RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY  
SEPARATION DATE:  20070519  

 
NAME:  XXXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1100443 
BOARD DATE:  20130131  
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  National  Guard  SGT/E-5  (88M20/Motor  Transport  Operator), 
medically  separated  for  right  knee  degenerative  arthritis,  radiographically  proven.    The 
condition began in 2002, when the CI ruptured his right patellar tendon in his civilian job.  He 
had continued pain and underwent arthroscopic retropatellar cartilage removal in 2003, with 
later prescription of a patellar knee brace.  Following increased symptoms including giving way, 
and  locking  of  his  right  knee  while  deployed  to  Kuwait,  and  magnetic  resonance  imaging 
suggesting  degeneration  of  the  posterior  horn  of  the  medial  and  lateral  menisci,  the  CI 
underwent arthroscopic partial meniscectomy for the anterior horn of a lateral meniscal tear in 
January  2006.    The  right  knee  condition  did  not  respond  adequately  to  operative  and 
rehabilitative  treatment  and  the  CI  was  unable  to  meet  the  physical  requirements  of  his 
Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was placed on 
temporary  L3  profile  and  referred  for  a  Medical  Evaluation  Board  (MEB).    Anxiety  disorder, 
hyperlipidemia,  and  tinnitus  conditions,  identified  in  the  rating  chart  below,  were  also 
identified  and  forwarded  by  the  MEB  as  meeting  standards.    The  Physical  Evaluation  Board 
(PEB)  adjudicated  the  right  knee  degenerative  arthritis  condition  as  unfitting,  rated  0%  with 
likely application of the US Army Physical Disability Agency (USAPDA) pain policy (or AR 635–40, 
B–29)  and  the  Veterans  Affairs  Schedule  for  Rating  Disabilities  (VASRD).    Initially  the  CI 
disagreed with the PEB findings and requested a formal hearing but withdrew his request for a 
formal appeal and accepted the PEB findings.  The CI was therefore medically separated with a 
0% disability rating.   
 
 
CI CONTENTION:  “PTSD and Torn right meniscus”   
 
 
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  right  knee  degenerative  arthritis 
condition (torn right meniscus) as requested for consideration meets the criteria prescribed in 
DoDI  6040.44  for  Board  purview;  and,  is  addressed  below.    The  other  requested  condition 
posttraumatic stress disorder (PTSD) is not within the Board’s purview.  However, the specific 
contention for PTSD which is a mental health diagnosis, infers a contention for the PEB’s not 
unfitting  diagnosis  of  anxiety  disorder.    Therefore,  anxiety  disorder  meets  the  criteria 
prescribed in DoDI 6040.44 for Board purview; and, is also addressed below.  The remaining 
conditions rated by the VA at separation 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 20070209 
Condition 

Code 

Rating 

Right  Knee  Degenerative 
Arthritis,  Radiographically 
Proven 

5003 

0% 

Anxiety Disorder 
Tinnitus 
Hyperlipidemia 

Not Unfitting 
Not Unfitting 
Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Leg 

Code 

Status 

Rating 

5262-5312 

10%* 

VA (~4 Mo. Post-Separation) – All Effective Date 20070520 
Condition 
Right 
Exertional 
Compartment  Syndrome,  Shin 
Splints  and  Knee  Pain  with 
Grinding, 
Post 
Fasciotomy 
Scar, Right Leg 
PTSD 
Tinnitus 
NO VA ENTRY 
Left 
Exertional 
Leg 
Compartment  Syndrome,  Shin 
Splints  and  Knee  Pain  with 
Grinding 
Not Service-Connected x 8 
Combined:  60%* 

10%* 
30%* 
10%* 

7804 
9411 
6260 

5262-5312 

10%* 

Exam 

STR 

STR 
STR/ 
20071001 
STR 

STR 

 

Combined:  0% 
*Combined 40% effective 19911123; R leg initially awarded 10% effective 19911123; PTSD, 9411 increased to 50% effective 
201101.    Combined  increased  to  90%  effective  20090325.    Not  Charted:    Right  and  Left  wrist  carpal  tunnel  syndrome 
retroactively added at 10% each, effective 20070520 from VARD 20091211 based on submission of service treatment records.   
 
 
ANALYSIS SUMMARY:   
 
Right  Knee  Condition.    The  goniometric  range-of-motion  evaluations  in  evidence  which  the 
Board  weighed  in  arriving  at  its  rating  recommendation,  with  documentation  of  additional 
ratable criteria, are summarized in the chart below.   
 

OT ~11 Mos. Pre-Sep  OT ~6 Mos. Pre-Sep  MEB ~6 Mos. Pre-Sep 

VA C&P ~3 yr. Post-Sep 

Left 

Right 

Left 

Right 

Left 

Right 

Left 

Right 

Knee ROM 

Flexion  
(140⁰ Normal) 
Extension  
(0⁰ Normal) 

Comment 

~ 135 

-5 

133, 

130, 
132⁰ 
-4, -5, -5⁰ 

140⁰ 

140⁰ 

0⁰ 

0⁰ 

Sx most days in R PF 
joint  with  knee 
in 
bent position 

Synvisc 

For 
non-tender, 
effusion 

#2; 
no 

- 

- 

 

“R  knee  ROM  is 
full” 

0-130⁰ 

0-123⁰ 

0⁰ 

0⁰ 

normal; 
Gait 
with 
+tender 
squat;  no  laxity; 
instability 
tests 
negative 
10% (PEB 0%) 

Pain-limited motion 

§4.71a Rating 

10% 

10% 

0% 

0% 

- 

10% 

10% 

* Note: Missing C&P Exams referenced in the original VARD as a result, data extracted from the VARD dated 20100610 on p. 
439 was used.  This VARD was closest to separation that presented RT Knee ROM.  “The veteran lost 3 degrees of active 
flexion after repetitive usage of the right knee.  Pain was the major factor causing loss of range of motion.”   

 
The narrative summary (NARUM) indicated that the CI had had bilateral anterior compartment 
syndrome  with  post-surgical  infections  and  hospitalization  in  1990,  leading  to  permanent 
scarring and discoloration and had a VA rating of 30% for his legs since 1990.  The CI had right 
knee  surgical  repair  of  a  ruptured  patella  tendon  in  2002,  retropatellar  cartilage  removal  in 
2003,  exacerbation  of  his  knee  condition  while  deployed,  and  surgery  in  January  2006  (17 
months  prior  to  separation)  to  repair  a  partial  meniscus  tear.    The  NARSUM  exam  is 
summarized  above  and  indicated  “there  is  tenderness  behind  the  medial  patella  edge  with 
squatting.”    The  functional  status  indicated  the  CI  would  have  difficulty  kneeling,  squatting, 
climbing into and out of the cab of his vehicle, etc.  Synvisc knee injections had not improved 

the degenerative arthritis condition.  The MEB exam completed approximately 9 months prior 
to separation, indicated “++ pain with squat.”  Multiple treatment notes indicated effusion and 
crepitus.   
There was no VA Compensation and Pension exams proximate to separation (CI failed to show) 
and the VA continued their 10% rating based on the treatment records.  Multiple VA exams and 
notes prior to separation indicated crepitus and episodic swelling.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB rate the CI’s right knee as 5003 at 0% indicating patellar crepitus and no mechanical loss of 
motion.  The MEB exam was considered to indicate pain on motion, and the treatment notes of 
crepitus  and  episodic  effusion  were  considered.    The  CI  had  multiple  surgeries  including 
meniscal repair and disability codes of 5099-5003 (arthritis), 5259 cartilage, semilunar, removal 
of,  symptomatic,  were  considered.    There  was  no  evidence  of  frequent  locking,  give  way  or 
instability.  As the primary symptoms were patellar and arthritic in nature, the Board favored 
coding  analogous  to  symptomatic  semilunar  cartilage  (5003-5259).    After  due  deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt) and 
§4.59  (Painful  motion),  the  Board  recommends  a  disability  rating  of  10%  for  the  right  knee 
condition.   
 
Contended PEB Conditions.  The contended condition adjudicated as not unfitting by the PEB 
was anxiety disorder (specific contention was PTSD which is a different mental health diagnosis, 
but infers a contention for mental health rating).  The Board’s first charge with respect to the 
anxiety  disorder  condition  is  an  assessment  of  the  appropriateness  of  the  PEB’s  fitness 
adjudication.    The  Board’s  threshold  for  countering  fitness  determinations  is higher  than  the 
VASRD  §4.3  (Resolution  of  reasonable  doubt)  standard  used  for  its  rating  recommendations, 
but remains adherent to the DoDI 6040.44 “fair and equitable” standard.   
 
The CI had a diagnosis of anxiety disorder on the MEB and appealed the MEB determination of 
meets  retention  standard  as  well  as  the  diagnosis  as  he  was  being  treated  for  PTSD.    The 
response to the appeal listed military-specific requirements for the diagnosis of PTSD that were 
not required to be used by civilian psychiatrists.  The PEB finding of not unfitting was based on 
the MEB diagnosis and meeting standards.   
 
There  are  numerous  treatment  notes  for  PTSD  prior  to  separation  and  the  DD  Form  2808 
(report  of  medical  examination)  recommended/indicated  an  S4  profile  from  the  military  (Air 
Force)  examiner  that  was  not  part  of  the  later  formal  DA  Form  3349  profile  which  was  S1.  
Following  return  from  deployment  with  frequent  convoy  duty,  the  CI  had  symptoms  of 
nightmares,  hyper-arousal,  poor  sleep,  avoidant  behavior,  numbing,  flashbacks,  suicidal 
ideations  and  marital  difficulties,  avoidant  behavior,  and  clinically  significant  functional 
impairment  that  impacted  his  ability  to  concentrate.    He  was  under  treatment  with  two 
medications and therapy.  The CI was not working within his MOS and was on medical hold for 
his  knee  condition.    The  commander’s  statement  from  the  Community  Based  Health  Care 
Organization  (CBHCO)  forward  indicated  good  performance  answering  phones,  maintaining 
personnel records, and other maintenance tasks.  There was a comprehensive psychiatric re-
assessment  as  part  of  a  “JBLM/MEDCOM  Tasker  to  address  MEB  inconsistencies”  which  the 
Board  considered  in  deliberations.    That  examiner  indicated  that  evidence  at  the  time  of 
separation would have indicated an S3 profile, not meeting retention standards, and a diagnosis 
of PTSD.   
 
Both  that  JBLM/MEDCOM  tasker  examiner  and  the  VA  examiner  highlighted  the  numerous 
psychiatric  assessments  and  Global  Assessments  of  Functioning  (GAF)  in  the  moderate  to 

serious symptom range (recorded GAFs were 45 to 51).  The examiner opined that the CI had 
“occasional decrease in work efficiency or there are intermittent periods of inability to perform 
occupational tasks due to signs and symptoms, but generally satisfactory functioning (routine 
behavior,  self-care,  and  conversation  normal).    Veteran  had  significantly  (sic)  difficulty  with 
concentration, focusing due to intrusive ideation, flashback.  The CI was also having difficulties 
with  sleep  and  irritability  which  impacted  both  his  occupational  functioning  as  well  as  his 
marital relationship.”   
 
The  VA  exam  4  months  after  separation  provided  a  diagnosis  of  PTSD.    The  mental  status 
examination  was  notable  for  mood  “anxious  and  somewhat  depressed”  mood.    The  CI  had 
suicidal  thoughts  in  the  past,  but  there  was  no  active  suicidal  ideation,  delusional  or 
hallucinatory symptoms, speech disturbance, or objective cognitive impairment.  He endorsed 
flashbacks;  occasional  feeling  of  depression;  occasionally  feels  hopeless,  helpless,  and 
worthless; withdrawn from friends, social phobia, and a 60-pound weight gain.  The GAF was 
50, which is in the serious range of impairment on that scale.  The Axis I diagnosis was “PTSD 
and Major Depressive Disorder,” each assigned a GAF of 50.  The examiner opined that the CI 
seemed to be under medicated.   
 
The Board directs attention to its fitness recommendation based on the above evidence.  The 
Board deliberated on the symptoms documented in the medical record and the commander’s 
statement of good performance in the CBHCO, as well as clear evidence that the CI’s referral 
into  the  disability  evaluation  system  and  the  CBHCO  was  due  to  the  CI’s  unfitting  knee 
condition rather than any inclusion of disability from any mental disorder or symptoms.   
 
The Board discussed the 1 June 2012 psychiatric re-assessment (JBLM/MEDCOM Tasker) and 
deliberated  if  any  changed  diagnosis  or  changed  MEB  assessment  of  meeting/not  meeting 
standards should have led to a finding of unfit, given the evidence of functional capacity at the 
time  of  separation.    The  CI’s  MOS  duties  of Motor  Transport  Operator  in  comparison to  the 
duties of the CI’s CBCHO assignment were considered.  The Board majority considered there 
was no formal profile for a mental disorder and no mention by the commander indicating any 
adverse  CBCHO  duty,  there  was  good  social  functioning  and  there  was  no  commander 
comment relating to mental disorder treatments or symptoms indicating impairment from any 
mental disorder.   
 
After  due  deliberation  in  consideration  of  the  preponderance  of  the  evidence,  the  Board 
majority concluded that there was insufficient cause to recommend a change in the PEB fitness 
determination  for  the  contended  anxiety  disorder  condition;  and,  therefore,  no  additional 
disability ratings can be recommended.   
 
 
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 the USAPDA pain policy or AR 635–40 for rating the right knee condition was likely 
operant  in  this  case  and  the  condition  was  adjudicated  independently  of  that  policy  by  the 
Board.    In  the  matter  of  the  right  knee  condition,  the  Board  unanimously  recommends  a 
disability rating of 10%, coded 5003-5259 IAW VASRD §4.71a.  In the matter of the contended 
anxiety disorder condition, the Board, by a vote of 2:1 recommends no change from the PEB 
determination as not  unfitting.   The single voter for dissent (who recommended an unfitting 
determination,  rated  9411-9413  with  application  of  §4.129  for  a  constructive  50%,  then  a 

permanent 30%) submitted the appended minority opinion.  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:   
 

VASRD CODE  RATING 
5003-5259 
COMBINED 

10% 
10% 

UNFITTING CONDITION 
Right Knee Degenerative Arthritis 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20110523, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

MINORITY OPINION:  The AO recommends that the Anxiety Disorder (contended as PTSD) be 
found additionally unfitting and rated IAW VASRD §4.129 and §4.130; as a constructive TDRL 
period at 50% and a permanent separation rating of 30%.   
 
The AO considered that the level of symptoms displayed throughout the treatment record and 
endorsed  by  the  psychiatric  re-assessment  (JBLM/MEDCOM  Tasker),  indicated  the  CI  did not 
meet retention standards and would not have been able to fulfill the duties of his MOS as a 
Motor  Transport  Operator.    The  CBCHO  commander’s  assessment  of  good  functioning  in  an 
office  setting  should  be  considered  as  good  functioning  in  a  protected  environment  and not 
representative of the CI’s ability to deploy or function in his MOS.  The AO strongly opines that 
had the CI’s profile been corrected to an S3 and MEB corrected to a “does not meet standards,” 
as supported by the psychiatric re-assessment (JBLM/MEDCOM Tasker), the PEB determination 
would  more  likely  than  not  be  an  unfit  determination.    The  anxiety  disorder  (analogous  to 
PTSD)  is  therefore  recommended  as  a  new  unfit  condition  for  rating  based  on  the 
preponderance of the evidence.   
 
There is overwhelming pre-separation evidence (mental health records and award of a CAB), as 
well as the psychiatric re-assessment determination, that the CI met the provisions of §4.129 
for a “mental disorder that develops in service as a result of a highly stressful event.”  There is 
insufficient evidence that the CI’s disability picture at the time of separation was higher than 
the  §4.130  criteria  for  a  50%  disability  level,  and  therefore  the  minimum  50%  rating  for  a 
retroactive six-month period on the Temporary Disability Retired List (TDRL) is recommended.   
 
Independent rating of the CI’s symptoms and disability picture at both separation and at the 
end of the retroactive TDRL period would be 30% for “Occupational and social impairment with 
occasional  decrease  in  work  efficiency  and  intermittent  periods  of  inability  to  perform 
occupational  tasks  (although  generally  functioning  satisfactorily,  with  routine  behavior,  self-
care, and conversation normal)” and coding as 9411-9413, therefore a permanent separation 
rating of 30% is recommended.   
 
The AO recommends that the CI’s prior determination be modified to reflect a six month period 
on TDRL (IAW §4.129), and then permanently retired with a combined disability rating of 40%:   
 

VASRD CODE  RATING 
5003-5259 
9411-9413 
COMBINED 

TDRL  PERMANENT 
10% 
50% 
60% 

UNFITTING CONDITION 
Right Knee Degenerative Arthritis 
Anxiety Disorder 

 

10% 
30% 
40% 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXX, AR20130003027 (PD201100443) 
 
 
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 10% 
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 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)