no evidence of synovitis. There was a protruding tip of the right ulna, which had diffuse tenderness on palpation over the bone area itself. There was no significant tenderness at muscle insertion sites, and no evidence of synovial perforation or fluid within the joint space itself. X-rays of the right elbow showed a tiny spur projecting from the tip of the olecranon process, which had not changed since May 1995, and no other abnormality was identified. The final assessment was post-traumatic right elbow pain. The record notes that the veteran historically reported that his right elbow was substantially painful with increased activity, and with mild trauma to the area. While he reported a prior operative procedure to the region, the records were not available. The examiner noted that the joint itself had no current evidence of inflammatory process, and passive range of motion showed completely normal function in the elbow. Based on this evidence, a June 1997 rating decision continued the noncompensable evaluation of the veteran's service- connected right elbow disorder, and a noncompensable evaluation was upheld by the Board in January 1998. Thereafter, pursuant to the previously noted Joint Motion of July 1998, the Board remanded this matter in December 1998 for further development, which included a new VA medical examination. A VA medical examination in April 1999 revealed that the veteran reported a history of slipping on ice while walking to his car during service and hitting his right elbow on a retaining wall. There was subsequent pain over a period of nine months, after which X-rays revealed a small bone fragment on his olecranon. Problems continued through 1984, at which time he underwent surgical removal of the bone fragment from the olecranon. Thereafter, while there was no longer catching and locking as there was before, there was sensitivity in the area, and bumping of the elbow would cause considerable discomfort. He was a postal employee, and he noted that resting the elbow on a hard surface would also cause discomfort and activities that have bothered him in the past included the painting of his house. Physical examination revealed full range of motion of the right shoulder, with forward flexion and abduction to 180 degrees. Examination of the veteran's right elbow revealed a well-healed incision over the olecranon with a little more prominence compared with the left. There was also some tenderness to palpation over the right olecranon and not the left. The range of motion of the elbow was indicated to be full with full extension compared to the left and flexion to 145 degrees bilaterally. Pronation and supination with his elbows at his side was full bilaterally with supination to 80 degrees and pronation to 80 degrees. X-rays taken from a week prior to this examination were compared to those taken in 1988, 1995, and 1997, and from 1995 to the present, the examiner indicated that there was a progressive increase in the size of an osteophyte off the tip of the olecranon that did not involve the joint. The examiner further indicated that compared to the films of 1988, there was just the very small beginnings of the osteophyte that was noted. However, the examiner stated that the osteophyte had progressed in size to approximately just shy of a centimeter compared to 1988 when it was very small. The examiner again noted that there were no degenerative changes noted in the elbow joint itself. The assessment was probable mild chronic olecranon bursitis that was aggravated with heavy activity of the veteran's right upper extremity or direct pressure or direct blow to the right elbow. The examiner also commented that the veteran did not complain of limited range of motion, and that the veteran did not have incoordination or an impairment of the ability to execute skilled maneuvers. It was further noted that the veteran had pain over his olecranon when he had pressure in that area. Analysis As was noted by the most recent VA examiner in April 1999, the veteran currently exhibited virtually no limitation of motion based on his examination of the right elbow. More specifically, a range of motion between 0 and 145 degrees is within the normal range found in 38 C.F.R. § 4.71, Plate I. Moreover, the 80 degrees of pronation is also considered to be full, and while the 80 degrees of supination is 5 degrees short of full based on Plate I, it was not reported as limited by the examiner, and is not compensable under the applicable rating criteria. For the same reasons as noted with respect to the period of June 1, 1988 to May 24, 1995, from May 25, 1995, the veteran is also not entitled to a compensable rating under 38 C.F.R. §§ 4.71a, Diagnostic Codes 5205, 5209, 5210, 5211, 5212 and 5213. However, the Board notes that while the medical evidence continues to lack current X-ray evidence of arthritis, the newly identified spurring on the olecranon of the right elbow has most recently been diagnosed as mild bursitis which is rated as degenerative arthritis under 38 C.F.R. § 4.71a, Diagnostic Code 5003. See 38 C.F.R. § 4.71a, Diagnostic Code 5019. In addition, the April 1999 examiner has indicated that from the time of the May 25, 1995 right elbow X-ray, there has been a progressive increase in the size of the osteophyte observed off the tip of the olecranon. It is also noted that although the veteran has not complained of or demonstrated significant limitation of motion, since May 25, 1995 there has consistently been reports of pain on use. Consequently, noting the provisions of Diagnostic Code 5003 which provide for a 10 percent rating for arthritis of a major joint without limited motion with satisfactory evidence of painful motion, and giving the veteran the benefit of the doubt, the Board finds that from May 25, 1995, there is sufficient X-ray findings to base a diagnosis of bursitis and pain on use for a 10 percent rating under Diagnostic Code 5003. 38 C.F.R. § 4.7. The Board further notes that a rating in excess of 10 percent from May 25, 1995 is not available or warranted under Diagnostic Codes 5003 and 5019 based on the evidence of record. Similarly, in view of the fact that pain is already the primary reason a 10 percent rating is justified under Diagnostic Code 5003, an even higher evaluation due to the same pain is not warranted. There is no objective evidence suggesting that the degree of functional impairment due to pain begins to exceed that contemplated by a 10 percent evaluation. ORDER A compensable evaluation for a right elbow disability for the period of June 1, 1988 to May 24, 1995, is denied. A 10 percent rating for a right elbow disability is granted, effective May 25, 1995, subject to the applicable provisions pertinent to the disbursement of monetary funds. Richard B. Frank Member, Board of Veterans' Appeals