RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200450 SEPARATION DATE: 20080531 

BOARD DATE: 20130208 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SSG/E-6 (63D30 / Field Artillery Mechanic), medically 
separated for “bilateral knee and left hip pain from conditions that occurred before entering 
the Army (EPTS [Existed Prior to Service]) but are compensable under 10USC 1207A.” The CI 
had a left hip injury prior to age one and right distal femur surgery at age 15 and received a 
waiver for entry into the military. The CI was in service for eight years prior to the onset of left 
hip and bilateral knee pain. The CI was treated with anti-inflammatory medications, physical 
therapy and activity modification without relief of pain. The bilateral knee and left hip pain 
conditions could not be adequately rehabilitated. The CI 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 L3 profile and referred for a 
Medical Evaluation Board (MEB). The MEB forwarded “Chronic Left Hip Pain, Status Post 
traumatic deformity (injuries prior to duty)”; and “Chronic bilateral anterior knee pain 
secondary to traumatic leg deformity” conditions to the PEB as not meeting retention 
standards. The PEB combined both MEB conditions and adjudicated it as bilateral knee and left 
hip pain condition as unfitting, rated 10%, with cited application of the US Army Physical 
Disability Agency (USAPDA) pain policy. The MEB forwarded no other conditions for PEB 
adjudication. The CI made no appeals, and was medically separated with a 10% disability 
rating. 

 

 

CI CONTENTION: “I was only given a 10% rating from the Army for a medical condition the VA 
rated me 90%. I wish to have the Army discharge reviewed.” 

 

 

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 Service 
ratings for unfitting conditions will be reviewed in all cases. The unfitting bilateral knee and left 
hip pain conditions as requested for consideration meet the criteria prescribed in DoDI 6040.44 
for Board purview and are addressed below. The other requested conditions (those rated at or 
after separation by the Department of Veterans Affairs (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 the 
Correction of Military Records (ABCMR). 

 

 

 


RATING COMPARISON: 

 

Service IPEB – Dated 20080802 

VA (~6 Mos. Post-Separation) – All Effective Date 20080601 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Knee & Lt Hip 
Pain 

5099-5003 

10% 

Lt Knee . . . . . 

5260-5010 

10% 

20081215 

Rt Knee DJD 

5260-5010 

NSC 

20081215 

Lt Hip . . . . . 

5299-5252 

NSC 

20081215 

.No Additional MEB/PEB Entries. 

PTSD . . . . . 

9434-9411 

50% 

20081215 

TBI Residuals 

8045 

10%* 

20081215 

Cervical Strain 

5237 

20% 

20081215 

Lt Finger Joints Scars & DJD . . . . . 

7804 

20% 

20081215 

Lt Ankle Strain . . . . . 

5271-5010 

10% 

20081215 

Rt Ankle Strain . . . . . 

5271-5010 

10% 

20081215 

Lt Long Finger Scar . . . . . 

7804 

10% 

20081215 

Lt Index Finger Scar . . . . . 

7804 

10% 

20081215 

0% X 5 / Not Service-Connected x 6 (Includes above) 

20081215 

Combined: 10% 

Combined: 80%* 



*VARD 20090324 awarded deferred TBI issue @10% initially retroactive to 20080601, raised it to 70% effective 20081023, and 
also raised the combined rating to 90% effective 20081023. 

 

 

ANALYSIS SUMMARY: The MEB forwarded two medically unacceptable conditions to the PEB. 
The PEB combined chronic “left hip pain status post traumatic deformity(injuries prior to duty)” 
and “chronic bilateral anterior knee pain secondary to traumatic deformity (injuries prior to 
duty)” as a single unfitting and solely rated condition, coded analogously to 5099-5003, 
USAPDA Pain Policy. Although this approach complied with AR 635.40 (B.24 f.); the Board must 
apply separate codes and ratings in its recommendations, if compensable ratings for each 
condition are achieved IAW VASRD §4.71a. 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 reasonably unfitting. 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, not a judgment that each condition was independently 
unfitting. Thus the Board must exercise 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. 

 

Bilateral Knee Condition. The narrative summary (NARSUM) notes that the CI sustained a left 
hip acetabular crush fracture before the age of one in a motor vehicle accident. At age 15 he 
underwent a right distal femur (epiphysoidesis) for a leg length discrepancy. It was noted that 
he was pain free and without disability upon entry unto active duty. After eight years of active 
duty service, the CI began to experience left hip and bilateral anterior knee pain. He was 
treated with NSAIDs, activity modification, and physical therapy without relief. The CI had a left 
patellar dislocation in 1999. The goniometric range of motion (ROM) 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. 

 

Knee ROM 

(In degrees) 

PT ~5 Mo. Pre-Sep 

MEB ~4 m. Pre-Sep 

VA C&P ~6 Mo. Post-Sep 

Left 

Right 

Left 

Right 

Left 

Right 

Flexion (140 Normal) 

128, 127, 128 

128, 130, 128 

Referenced PT ROMs/exam 

130 

130 

Extension (0 Normal) 

0, 0,-2* 

-3, -4, -3* 

0 

0 

Comment: 

Pain free motion (see text) 

+Tenderness to palpation, 
pain free motion;+ mild 
crepitus 

Pain free motion; mildly 
antalgic and arthrogenic gait 
due to hip and knee pain 




§4.71a Rating 

0%-10% 

0%-10% 

10% 

10% 

10% (VA 10%) 

10% (VA NSC) 



*Cited PT ROMs: Stated negative numbers represented genu recurvatum (hyperextension) which would be 
positive extension numbers for VA ROMs 

 

At the MEB exam 4 months prior to separation, the CI reported bilateral dull, aching anterior 
knee pain. The pain was intermittently sharp. The MEB physical exam noted tenderness to 
palpation in the supra and peripatellar areas and tibial tuberosity of both knees with crepitus. 
Gait was noted as normal and tandem. Radiographs demonstrated mild medial compartment 
joint space narrowing bilaterally. At the VA Compensation and Pension (C&P) exam 6 months 
after separation, the CI reported daily bilateral knee pain rated a 5/10. He reported weekly 
flare-up to 7/10 treated with aspirin. He denied use of a brace or other assistive devices for 
ambulation. He reported chronic stiffness in both knees. He also reported that his right knee 
“sometimes gives way on him.” The exam noted a mildly antalgic and arthrogenic gait due to 
pain the left hip and both knees, but with pain free motion on ROM examination. 

 

The Board first considered if the left and right knee secondary to traumatic deformity (injuries 
prior to duty) conditions, having been de-coupled from the combined PEB adjudication, 
remained reasonably unfitting. The MEB forwarded the bilateral knee pain as medically 
unacceptable for retention. Each knee had radiographic pathology and most treatment notes 
were for bilateral knee pain on numerous and repeated occasions. Both knees were profiled. 
The Board consensus was that both the right knee and left knee conditions were reasonably 
unfitting. The Board directs attention to its rating recommendation based on the above 
evidence. The PEB combined both MEB conditions and adjudicated it as bilateral knee and left 
hip pain condition as unfitting, rated 10%, with cited application of the USAPDA pain policy. 
The VA rated the left knee, status post patellar dislocation and strain with degenerative joint 
disease (claimed as arthritis) at 10% coded 5260-5010. The VA did not service connect the right 
knee. All exams met the 10% criteria for each knee with consideration of VASRD §4.59 (to 
recognize actually painful, unstable, or malaligned joints as entitled to at least the minimum 
compensable rating for the joint) and §4.45 (the joints). 

 

After due deliberation, the Board majority agreed that the evidence with regard to the 
functional impairment of the right knee and the left knee reasonably favors recommendation as 
each knee being an unfitting condition for disability rating. Considering all of the evidence and 
mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating 
of 10% for each knee coded 5099-5260, both IAW VASRD §4.71a. 

 

Left Hip Condition. The narrative summary (NARSUM) notes that the CI sustained a left hip 
acetabular crush fracture before the age of one in a motor vehicle accident. From age 4-8 the 
CI wore bilateral leg braces typically used for Legg-Calve-Perthes disease (Coxa Plana). At age 
15 he underwent a right distal femur (epiphysoidesis) for a leg length discrepancy. It was noted 
that he was pain free and without disability upon entry unto active duty. After eight years of 
active duty service, the CI began to experience left hip and bilateral anterior knee pain. He was 
treated with NSAIDs, activity modification, and physical therapy without relief. 

 

 


The goniometric range of motion (ROM) 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. 

 

Left Hip (Thigh) ROM 

(in degrees) 

Ortho ~7 Mo. Pre-Sep 

(20071017) 

PT ~6 Mo. Pre-Sep 
(20071128) 

VA C&P ~6 Mo. Post-Sep 

(20081215) 

Flexion (0-125) 

100 

116, 114, 114 

115 (Bent Knee) 

Extension (0-20) 

 

12, 14, 12 

10 

External Rot. (0-45) 

30 

27, 26, 25 

30 

Abduction (0-45) 

45 

34, 33, 35 

40 

Adduction (0-45) 

20 

23, 22, 24 

20 

Comment: 

Pain throughout 
ROM; gait normal; 
tenderness 

Left hip painful 
motion 

Painful motion, hip 
flexion to 50° straight leg 
(hamstring tightness) 

§4.71a Rating 

10% 

10% 

10% (VA NSC) 



 

At the MEB exam 4 months prior to separation, the CI reported sharp, stabbing daily hip pain. 
The pain worsened with standing greater than 10 minutes, crouching, climbing, running greater 
than ¼ mile, walking greater than two miles and wearing or carrying weight greater than 20 
pounds. The pain was relieved by rest and NSAIDs. The MEB physical exam noted “no hip 
tenderness with full extension and external rotation”, and referenced the orthopedic and PT 
exams as summarized above. X-ray evaluation demonstrated left hip deformity with coxa 
plana. The femoral head and acetabulum are both flattened, varus, and the neck is shortened 
demonstrating post-traumatic deformity of the left hip. The NARSUM referenced general 
physical exam on the DD Form 2808 MEB physical dated 6 December 2007 indicated no hip 
tenderness to palpation, full extension, external rotation with no abduction and no internal 
rotation. At the VA Compensation and Pension (C&P) exam 6 months after separation, the CI 
reported daily but intermittent left hip pain reaching a 5/10. He report increased pain reaching 
a level of 7/10 and lasting all day, 2-3 times per month. Aspirin provides some benefit. The 
exam noted painful motion of the left hip. X-ray evaluation demonstrated abnormal 
configuration of the left hip without evidence of degenerative changes. 

 

The Board first considered if chronic left hip pain secondary to traumatic deformity (injuries 
prior to duty) condition, having been de-coupled from the combined PEB adjudication, 
remained reasonably unfitting. The MEB forwarded the chronic left hip pain secondary to 
traumatic deformity (injuries prior to duty) condition as medically unacceptable for retention. 
Although the CI had a history of left hip trauma prior to service, it was noted by the MEB that 
he was pain free upon entry into service and that the hip was permanently aggravated by 
service. The service treatment record shows a 6 years history of left hip pain complaints, 
treatment, and profile activity modification. The Board consensus was that the chronic left hip 
pain secondary to traumatic deformity (injuries prior to duty) conditions was reasonably 
unfitting. The Board directs attention to its rating recommendation based on the above 
evidence. The PEB combined both MEB conditions and adjudicated it as bilateral knee and left 
hip pain condition as unfitting, rated 10%, with cited application of the USAPDA pain policy. 
The VA did not service connect the left hip. The PT and orthopedic evaluations and the VA 
exams met the 10% criteria for the left hip with consideration of VASRD §4.59 (to recognize 
actually painful, unstable, or malaligned joints as entitled to at least the minimum compensable 
rating for the joint and §4.45 (the joints). 

 

After due deliberation, the Board majority agreed that the evidence with regard to the 
functional impairment of left hip reasonably favor its recommendation as a separately unfitting 
condition for disability rating. Considering all of the evidence and mindful of VASRD §4.3 


(reasonable doubt), the Board majority recommends a disability rating of 10% for the chronic 
left hip pain secondary to traumatic deformity (injuries prior to duty) condition, coded 5099-
5014. 

 

 

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 for rating chronic left hip and bilateral knee pain secondary 
to traumatic deformity (injuries prior to duty) conditions was operant in this case and the 
condition was adjudicated independently of that policy by the Board. In the matter of the 
chronic left hip and bilateral knee pain secondary to traumatic deformity (injuries prior to duty), 
the Board, by a vote of 2:1, recommends that it be rated for three separate unfitting conditions 
as follows: chronic left hip pain condition coded 5099-5014 and rated 10%; chronic right knee 
pain coded 5099-5260 and rated 10%; and chronic left knee pain coded 5099-5260 and rated 
10%; all IAW VASRD §4.71a. The single voter for dissent (who recommends no 
recharacterization) elected to submit the addended 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; and, that the discharge with severance pay be recharacterized to reflect permanent 
disability retirement, effective as of the date of his prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic left hip pain secondary to traumatic deformity (injuries 
prior to duty) 

5099-5014 

10% 

Chronic right knee pain secondary to traumatic deformity (injuries 
prior to duty) 

5099-5260 

10% 

Chronic Left knee pain 

5099-5260 

10% 

COMBINED (w/ BLF) 

30% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120423, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director 

 Physical Disability Board of Review 

 


 


 

SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130005494 (PD201200450) 

 

 

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 reject the Board’s recommendation and accept the Board’s minority opinion as accurate that 
the applicant’s final Physical Evaluation Board disability rating be modified. There is insufficient 
justification to support the Board’s recommendation in accordance with Army and Department 
of Defense regulations. 

 

2. This modification results in a combined rating of 20% and does not result in a 
recharacterization of your separation, any change to your separation document or the amount 
of severance pay. 

 

3. 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. 

 

4. 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 xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)