RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-00995	
BRANCH OF SERVICE:  Army 	 BOARD DATE:  20150116
SEPARATION DATE:  20060111		 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-5 (Carpentry Masonry Specialist) medically separated for chronic right elbow pain due to epicondylitis.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The right elbow condition, characterized as “chronic right lateral epicondylitis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “chronic right elbow pain due to epicondylitis,” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated.

CI CONTENTION:  Her condition continues to worsen and negatively impact her daily activities.  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 the 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:  
   
Service IPEB – Dated 20080227	VA - (7 Mos. Pre-Separation)  - Based on statements in VARD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Elbow Pain Due To Epicondylitis (Tenosynovitis)	5024	10%	Right Lateral Epicondylitis	5024-5260	10%	20071106	
Other x 0  (Not in Scope)	Other x 0	
RATING:  10%	RATING:  10%	
Derived from VA Rating Decision (VARD) dated 20080206 (most proximate to date of separation [DOS]).   This CI has an initial VARD dated 20061019 awarding a rating of 10%.  VARD 20080206 continued the rating of 10%.  VARD 20130702 retained the 10% rating.

ANALYSIS SUMMARY:  

Right Elbow Pain.  The narrative summary noted the CI injured the elbow of her right non-dominant upper extremity (UE) in 2005 through repetitive strain injury and was diagnosed with right lateral epicondylitis.  An Orthopedic evaluation performed on 25 June 2007 noted full range-of-motion (ROM) of the right UE (RUE) with tenderness to palpation over the outer aspect of the elbow (lateral epicondyle).  Treatment with medication and physical therapy failed to resolve the right elbow pain.  Electromyography/nerve conduction studies of the RUE (performed to evaluate reported pain, numbness, and tingling that radiated to the hand), were normal.  The orthopedic specialist discussed the option of surgery but the CI declined.  At the MEB examination completed 4 October 2007, approximately 8 months prior to separation, the CI reported frequent intermittent pain aggravated by activity.  The MEB physical exam noted full right elbow ROM with pain on extension and tenderness to palpation (TTP) of the lateral epicondyle that radiated down the forearm.  Sensation and reflexes of the RUE were normal with decreased grip strength on the right, rated 4/5 compared with the left. 

At the VA Compensation and Pension (C&P) examination performed on 18 May 2006, 24 months prior to separation, the CI reported right elbow pain and that she could function with the pain without medication.  Elbow ROM was full, but was noted to be decreased by 5 degrees with repetition of ROM due to pain.  Motor and sensory examination was normal.  Elbow X-rays were within normal.  At the C&P examination performed on 6 November 2007, 7 months prior to separation, the CI reported right elbow pain, unchanged from the earlier C&P examination.  There was TTP of the outside of the elbow with full ROM with no change with repetition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right elbow condition 10%, coded 5024 (tenosynovitis).  The VA originally rated it 10%, coded 5299-5024 (analogous to tenosynovitis), and the VARD dated 6 February 2008 continued the 10% rating, with change of the code to 5024-5206 (limited forearm flexion with tenosynovitis).  The Board agreed that the evidence in record supported a 10% rating with multiple codes IAW VASRD 4.71a for painful elbow motion IAW VASRD 4.59 (painful motion).  The Board reviewed to see if a higher evaluation was achieved with any applicable VASRD code.  There was no evidence in record of compensable limited elbow ROM coding with 5206 (flexion); 5207 (extension); 5208 (flexion and extension); or 5213 (supination or pronation) and there was no evidence of any other ratable impairment of the elbow.  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 right elbow 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 right elbow condition and IAW VASRD §4.71a, 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXX, AR20150018855 (PD201400995)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA