RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200443 SEPARATION DATE: 20061103 

BOARD DATE: 20130221 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an activated Reserve SGT/E-5 (11B10/Infantryman), on a temporary 
tour of active duty, medically separated for chronic bilateral knee and ankle pains with 
radiographic evidence of degenerative joint disease (DJD) in all joints. The CI first noted 
symptoms while deployed and was evacuated from theater for fever and polyarthralgias. The 
chronic bilateral knee and ankle pain conditions did not improve adequately with treatment to 
meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical 
fitness standards. He was issued a permanent P3/U3/L3/H3/S2 profile and referred for a 
Medical Evaluation Board (MEB). The MEB forwarded nine conditions to the Informal Physical 
Evaluation Board (IPEB) for adjudication. The IPEB adjudicated gouty and degenerative arthritis 
involving the ankles, knees and elbows with an acute flare following mobilization in August 
2005 as a single unfitting condition, and determined the condition existed prior to mobilization 
and followed a course of normal progression without permanent service aggravation. It was 
therefore unrated. The remaining six conditions were forwarded by the MEB as meeting 
retention standards, and were not addressed by the IPEB. The CI appealed to the Formal PEB 
(FPEB). The FPEB adjudicated the “chronic bilateral knee and ankle pain with radiographic 
evidence of degenerative joint disease (DJD) in all joints” as a single unfitting condition with 
application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) and rated it 10%. 
The FPEB determined the gouty arthritis condition was well controlled with medication at that 
time, and was no longer unfitting and therefore non-compensable. The FPEB also determined 
that the remaining conditions, forwarded by the MEB as medically acceptable, were not 
unfitting and not ratable. All conditions identified and forwarded by the MEB and addressed by 
the FPEB are identified in the rating chart below. The CI made no further appeals and was then 
medically separated with a 10% disability rating. 

 

 

CI CONTENTION: “I was severely injury / illness during the time of rating but an unfair rating 
was issue. I was on crutches and as of today I’m on crutches when its worse + on cane e/ day.” 
The CI also states “Also I was P3 on hearing but I was not rated. Also my PTSD (posttraumatic 
stress disorder) was not rated.” 

 

 

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 CI’s unfitting ankle and knee 
conditions, as well as his not unfitting gout, depression (PTSD contended) and hearing loss 
conditions, as requested for review, meet the criteria prescribed in DoDI 6040.44 for Board 
purview and are addressed below. 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 FPEB – Dated 20060907 

VA (4.5 Mos. Post-Separation) – All Effective Date 20061104 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bil Knee & Ankle Pain w/ 
X-Ray Evidence of DJD in 
All Joints 

5003 

10% 

Degenerative Arthritis Lt Knee 

5002-5260 

10% 

20070314 

Degenerative Arthritis Rt Knee… 

5002-5260 

10%* 

20070314 

DJD, Lt Ankle 

5002-5260 

10%** 

20070314 

DJD, Rt Ankle 

5002-5260 

10%** 

20070314 

Gouty Arthritis* 

Not Unfitting 

Gouty Arthritis, Lt Great Toe 

5002-5284 

10% 

20070314 

Gouty Arthritis, Rt Great Toe 

5002-5284 

10% 

20070314 

Headaches 

Not Unfitting 

NO VA ENTRY 

20070314 

LBP 

Not Unfitting 

Osteophytes, Thoracolumbar 
Spine 

5002-5242 

10% 

20070314 

Neck Pain 

Not Unfitting 

Osteophytes, Cervical Spine 

5002-5242 

10% 

20070314 

Depression 

Not Unfitting 

PTSD 

9411 

50% 

20070509 

ED 

Not Unfitting 

ED 

7522 

0% 

20070314 

Hearing Loss 

Not Unfitting 

B/L Hearing Loss 

6100 

NSC 

20070228 

.No Additional MEB/PEB Entries. 

Tinnitus 

6260 

0% 

20070228 

0% X 2 / Not Service-Connected x 3 (Includes Above) 

20070314 

Combined: 10% 

Combined: 80% 



*30% effective 20100802; 20% effective 20100802; Instability left and right knee, 10% each, added effective 20110512 

 

 

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. 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. The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or potential complications of conditions resulting in medical separation nor for conditions 
determined to be service-connected by the Department of Veterans Affairs (DVA) but not 
determined to be unfitting by the PEB. However the DVA, operating under a different set of 
laws (Title 38, United States Code), is empowered to compensate all service-connected 
conditions and to periodically re-evaluate said conditions for the purpose of adjusting the 
Veteran’s disability rating should the degree of impairment vary over time. The Board utilizes 
DVA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 
defines a 12-month interval for special consideration to post-separation evidence. The Board’s 
authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES fitness 
determinations and rating decisions for disability at the time of separation. Post-separation 
evidence, therefore, is probative only to the extent that it reasonably reflects the disability and 
fitness implications at the time of separation. The Board has neither the jurisdiction nor 
authority to scrutinize or render opinions in reference to the CI’s statements in the application 
regarding suspected DES improprieties in the processing of his case. The Board noted that the 
PEB combined the bilateral knee and ankle pain as a single unfitting condition coded 5003 and 
rated 10%. The PEB may have relied on AR 635.40 (B.24 f.) and, or the US Army Physical 
Disability Agency pain policy for not applying separately compensable VASRD codes. Not 
uncommonly this approach by the PEB reflects its judgment that the constellation of conditions 
was unfitting and that there was no need for separate fitness adjudications rather than a 
judgment that each condition was independently unfitting. The Board must consider if each 
“unbundled” condition was unfitting in and of itself. If the Board determines that a condition is 
separately unfitting, it must apply separate code(s) and rating(s) IAW VASRD §4.71a. The Board 
exercises the prerogative of separate fitness recommendations in this circumstance with the 
caveat that its recommendations may not produce a lower combined rating than that of the 


PEB. The Board first considered the knees and ankles to determine if they were separately 
unfitting and, if so, the appropriate rating. 

 

Chronic Bilateral Knee and Ankle Pains with Radiographic Evidence of Degenerative Joint 
Disease (DJD) in all Joints Condition. The CI injured his right ankle while in theater with 
subsequent swelling and pain. He then had swelling of the left ankle followed by both knees; 
this lead to his evacuation from theater. His symptoms continued to progress and he was for a 
period of time wheelchair bound. Multiple diagnoses were considered until a diagnosis was 
made of gout based on a positive joint aspirate of the left knee. He responded well to 
medications for the gout, but had persistent bilateral knee and ankle pain, left 2nd finger pain 
and left elbow pain. X-rays of the knees and ankles showed degenerative arthritis. 

 

Knees. There was one goniometric range-of-motion (ROM) evaluation for the knees in 
evidence, with documentation of additional ratable criteria, which the Board weighed in 
arriving at its rating recommendation as summarized in the chart below. 

 

Knee ROM 

MEB ~4 Mo. Pre-Sep 

VA C&P ~4.5 Mo. Post-Sep 

Left 

Right 

Left 

Right 

Flexion (140 Normal) 

Full 

Full 

130 

130 

Extension (0 Normal) 

0 

0 

Comment 

Sl pain with full 
flexion/extension 

 

 

§4.71a Rating 

10% 

10% 

10% 

10% 



 

Right knee. The CI first developed right knee pain on 22 July 2005 while deployed. He then had 
fever and swelling of the other knee and both ankles which lead to his evacuation from theater 
a month later. He was treated with oral steroids and mediations for gout, but had persistent 
pain. A rheumatology evaluation on 20 December 2005 noted that he walked with a non-
antalgic gait. Per the narrative summary (NARSUM) a magnetic resonance imaging (MRI) exam 
performed on 27 December 2005 showed a deficient anterior cruciate ligament (ACL) and 
damage to both the lateral and medial meniscus. It also noted old injuries to the medial and 
lateral collateral ligaments (MCL and LCL). At the MEB examination on 4 January 2006, the CI 
reported continued pain in both knees, but that the swelling had resolved. The MEB examiner 
did not annotate specific findings for the knees. The NARSUM was dictated on 30 June 2006, 4 
months prior to separation. It noted the above X-ray findings. On examination, ROM was 
noted to be full, but with pain at the extremes of movement. The knee was stable. The FPEB 
dated 7 September 2006 noted that the CI had a repair of the right ACL in April of 2006. At the 
VA Compensation and Pension (C&P) examination on 14 March 2007, 4 months after 
separation, the CI reported intermittent pain with walking and intermittent swelling. He used 
both a cane and crutches, but no brace. The CI did endorse intermittent locking and “giving 
out” of both knees. The examiner noted that the CI had undergone repair of both the ACL and 
medial meniscus. On examination, he had no effusion, but did have moderate tenderness over 
the joint lines. The ROM is noted above and was painful. There was no ligamentous laxity. X-
rays were consistent with the prior ACL repair and showed mild degenerative changes. DeLuca 
criteria were negative. The Board considered if the right knee was separately unfitting. It 
noted that both the NARSUM and VA examiners documented a stable knee after surgery, 
essentially normal ROM and no effusion was noted. The Board unanimously determined that 
the evidence did not support a separate unfitting determination for the right knee. The Board 
concluded therefore that this condition could not be recommended for a separate disability 
rating. 

 


Left knee. The Board then considered the left knee condition. The CI first developed left knee 
pain while in theater. He had fever and swelling of the other knee and ankles which lead to his 
evacuation from theater one month later. X-rays on 25 August 2005 showed bilateral 
degenerative changes. A joint aspirate was positive for gout crystals. He was treated with oral 
steroids and mediations for gout, but had persistent pain. On 20 December 2005 a 
rheumatology evaluation noted that he walked with a non-antalgic gait. On 4 January 2006 at 
the MEB examination, the CI reported continued pain in both knees, but that the swelling had 
resolved. The MEB examiner did not annotate specific findings for the knees. The NARSUM 
was dictated on 30 June 2006, 4 months prior to separation. It noted the above X-ray findings. 
On examination, ROM was noted to be full, but with pain at the extremes of movement. The 
knee was stable. An MRI on 5 August 2006 showed possible bone infarcts vice benign cartilage 
cysts as well as a tear of the lateral meniscus. The FPEB dated 7 September 2006 noted that 
the CI was scheduled to have a meniscectomy in October of 2006. At the C&P examination (4 
months after separation), on 14 March 2007, the CI reported intermittent pain with walking 
and intermittent swelling. He used both a cane and crutches, but no brace. The CI endorsed 
buckling and locking of his knee. The examiner noted that surgery had been recommended, but 
not performed. On examination, the CI had no effusion, but did have moderate tenderness 
over the lateral joint line. The ROM is above and was painful. There was no ligamentous laxity. 
X-rays showed mild degenerative changes. DeLuca criteria were negative. The Board 
considered if the left knee was separately unfitting. It noted that both the NARSUM and VA 
examiners documented a stable knee, essentially normal ROM and no effusion was noted. 
However, it was also noted that there was a tear of the lateral meniscus which had not been 
repaired. The Board majority determined that evidence did support a separate unfitting 
determination for the left knee. It then considered the coding option. It noted painful motion, 
non-compensable but limited motion, and radiographic changes were all present. The Board 
considered the different coding options, but determined that none provided a better 
description of the underlying disability or provided an advantage to the CI compared to 5003, 
degenerative arthritis. It specifically noted that the examination did not support the use of 
code 5258 for a dislocated meniscus. The majority recommended the condition be rated 10%. 

 

Ankles. The Board then turned its attention to the ankles. As noted already, the CI developed 
pain in both knees and ankles while deployed and was treated for gout with persistent pain. 
The CI was next seen for his ankles on 3 August 2005 when he complained of pain in the right 
ankle. He was noted to have an old medial avulsion fracture on X-ray. He was treated 
conservatively with persistent pain. X-rays on 25 August 2005 showed degenerative arthritis of 
both ankles and lateral soft tissue swelling of the right ankle. On 12 July 2006, an MRI of the 
right ankle showed thickening of the anterior talofibular ligament and calcaneofibular ligaments 
consistent with prior injury and tendinopathy of the Achilles tendon with degenerative changes 
of the tibiotalar and talonavicular joints. At the MEB examination on 4 January 2006, the CI 
reported continued pain in both ankles, but that the swelling had resolved. The MEB examiner 
did not annotate specific findings for the ankles other than a tattoo on the left. The NARSUM 
was dictated on 30 June 2006, 4 months prior to separation. It noted the above X-ray findings. 
On examination, ROM was noted to be reduced on the left, but the dorsiflexion values 
significantly exceed expected values and most likely represent an error. At the VA C&P 
examination, 4 months after separation, the CI reported bilateral ankle pain and intermittent 
swelling. On examination, he had no effusion, but did have circumferential tenderness over 
both ankles. The ROM was normal bilaterally in dorsiflexion and bilaterally reduced 10 degrees 
to 35 degrees in plantar flexion. There was no joint instability. All motion was painful. 
Strength and sensation were intact. The Board considered if either ankle was separately 
unfitting. It noted that the VA examiner documented stable ankles with essentially normal 
ROM and no effusion. Only the right ankle had been specifically profiled. Soft tissue swelling 


was noted on the right, but not the left ankle. There was no record in evidence that the CI was 
seen separately for the left ankle as he had been for the right. The VA examiner diagnosed 
right ankle DJD, but left ankle sprain. The Board majority determined that the evidence 
supports that the right ankle was separately unfitting and recommends a disability rating of 
10% coded 5271 for limitation of motion. The Board unanimously determined that the left 
ankle was not separately unfitting. The Board concluded therefore that this condition could not 
be recommended for a separate disability rating. 

 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
were gout, depression (diagnosed as PTSD by the VA) and hearing loss. The Board’s first charge 
with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness 
adjudications. 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 was diagnosed 
with gout after a positive joint aspirate. The rheumatology NARSUM dictated 11 months prior 
to separation noted that his condition was stable, but symptomatic. The general NARSUM 
dictated 5 months prior to separation noted that the knee and ankle pain were the primary 
problems. Neither the commander’s letter nor the profile specifically addresses gout. The 
FPEB noted that the gout was well controlled and was no longer unfitting. There were no 
clinical visits for the gout condition after the rheumatology NARSUM was dictated. The Board 
determined that there is not a preponderance of evidence to change the not unfitting 
adjudication by the FPEB. The CI also contends for PTSD. This condition was not diagnosed 
while on active status. He was treated for depression and noted to be responding to 
medications. His profile was upgraded from an S3 to an S2 during the DES period and he was 
determined to meet retention standards. The Board noted that the CI had an H3 profile. 
However, his entrance examination showed a significant hearing loss which was essentially 
unchanged on the C&P examination after separation. The evidence does not support the 
contention that the CI’s hearing deteriorated while on active duty. The initial commander’s 
statement dated 27 March 2006 indicated that “posttraumatic stress syndrome” and loss of 
hearing contributed to the CI’s duty impairment. The second commander’s letter, dated 5 May 
2006, written by the same officer, did not specifically note these limitations but did comment 
“...is currently assigned to assist with MWR activities, particularly the Schofield pool. He enjoys 
his interaction with the public and assisting in managing and maintaining the facility…” This 
statement does not support significant duty impairment from a mental health condition. 
Although depression and hearing conditions were profiled and implicated in the commander’s 
first statement, neither was judged to fail retention standards at any time during processing 
within the DES. All of the contended conditions were reviewed by the action officer and 
considered by the Board. There was no indication from the record that any of these conditions 
significantly interfered with satisfactory duty performance at the time of separation. After due 
deliberation in consideration of the preponderance of the evidence, the Board concluded that 
there was insufficient cause to recommend a change in the PEB fitness determination for any of 
the contended conditions 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. By a 2:1 vote, the Board 
recommends that the bilateral knees and ankles condition be unbundled for rating purposes. In 
the matter of the left knee condition, the Board majority recommends a separate disability 
rating of 10%, coded 5003 IAW VASRD §4.71a. In the matter of the right ankle condition, the 


Board majority recommends a separate disability rating of 10%, coded 5271 IAW VASRD §4.71a. 
In the matter of the right knee and left ankle conditions and IAW VASRD §4.71a, the Board 
unanimously determined that these are not separately unfitting and that no disability rating can 
be recommended. The minority voter, who recommended no recharacterization, did not elect 
to submit a minority opinion. In the matter of the contended gout, hearing loss and PTSD 
(depression) conditions, the Board unanimously recommends no change from the PEB 
determinations as not unfitting. 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 

Left Knee DJD 

5003 

10% 

Right Ankle DJD 

5271 

10% 

Right Knee DJD 

Not unfitting 

Left Ankle Strain 

Not unfitting 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120519, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


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 xxxxxxxxxxxxxxxx, AR20130005559 (PD201200443) 

 

 

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)