RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1100723 SEPARATION DATE: 20060620 

BOARD DATE: 20121101 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (11B/Infantry Rifleman), medically separated 
for a bilateral knee condition. He did not respond adequately to conservative treatment and 
was unable to perform within his Military Occupational Specialty (MOS), meet worldwide 
deployment standards or meet physical fitness standards. He was issued a permanent L3 
profile and underwent a Medical Evaluation Board (MEB). Plica syndrome was forwarded to 
the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. No other 
conditions appeared on the MEB’s submission. The PEB adjudicated the bilateral knee 
condition as a single unfitting condition, rated 10%, with application of the US Army Physical 
Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated 
with a 10% disability rating. 

 

 

CI CONTENTION: “As the rating from the VA (40%) substantially differs from the PEB rating 
(10%), this difference should be addressed and uniformed if at all possible.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings 
for unfitting conditions will be reviewed in all cases. The bilateral knee condition, as requested 
for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; and, are 
addressed below. The other requested conditions, although not specifically stated, bilateral 
carpal tunnel syndrome and right ear hearing loss (which was part of the 40% rating from the 
VA) are not within the Board’s purview. Any conditions or contention not requested in this 
application, or otherwise outside the Board’s defined scope of review, remain eligible for future 
consideration by the Army Board for Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20060508 

VA (10 Mos. Post-Separation) – All Effective Date 20060621 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic pain both knees 
secondary to Plica 
syndrome 

5099-5003 

10% 

R knee Patellar Tendonitis 

5024 

10% 

20070424 

L knee Patellar Tendonitis 

5024 

10% 

20070424 

.No Additional MEB/PEB Entries. 

L Carpal Tunnel Syndrome 

8515 

10% 

20070424 

R Carpal Tunnel Syndrome 

8515 

10% 

20070424 

0% X 1 / Not Service-Connected x 3 

20070424 

Combined: 10% 

Combined: 40% 



 

 

ANALYSIS SUMMARY: The Board acknowledges the CI’s contention that suggests ratings should 
have been conferred for other conditions documented at the time of separation. The Board 
wishes to clarify that it is subject to the same laws for disability entitlements as those under 


which the Disability Evaluation System (DES) operates. While the DES considers all of the 
member's medical conditions, compensation can only be offered for those medical conditions 
that cut short a member’s career, and then only to the degree of severity present at the time of 
final disposition. However the Department of Veterans’ Affairs (DVA), operating under a 
different set of laws (Title 38, United States Code), is empowered to compensate all service-
connected conditions and to periodically reevaluate said conditions for the purpose of adjusting 
the Veteran’s disability rating should the degree of impairment vary over time. 

 

Bilateral Knee Condition (Plica Syndrome). The CI’s bilateral knee pain began gradually without 
trauma and did not improve adequately with treatment which included non-steroidal 
medication, physical therapy, ultrasound treatments, a cortisone injection and limited duty. X-
rays and bone scan were normal and he was referred to orthopedics. After an exam and a 
review of the magnetic resonance imaging (MRI) results, the examiner diagnosed Plica 
syndrome and patellar tendonitis and offered surgery. Due to a low percentage rate of success 
with surgery, the CI declined. There were two goniometric range-of-motion (ROM) evaluations 
in evidence, with documentation of additional ratable criteria, which the Board weighed in 
arriving at its rating recommendation; as summarized in the chart below. 

 

DOS 20060620 

Knee ROM 

P.T. exam for MEB ~5 Mo. Pre-Sep 

VA C&P ~4 Mo. Post-Sep 

Left 

Right 

Left 

Right 

Flexion (140° Normal) 

125° 

120° 

110° 

120° 

Extension (0° Normal) 

5° 

0° 

0° 

0° 

Comment 

Gait limping, 
painful 
motion 

Gait limping, 
painful motion 

Normal gait; 
additional LOM 
with repetitive 
use at 90° 

Normal gait; NO 
additional LOM 
with repetitive 
use 

§4.71a Rating 

10% 

10% 

10% 

10% 



 

At the MEB exam, the CI reported bilateral knee pain, worse with running with an intensity of 3-
4 of 10 on a pain scale. The MEB physical exam documented a limping gait and normal 
neurologic findings. The MRI performed in October 2005 revealed possible bone bruise on the 
medial femoral condyle, small joint effusion and on the left a suggestion of a partial anterior 
cruciate ligament (ACL) tear and a joint effusion. The examiner diagnosed Plica syndrome and 
documented the CI was not working in his MOS, could not run or rucksack and could not 
perform his duties as an infantryman. At the VA Compensation and Pension (C&P) exam the CI 
reported progressively worsened knee pain with activity and that he took Aleve 3-4 times per 
day for relief. The C&P exam demonstrated painful motion, crepitation and grinding, no 
instability or giving way, normal gait, able to stand for an hour, able to walk ¼ of a mile, no 
Deluca observations on the right but noted on the left with further limitation motion to 90 
degrees due to pain. X-rays were negative. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB combined the separate knee conditions under a single rating, coded analogously to 5003. 
This coding approach is countenanced by AR 635-40; but, IAW DoDI 6040.44, the Board must 
apply separate codes and ratings in its recommendations if compensable ratings for each joint 
are achieved IAW VASRD §4.71a. When 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. All members agreed that no distinctions between the 
two joints could be made regarding functional limitations, and that it was reasonable to 
concede that either knee alone would have resulted in the same fitness consequences. The 
PEB’s analogous rating to 5003 (degenerative arthritis) for “chronic pain both knees secondary 


to Plica syndrome,” could justify a single rating for both joints absent painful motion. The VA 
achieved separate 10% ratings with application of VASRD §4.59 (painful motion). The MEB 
examiner did document painful motion; and, therefore agreed it could not consider the 5003 
code at 10% as a single rating. The Board concedes §4.59 to achieve the minimal compensable 
rating (10%) for each joint. After due deliberation and mindful of VASRD §4.3 (reasonable 
doubt), the Board consensus was that separate ratings were supported; and, the Board 
recommends a disability rating of 10% each for the left and right knees. The action officer 
recommended, and the Board concurred with, the code 5099-5024 (Tenosynovitis) for its 
clinical compatibility with patellofemoral syndrome (PFS). 

 

 

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. As discussed above, PEB reliance on the USAPDA pain policy for rating bilateral 
knee condition was operant in this case and the condition was adjudicated independently of 
that policy by the Board. In the matter of the bilateral knee condition, the Board unanimously 
recommends that each joint be separately adjudicated as follows: an unfitting left knee 
condition coded 5099-5024 and rated 10%, and an unfitting right knee condition coded 5099-
5024 and rated 10%; both IAW VASRD §4.71a. There were no other conditions within the 
Board’s scope of review for consideration. 

 

 

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 

VASRD CODE 

RATING 

Right knee pain secondary to Plica syndrome/tendonitis 

5099-5024 

10% 

Left knee pain secondary to Plica syndrome/tendonitis 

5099-5024 

10% 

COMBINED (w/ BLF) 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20110830, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxx, DAF 

 President 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxx, AR20130004947 (PD201100723) 

 

 

1. 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 to modify the individual’s disability rating to 20% 
without recharacterization of the individual’s separation. This decision is final. 

 

2. I direct that all the Department of the Army records of the individual concerned be 
corrected accordingly no later than 120 days from the date of this memorandum. 

 

3. I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 
shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)