RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  NAVY 
SEPARATION DATE:  20080124 

 
NAME:    
CASE NUMBER:  PD1100212  
BOARD DATE:  20120214 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  mobilized  Reserve  BM1/E-5  (Boatswain’s  Mate),  medically 
separated for the overall effect of left cubital tunnel syndrome, left medial epicondylitis and left 
medial collateral ligament (MCL) sprain.  He did not respond adequately to treatment to fully 
perform  within  his  rating  or  meet  physical  fitness  standards.    He  was  referred  to  a  Medical 
Evaluation Board (MEB) and then placed on limited duty (LIMDU).  Left knee MCL sprain, medial 
epicondylitis, and lesion of ulnar nerve were forwarded to the Physical Evaluation Board (PEB) 
as  medically  unacceptable  IAW  SECNAVINST  1850.4E.    No  other  conditions  appeared  on  the 
MEB’s submission.  Other conditions included in the Disability Evaluation System (DES) file will 
be discussed below.  The PEB adjudicated the overall effect of the left cubital tunnel syndrome, 
left  medial  epicondylitis  and  left  MCL  sprain  conditions  as  unfitting,  rated  0%  utilizing 
SECNAVINST 1850.4E.  The CI elected transfer to the Reserve Retired List awaiting pay at age 60 
in-lieu of disability discharge with severance pay.    
 
 
CI CONTENTION:  The CI states: “Left elbow medial epicondylitis, Left upper extremity cubital 
tunnel syndrome, Left knee strain.”  He elaborates no specific contentions regarding rating or 
coding and mentions no additionally contended conditions. 
 
 
RATING COMPARISON: 
 

Service IPEB – Dated 20070727 

VA (18 Mo. After Separation) – All Effective 20080125 

Condition 

Left Knee MCL Strain 
Left Cubital Tunnel Syn. 
Left Medial Epicondylitis 

Code 

Rating 

Combined 

Effect 

0% 

↓No Additional MEB/PEB Entries↓ 

Condition 

Left Knee Strain 
Left Cubital Tunnel Syn. 
Left Medial Epicondylitis 
Lumbosacral Strain 

0% x 5 

Code 

5014-5260 
8599-8516 
5024-5206 
5010-5237 

Rating 
10% 
10% 
10% 
10% 

Exam 

20090711 
20090711 
20090711 
19990222 
20090711 

Combined:  0% 

Combined:  30% 

 
 
ANALYSIS SUMMARY:  The PEB combined left cubital tunnel syndrome, left medial epicondylitis 
and left MCL strain as a single unfitting condition, uncoded and rated 0%.  The PEB may have 
relied  on  SECNAVINST  1850.4E  for  not  applying  separately  compensable  VASRD  codes.  Not 
uncommonly,  this  approach  by  the  PEB  reflected  its  judgment  that  the  constellation  of 
conditions  was  unfitting,  but  that  individually  each  condition  alone  was  not  considered 
unfitting, hence the “combined effect.”  The Board’s initial charge in this case was therefore 
directed at determining if the PEB’s approach of combining conditions under a single rating was 
justified in lieu of separate ratings.  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.    Thus,  the  Board  must  maintain  the  prerogative  of 
separate 
its 
recommendations may not produce a lower combined rating than that of the PEB. 
 
 

in  this  circumstance,  with  the  caveat 

fitness  recommendations 

that 

Left Knee ROM 

Flexion 140⁰ normal 
Extension 0⁰ normal 

Comments 
§4.71a Rating 

130⁰ 
5⁰ 

Stable joint 

10%* 

Full 
0⁰ 

0% 

125⁰ 
0⁰ 

0% 

 
Left Knee  Condition.   The  CI’s  knee  pain  began  as  a  sports injury.    He was  diagnosed  with  a 
medial  collateral  ligament  (MCL)  sprain  by  clinical  examination  and  MRI,  and  referred  to 
physical therapy.  Six months later an orthopedic re-evaluation diagnosed a healed MCL sprain 
with residual pain and cleared the CI for demobilization.  There were two goniometric and one 
non-goniometric  range-of-motion  (ROM)  evaluations  in  evidence,  with  documentation  of 
additional ratable criteria, which the Board weighed in arriving at its rating recommendation. 
 

Ortho – 16 Mo. Pre Sep  MEB – 7 Mo. Pre Sep  VA C&P –18 Mo. Post Sep 

Stable joint 

Stable; painless motion 

* Conceding §4.59 (painful motion) or §4.40 (functional loss) as below. 

 
 
At  the  MEB  exam  there  was  history  of  persistent  pain  and  inability  to  run  or  do  lateral 
movements.  The examiner found a “full” ROM, no effusion, but point tenderness at the MCL 
femoral insertion.  The knee was stable to all stresses, with valgus stress producing pain.  Plain 
radiographs  of the  knee  were  normal,  and  a  repeat  MRI  showed no  evidence  of  a  meniscus 
tear,  or  abnormality  of  the  cruciate  or  collateral  ligaments.    Earlier  orthopedic  examinations 
revealed  minimal  deficits  in  ROM,  and  a  stable  joint  with  tender  plica.    A  sports  medicine 
examination one year before separation recorded full active range of motion.  No Department 
of  Veterans’  Affairs  (DVA)  Compensation  &  Pension  (C&P)  or  other  exams  were  conducted 
within 12 months of separation.  A C&P exam 18 months after separation revealed a painless 
active  and  passive  ROM  that  was  minimally  impaired  in  flexion,  and  unchanged  with 
repetitions.  The motor and sensory exams of the lower extremities were normal.  The Board 
first  considered  the  probative  value  of  the  evidence  presented.    The  MEB  exam,  although 
closest  to  separation,  did  not  provide  complete  goniometric  measurement  for  flexion.  
However,  taken  together  with  the  earlier  orthopedic  and  sports  medicine  examinations,  the 
MEB exam did provide an accurate picture of the pathology and residual disability associated 
with the CI’s knee pain condition that could be fairly rated by VASRD standards.  The VA C&P 
exam was most distant from separation and well outside the DoDI 6040.44 defined 12-month 
interval for special consideration to post-separation evidence.  The Board therefore assigned 
least  probative  value  to  this  exam.    The  PEB’s  record  of  proceedings  reflected  the  likely 
application  of  SECNAVINST  1850.4E  for  rating,  but  its  0%  determination  was  consistent  with 
§4.71a standards based on the MEB exam data.  The VA rating decision indicates that its 10% 
rating was “based on objective evidence of limited motion of a major joint,” but there is no 
VASRD  compliant  pathway  to  a  minimal  compensable  rating  given  the  absence  of  painful 
motion, DeLuca criteria, and radiographic evidence of degenerative arthritis as described in the 
C&P  exam.    The  Board;  however,  concluded  that  the  totality  of  evidence  from  the  service 
treatment  record,  provided  sufficient  evidence  that  the  CI’s  knee  became  painful  with  use 
leading to functional loss to support a minimal compensable rating with application of VASRD 
§4.59 (painful motion) or §4.40 (functional loss).  After due deliberation, considering all of the 
evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a separation 
rating of 10% for the left knee condition, coded 5099-5003. 
 
Left  Elbow  Medial  Epicondylitis  and  Cubital  Tunnel  (Ulnar  Neuropathy)  Conditions.    The  CI 
developed left elbow pain and left hand numbness insidiously, without trauma while deployed.  
The condition first appears in the service treatment record (STR) during a demobilization exam 
following  successful  completion  of  this  deployment.    He  was  treated  with  anti-inflammatory 
medication, active rest, and iontophoresis, but continued to have pain with the use of his left 
arm and a subjective sense of weakness of the left hand.  There is no LIMDU for this condition 
in evidence prior to completion of MEB procedures.  The MEB examiner noted that the CI was 

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point tender in the left medial epicondyle and he had medial epicondyle pain with wrist flexion 
and pronation against resistance.  He had a positive Tinel sign at the cubital tunnel.  The motor 
exam of the left upper extremity was normal to include the muscles of the hand innervated by 
the  ulnar  nerve.    The  sensory  exam  was  intact  to  two  point  discrimination  in  all  fingers.    A 
neurology consultation five months prior to the MEB also recorded a normal motor exam, but 
found diminished sensation along the median palmar surface and fourth and fifth digits of the 
left hand.  An extensive electrodiagnostic examination of the left upper extremity showed no 
evidence  of  an  ulnar  mononeuropathy  or  C8  motor  radiculopathy  (spinal  nerve  root 
innervations to the same area).  No formal ROM exam of the elbow is in evidence in the STR.  
However, medial epicondylitis is not a condition that would be expected to impair elbow range 
of  motion,  and  radiographs  of  the  left  elbow  showed  no  significant  abnormality.    A  VA  C&P 
exam  18  months  after  separation,  although  of  limited  probative  value  as  discussed  above, 
included the CI’s assessment that his left elbow pain was intermittent and did not impact him 
occupationally or in usual daily activities.  The exam revealed a full, painless active and passive 
ROM  of  the  elbow  that  was  unchanged  with  repetitions.    There  was  no  motor  exam  of  the 
upper extremities recorded.  The examiner noted a negative Tinel sign at the cubital tunnel, and 
decreased sensation in the long finger, the ring finger, and the small finger of the hand as well 
as the ulnar aspect of the forearm, but opined that this distribution was not consistent with 
cubital tunnel syndrome.   
 
As  previously  elaborated,  the  Board  must  first  consider  whether  left  medial  epicondylitis 
remains  separately  unfitting,  having  de-coupled  it  from  a  combined  PEB  adjudication.  In 
analyzing the intrinsic impairment for appropriately coding and rating this condition the Board 
is left with a questionable basis for arguing that medial epicondylitis was indeed independently 
unfitting.    The  medial  epicondylitis  condition  was  designated  by  the  MEB  as  not  meeting 
retention  standards,  although  that  fact  does  not  establish  whether  or  not  a  condition  is 
unfitting. The PEB arrives at that determination through a performance-based assessment.  The 
joint  disability  evaluation  tracking  system  (JDETS)  attachment  to  the  PEB’s  determination 
indicates that board members had doubts that this condition was independently unfitting, but 
that it could contribute to an “overall effect” of unfitting.   The Board’s threshold for countering 
DES fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for 
its  rating  recommendations,  but  remains  adherent  to  the  DoDI  6040.44  “fair  and  equitable” 
standard.  The Board considered that the CI successfully completed a deployment during which 
the  elbow  pain  condition  began;  that  the  condition  surfaced  as,  essentially,  an  incidental 
complaint during a demobilization exam; and that no LIMDU was issued for this condition prior 
to the MEB.  The Board could not find evidence in the commander’s statement or elsewhere in 
the  service  file  that  documented  any  interference  of  the  medial  epicondylitis  condition  with 
performance of duties.  All evidence considered, there is not reasonable doubt in the CI’s favor 
supporting addition of medial epicondylitis as an unfitting condition for separation rating. 
 
Regarding the cubital tunnel syndrome/ulnar neuropathy, 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. The sensory component in this case has no functional implications. 
The  motor  impairment  was  either  intermittent  or  relatively  minor  and  cannot  be  linked  to 
significant physical impairment. Since no evidence of functional impairment exists in this case, 
the Board cannot support a recommendation for additional rating based on peripheral nerve 
impairment.  After  due  deliberation,  the  Board  agreed  that  evidence  does  not  support  a 
conclusion that cubital tunnel syndrome, as an isolated condition, would have rendered the CI 
incapable of continued service within his Rating, and accordingly cannot recommend a separate 
service rating for it.  
 
Remaining Conditions.  One other condition, low high-density lipoprotein (HDL), was identified 
in the DES file.  This is not a ratable condition IAW DoD and VA regulations.  Several additional 
non-acute conditions or medical complaints were also documented.  These conditions were not 

   3                                                           PD1100212 
 

significantly clinically or occupationally active during the MEB period, carried no attached duty 
limitations,  nor  were  implicated  in  the  non-medical  assessment.    These  conditions  were 
reviewed by the action officer and considered by the Board.  It was determined that none could 
be argued as unfitting and subject to separation rating.   Additionally lumbosacral strain and 
several  other  non-acute  conditions  were  noted  in  the  VA  proximal  to  separation  were  not 
documented in the DES file.  The CI had a service connected ratings lumbosacral strain (10%), 
right  shoulder  condition  (0%),  and  right  ankle  condition  (0%),  all  effective  September  1998, 
eight years prior to his mobilization.  At the time of the MEB history and physical examination,  
9 July 2007, the CI checked no to question 12c on DD Form 2807 regarding recurrent back pain 
or any back pain.  On DD Form 2697, Report of Medical Assessment, the CI did not list back pain 
as a problem.  Similarly, ankle and shoulder problems are also not reported.  The Board does 
not have the authority under DoDI 6040.44 to render fitness or rating recommendations for any 
conditions not considered by the DES.  Even if their presence in the DES file is conceded, there 
was no evidence for concluding that any of them interfered with duty performance to a degree 
that  could  be  argued  as  unfitting.    The  Board  therefore  has  no  reasonable  basis  for 
recommending any additional unfitting conditions for separation rating. 
 
 
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.  As discussed above, PEB 
reliance  on  SECNAVINST  1850.4E  for  rating  a  combined  effect  of  multiple  conditions  was 
operant in this case and the conditions were adjudicated independently of that instruction by 
the Board.  In the matter of the combined effect of the left knee, left medial epicondylitis, and 
left  cubital  tunnel  syndrome  conditions,  the  Board  unanimously  recommends  that  each 
condition  be  separately  adjudicated  as  follows:  an  unfitting  left  knee  sprain  condition  coded 
5099-5003 and rated 10% IAW VASRD §4.71a; a not unfitting left medial epicondylitis condition; 
and,  a  not  unfitting  left  cubital  tunnel  syndrome/ulnar  neuropathy  condition.    The  Board 
unanimously agrees that there were no other conditions eligible for Board consideration which 
could be recommended as additionally unfitting for rating at separation. 
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation: 
 

UNFITTING CONDITION 

Residuals, Left Knee Sprain 
Left Medial Epicondylitis 
Cubital Tunnel Syndrome/Ulnar Neuropathy 

 
 

 
 
 
 
 
 
 
 
 
 
 

VASRD CODE 
5099-5003 

RATING 

10% 

Not Unfitting 
Not Unfitting 

COMBINED 

10% 

   4                                                           PD1100212 
 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20110331, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans Affairs Treatment Record 
 
 
 
 
 
 
 

             
           President 
           Physical Disability Board of Review 

 

 

   5                                                           PD1100212 
 

      
 

                           

           COMMANDER, NAVY PERSONNEL COMMAND 
            

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS 
 
 
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS           
 
Ref:   (a) DoDI 6040.44 
          (b) PDBR ltr dtd 17 Feb 12  
          (c) PDBR ltr dtd 26 Dec 12  
          (d) PDBR ltr dtd 8 Jan 13 ICO  
          (e) PDBR ltr dtd 14 Jan 13 ICO 
 
                                         
1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in 
references (b) through (e). 
 
2.  The official records of the following individuals are to be corrected to reflect the stated disposition: 
 
 
with entitlement to disability severance pay effective the date of discharge. 
 
 
percent) with entitlement to disability severance pay effective the date of discharge. 
 
 
percent) with entitlement to disability severance  pay effective the date of discharge.  

b.  former USMC:  Disability separation with a final disability rating of 20 percent (increased from 10 

c.  former USN:  Disability separation with a final disability rating of 20 percent (increased from 10 

a.  former USN:  Disability separation with a final disability rating of 10 percent (increased from 0 percent) 

 
d.  former USN:  Disability separation with a final disability rating of 20 percent (increased from 10 

 

percent) with entitlement to disability severance pay effective the date of discharge. 
 
3.  Please ensure all necessary actions are taken, included the recoupment of disability severance pay if warranted, to 
implement these decisions and that subject members are notified once those actions are completed. 
 
 
 
 
 
 
 

    
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

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