RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX	CASE:  PD-2014-00241
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20070828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Vehicle and Vehicular Equipment Maintenance Journeyman) medically separated for benign hyper mobility joint syndrome (BHJS).  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFS) or satisfy physical fitness standards.  She was issued a permanent P4 profile and referred for a Medical Evaluation Board (MEB).  The “benign hyper mobility syndrome” condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “benign hyper mobility joint syndrome” as unfitting, rated 10%, citing application of Department of Defense Instruction (DoDI) 1332.39 and Veterans Affairs Schedule for Rating Disabilities (VASRD).  The PEB also identified and adjudicated one additional condition detailed in the chart below as Category III, not separately unfitting and not compensable or ratable.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI contends that the condition was not adjudicated properly by the PEB or VA.  Her complete submission is at Exhibit A.  

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  
IPEB – Dated 20070712	VA* - ~2 Mos. Post-Separation 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Benign Hyper Mobility Joint Syndrome	5099-5003	10%	Benign Hyper Mobility Joint Syndrome	5099-5024	Not Service Connected	20071119	
Obesity	Not Unfitting	No VA Placement	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 0	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20080402 (most proximate to date of separation (DOS)); VA awarded 10% for pension purposes.  

ANALYSIS SUMMARY:  The contended obesity diagnosis is a condition or circumstance that does not constitute a physical disability IAW DODI 1332.38, E5, in effect at the time.  The Board adjudged that it was correctly adjudicated as not compensable.  

Benign Hyper Mobility Joint Syndrome.  The narrative summary (NARSUM) and record noted a normal entrance exam in July 2001 aside from a childhood history of a broken right arm.  The CI developed bilateral wrist pain and hand tingling in 2004 with noted diffuse joint hypermobility.  She began having multiple other joint pains and popping of joints with normal activities.  Rheumatology confirmed a diagnosis of benign hypermobility syndrome and her joint pains were not adequately relieved with splints, physical and occupational therapy, and pain medications (nonsteroidal anti-inflammatory with narcotic as needed at night).  At the MEB exam the CI reported joint pain and frequent popping of all digits of both hands, shoulders, hips, knees and ankles.  Pain was increased with activity and/or weight bearing.  Her wrists, knees and hips caused her the most discomfort with pain at 5/10.  She had been doing physical therapy for her left hip pain for 4 months (injured in a fall in January 2007).  “Her mechanical job exacerbates in particular her wrist pain and laxity.”  The MEB physical documented normal appearing fingers and wrist joints; there was ligamentous laxity with the joints able to be hyperextended.  The hips had normal painless range-of-motion (ROM) and no instability.  Bilateral knees were non-tender and had normal, painless ROM with negative instability tests (McMurray's, Lachman and Drawer's tests).  Ankles appeared normal without instability.  The examiner’s diagnosis was benign hypermobility syndrome with multiple joint pains and ligament laxity.  X-rays of the left hip and left wrist were normal.  

At the VA Compensation and Pension (C&P) exam performed 2 months after separation, the CI reported a similar history and symptoms.  Gait was normal.  There was hyperextension of elbows, wrists, fingers, knees and ankles.  The right knee documented ligament laxity and instability.  The examiner diagnosed benign hypermobility syndrome and found no abnormalities which were not part of the syndrome.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10% analogous to 5003 (arthritis).  The VA found the condition not service-connected/not subject to compensation (for possible pension entitlement) but assigned a rating of 10% coded analogous to 5024 (tenosynovitis), which uses the same criteria as disability code 5003.  There was no evidence of joint arthritis or objective evidence of pain-limited motion for any specific joint for any stand-alone joint rating.  The CI had “evidence of involvement of 2 or more major joints or 2 or more minor joint groups” meeting the 10% rating criteria under code 5003.  There were no episodes of incapacitation to support any higher rating.  

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 benign hyper mobility joint syndrome 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 benign hyper mobility joint syndrome condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended obesity condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140104, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

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XXXXXXXXXXXX

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00241.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings