RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02467
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Chemical Operations Specialist, medically separated for “left [elbow] lateral epicondylitis” and “patellofemoral pain syndrome, right knee,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (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 or non-compensable.  Any conditions outside the panel’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 Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel 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 panel 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 PEB - 20090506	VARD – 20091215	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left [Elbow]Lateral Epicondylitis	5099-5003	10%	Left Lateral Epicondylitis	5207-5024	10%	20090810	
Patellofemoral Pain Syndrome, Right Knee	5099-5003	10%	Right Chondromalacia Patella and Popliteus Tenosynovitis	5257-5014	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Left [Elbow] Lateral Epicondylitis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominate CI’s left elbow condition began in January 2008 after putting on and taking off individual body armor multiple times per day during pre-deployment training.  On 3 April 2008 a left elbow X-ray showed mild degenerative spurring at the olecranon process (back of the elbow).  There was no surgical indication.

At the 29 October 2008 VA Compensation and Pension (C&P) evaluation, 8 months before separation, the CI reported left elbow pain that was severe in intensity, occurred 8 times per day and lasted 2 hours each episode.  She reported that she did not experience any functional impairment from the condition.  Physical examination showed range of motion (ROM) of flexion to 145 degrees (normal 145) and extension to 0 degrees (normal 0) with painful motion.  Forearm pronation was 80 degrees (normal 80) and supination was 85 degrees (normal 85) with painful motion.

The 13 April 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of daily left elbow pain that worsened with repetitive use or overhead work.   Physical examination showed elbow tenderness.  ROM was flexion to 132 degrees and extension was 0 degrees with painful motion.  Pronation and supination of the forearm were normal.

At the 10 August 2009 C&P evaluation, performed 1 month after separation, the CI reported she retained good ROM but left elbow tenderness.  Physical examination showed tenderness over the left lateral epicondyle (left-outer side of the elbow).  Repetitive ROM was flexion to 145 degrees and extension to 0 degrees with painful motion.  Forearm pronation and supination were full with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left elbow condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing painful motion.  The VA also rated the left elbow condition 10%, analogously coded 5207-5024 (forearm limitation of extension - tenosynovitis), based on the C&P examination 1 month after separation, citing painful motion.

The panel agreed there was no evidence of limitation of flexion or extension of the elbow to justify ratings under VASRD codes 5206, 5207 or 5208.  There was no history of fracture with nonunion or malunion to validate a rating under codes 5209, 5210, 5211 or 5212.  There was no limitation of pronation or supination of the forearm to rate using code 5213.  There was evidence of painful motion on several examination to justify a minimum, 10% rating IAW VASRD §4.59, painful motion.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left [elbow] lateral epicondylitis condition.

Patellofemoral Pain Syndrome, Right Knee.  According to the STR and the MEB NARSUM, the CI’s right knee pain condition began in September 2008 while walking without specific trauma or injury.  There was no surgical indication.

At the 29 October 2008 C&P evaluation, performed 8 months before separation, the CI reported weakness, swelling, heat, redness, lack of endurance and fatigability of the right knee.  She denied stiffness, giving way, locking and dislocations.  Physical examination showed no edema, effusion, weakness, redness, heat, guarding of movements or subluxation.  ROM was flexion to 140 degrees (normal 140) and extension was 0 degrees (normal 0) with painful motion.  Joint function was not additionally limited by weakness or incoordination after repetitive motion.

An MRI study on 31 October 2008 showed right knee mild chondromalacia of the patellofemoral joint (cartilage on back side of the knee cap was wearing away) and no other abnormalities.  X-Rays taken on 11 December 2008 showed a normal right knee.

At the 13 April 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of right knee pain that was aggravated with long walks, bending, twisting and weight bearing.  Physical examination showed ROM of flexion to 135 degrees and extension to 1 degree with no painful motion.

At the 10 August 2009 C&P evaluation, performed 1 month after separation, the CI reported right knee intermittent tenderness and pain that interfered with her daily activities of walking but not employment.  Physical examination showed mild tenderness over the medial aspect of the patella.  Repetitive ROM was flexion to 140 degrees and extension to 0 degrees without painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing painful motion.  The VA rated the right knee condition 10%, analogously coded 5257-5014 (other impairment of the knee-osteomalacia), based on the C&P examination 1 month after separation, citing painful motion.

Panel members agreed there was no limitation of flexion or extension that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, nonunion, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was evidence of painful motion in examinations proximate to separation to provide for a minimum 10% rating IAW VASRD §4.59, painful motion.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the patellofemoral pain syndrome, right knee condition.

BOARD FINDINGS:  In the matter of the left [elbow] lateral epicondylitis condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the patellofemoral pain syndrome, right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151016, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013240, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure