RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200822 SEPARATION DATE: 20040120 

BOARD DATE: 20130301 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a National Guard SSG/E-6 (12C30/Bridge Crewmember); medically 
separated for chronic pain, right knee, right shoulder and right elbow, and chronic back pain 
without neurologic abnormality. In 1997 while performing physical training on active duty, the 
CI sustained a twisting injury to the right knee. The CI was treated with activity restriction, non-
steroidal anti-inflammatory drugs (NSAIDS) and arthroscopic surgery in 2002. In January 2003, 
the CI was mobilized, evaluated by orthopedics, and treated with a different NSAID and physical 
therapy (PT). The CI suffered a traumatic injury to the right shoulder in July 1997 while on 
active duty. He had significant pain associated with his shoulder even after rehabilitation, and 
underwent distal clavicle resection of the right shoulder in 1998. Right elbow pain began in 
June 2003 with insidious onset. He was treated with rest and NSAIDs. The first record of low 
back pain (LBP) noted in the service treatment record (STR) occurred in October 1991 when the 
CI sustained a twisting injury to his back while playing basketball while on active duty. The CI 
was on active duty from 10 May 1990 to 9 July 1994, from 10 March 1995 to 9 March 1998, and 
21 January 2003 to 20 January 2004. Despite extensive PT, several different NSAIDs, and 
orthopedic evaluations for his conditions, the CI failed to meet the physical requirements of his 
Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a 
permanent P2 U2 L3 profile for right knee pain, chronic LBP, chronic right shoulder pain, and 
pseudofolliculitis barbae and he was referred for a Medical Evaluation Board (MEB). The MEB 
forwarded retropatellar pain syndrome right knee status post (s/p) arthroscopy, chronic LBP 
with L5-S1 degenerative joint disease (DJD) nonradiating, right shoulder acromioclavicular (AC) 
joint separation Type II s/p right shoulder AC joint resection in 1997, and right elbow pain 
olecranon bursitis associated with small olecranon spur to the Physical Evaluation Board (PEB) 
for adjudication. The MEB noted all of these conditions had existed prior to service (EPTS) and 
had not been permanently aggravated by service. The MEB forwarded no other conditions for 
adjudication. The PEB adjudicated the 1) chronic pain, right knee, right shoulder, and right 
elbow as unfitting rated 10% with application of the US Army Physical Disability Agency 
(USAPDA) pain policy and 2) chronic back pain without neurologic abnormality as unfitting with 
application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD) rated at 10%. Both 
conditions were considered to have EPTS and not permanently aggravated by service but were 
compensable IAW 10 USC 1207a. The CI submitted an undated rebuttal stating that his 
disabilities each resulted from separate incidences that occurred during previous periods of 
active duty. He requested the PEB provide separate evaluations of each condition as the VA 
had done. A December 2003 USAPDA response to this rebuttal stated the DA 199 had been 
administratively changed to reflect that the back condition was service related and items 3d, 
3e, and 3f had been changed to yes for the back condition. It also stated that item 8b, 
paragraph 3, and was changed to: "The disabilities rated IAW 5003 existed prior to service and 
are not permanently aggravated by service, but are compensable in accordance with 10 USC 
1207a." There is no clear evidence of any rating deduction related to service aggravation. The 
CI was medically separated with a 20% disability rating. 

 

 

CI CONTENTION: “Check medical and VA medical records“ 

 


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44 (4.a) is limited to those conditions that were determined by the PEB to be specifically 
unfitting for continued military service; and, when requested by the CI, those condition(s) 
“identified but not determined to be unfitting by the PEB.” The unfitting conditions chronic 
pain, right knee, right shoulder and right elbow and chronic back pain without neurologic 
abnormality 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 service Board 
for the Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20031113 

VA (3 Mos. Post-Separation) – All Effective Date 20040121 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Pain, Right Knee, 
Right Shoulder and Right 
Elbow 

5099-
5003 

10% 

Meniscal Disease Status Post 
Arthroscopic Repair, Right Knee, 

5260-
5020 

10%* 

20040419 

Acromioclavicular Arthritis Status Post 
Mumford Procedure, Right Shoulder 

5201-
5010 

10%** 

20040419 

Right Elbow Condition 

5019 

NSC*** 

20040419 

Chronic Back Pain without 
Neurologic Abnormality 

5299-
5237 

10% 

Lumbar Spondylosis 

5299-
5295 

10% 

20040419 

No Additional MEB/PEB Entries 

0%**** X 3 / Not Service-Connected x 7 

20040419 

Combined: 20% 

Combined: 30% 



*Increased to 20% effective 20050202 based on VA treatment records and C&P exam 20050709. 

**Increased to 20% effective 20060828 based on C&P 20061118. 

***Initially NSC based on no diagnosis of a chronic elbow condition, but the 20061204 VARD determined it was 
service connected and rated 5019 at 10% effective 20040121 based on the original C&P 20040419 and intervening 
VA treatment records 

****All three 0% ratings were effective 20040331 

 

 

ANALYSIS SUMMARY: The Board’s authority as defined in DoDI 6040.44, resides in evaluating 
the fairness of Disability Evaluation System fitness determinations and rating decisions for 
disability at the time of separation. The Board utilizes VA 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. Post-separation evidence is probative only to the 
extent that it reasonably reflects the disability and fitness implications at the time of 
separation. 

 

The PEB combined the chronic pain, right knee, right shoulder and right elbow conditions as a 
single unfitting condition, coded 5099 analogously to 5003 and rated 10%. This coding 
approach is countenanced by AR 635-40 (B.24f), but IAW DoDI 6040.44 the Board must apply 
only VASRD guidance to its recommendation. The Board must therefore apply separate codes 
and ratings in its recommendations if compensable ratings for each joint 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 justified as unfitting in and of it. 

 

The DA Form 3947 documented that the retropatellar pain syndrome right knee status post 
(s/p) arthroscopy, chronic LBP with L5-S1 DJD non-radiating, right shoulder AC joint separation 
Type II s/p right shoulder AC joint resection in 1997, and right elbow pain olecranon bursitis 
associated with small olecranon spur conditions were all EPTS and not permanently aggravated 
by service. However, the PEB determined that the back pain condition was service related. It 
also determined that while the chronic pain, right knee, right shoulder, and right elbow 
condition was EPTS and was not permanently aggravated by service, it was compensable in 
accordance with 10 USC 1207a. The Military Entrance Processing Station physical exam findings 


in January 1990 documented normal upper extremities (shoulders, elbows), normal lower 
extremities (knees) and normal spine. Back, right knee, right shoulder, and right elbow injuries 
were all determined to have occurred in the line of duty as documented on two separate DA 
Form 2173s, dated 22 and 23 December 2003. 

 

Chronic Right Knee Pain Condition. The Board first considered whether the chronic pain right 
knee condition, having been de-coupled from the combined PEB adjudication, remained 
independently unfitting as established above. The CI was issued a permanent profile related to 
the right knee pain in May 2003 and his commander’s statement from June 2003 noted that the 
CI was physically incapable of reasonably performing his duties required for his MOS due to his 
right knee pain and LBP. Service treatment records (STRs) document ongoing care for right 
knee pain and decreased motion from 1998 to 2003. All Board members agreed that chronic 
pain right knee, as an isolated condition, would have rendered the CI incapable of continued 
service within his MOS and it accordingly merits a separate rating. 

 

There were 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. 

 

Right Knee ROM 

(Degrees) 

Ortho ~9 Mo. 

Pre-Sep 

 

MEB NARSUM ~4 Mo. Pre-Sep 

VA C&P ~3 Mo. 
Post-Sep 

 

Flexion (140 Normal) 

- 

- 

120* 

Extension (0 Normal) 

- 

- 

0 

Comment 

Retro patellar 
Tenderness to 
palpation; + 
theater sign-pain 
with prolonged 
sitting; “pain with 
stairs” 

DD2808 noted right knee RPPS-chondromalacia 
with persistent pain 

 

No ROMs in STR except 0-130 degrees 20020701 
and 0-120 20020819 and both were before surgery; 
(exams from 20030514 and 20030618 not in STR) 

*With pain; Hinged 
knee brace; positive 
McMurray’s test; 
motor 5/5 bilateral, 
reflexes normal; no 
gait abnormalities 

§4.71a Rating 

10% 

10% 

10% 



 

Decreased ROM with flexion limited to 130 degrees and 120 degrees, along with tenderness 
along the medial patellar facet and medial joint line were noted prior to surgery. Magnetic 
resonance imaging performed in July 2002 revealed no significant abnormalities. The CI 
underwent a right knee arthroscopy, synovectomy, and chondroplasty in August 2002. No 
ROM measurements were made by the service after this surgery. A right knee X-ray was 
normal. Orthopedics evaluated the CI‘s knee approximately 9 months prior to separation and 
noted pain with going up and down stairs. The orthopedic physical exam findings are 
summarized in the chart above. The MEB narrative summary (NARSUM) examination 
approximately 4 months prior to separation noted ongoing complaints of right knee pain 
exacerbated by sitting, standing for prolonged periods, lifting, and climbing. The NARSUM 
physical exam findings are summarized in the chart above. The VA Compensation and Pension 
(C&P) examination 3 months after separation indicated that there was pain, weakness, 
stiffness, instability and fatigability, and an additional motion functional impairment of up to 
25% with flares weekly caused by stooping or crawling with running, bending walking on 
uneven surfaces. Bilateral knee x-rays were normal. The C&P physical exam findings are 
summarized in the chart above. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB combined the three conditions of right knee, right shoulder, and right elbow pain under 
5099-5003 at 10%, reflecting application of the USAPDA pain policy for rating. The VA 


evaluated meniscal disease s/p arthroscopic repair, right knee using VASRD 5260 leg, limitation 
of flexion of combined with 5020 synovitis and assigned a 10% rating based on pain-limited 
motion. Service exams and the STR document a history of painful motion although pain with 
motion is not specifically stated on the NARSUM exam. No exams noted any instability. 
Although it was completed 3 months after separation, the VA examination is more complete as 
it documents both ROM measurements and the presence of painful motion and it was 
therefore given greater probative value by the Board. The knee could not be reasonably rated 
higher than 10% using any exam proximate to separation or any alternate coding schema. After 
due deliberation, considering all of the evidence and mindful of VASRD §4.3 Resolution of 
reasonable doubt and VASRD §4.59 Painful motion, the Board concluded that the chronic right 
knee pain was reasonably justified as separately unfitting and recommends a disability rating of 
10% for the right knee pain condition. 

 

Chronic Right Shoulder Pain Condition. As previously stated, the Board must first consider 
whether the chronic pain right shoulder condition remains separately unfitting, having been de-
coupled it from the combined PEB adjudication. The CI was issued a permanent profile related 
to the right shoulder pain in June 2003 that prohibited wearing a backpack and lifting greater 
than 40 pounds. The addendum to the NARSUM prepared in August 2003 noted the CI was 
unable to perform push-ups, pull-ups, or lift greater than 30 pounds due to his right shoulder 
and right elbow pain. The commander’s statement does not specifically mention this condition 
but it was written prior to the date the permanent profile for the right shoulder was written. 
The STRs document ongoing but intermittent treatment for a Grade II AC joint separation with 
shoulder pain, decreased ROM, and weakness that began after an injury in July 1997 and 
continued after a distal AC joint resection surgery in 1998. A majority of the members agreed 
that the chronic right shoulder pain condition, as an isolated condition, would not have 
rendered the CI incapable of continued service within his MOS and, therefore, no separate 
service rating is warranted. 

 

Chronic Right Elbow Pain Condition. As previously stated, the Board must first consider 
whether the chronic pain right elbow condition remains separately unfitting, having been de-
coupled it from a combined PEB adjudication. In analyzing the intrinsic impairment for 
appropriately coding and rating the chronic right elbow pain, the Board is left with a 
questionable basis for arguing that it was indeed independently unfitting. The CI had an 
insidious onset of right elbow pain that was noted to be daily persistent pain. However, while 
some restrictions could be attributed to the right elbow, the condition is not mentioned on the 
permanent profile. The commander’s statement does not specifically mention this condition 
but it was written prior to the date of the NARSUM addendum describing the elbow condition. 
A right elbow X-ray was normal except for a very small spur formation at the insertion of the 
triceps tendon on the right side. The VA did not initially service-connect this condition due to a 
lack of evidence of a chronic condition. However, after VA treatment records documented 
ongoing pain, the condition was service-connected and rated at 10% (based on painful motion) 
effective the day after separation. All members agreed that the chronic right elbow pain 
condition, as an isolated condition, would not have rendered the CI incapable of continued 
service within his MOS and no separate rating is warranted. 

 

Chronic Back Pain without Neurologic Abnormality Condition. There were two goniometric 
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. 

 

 

 

 


Thoracolumbar ROM 

(Degrees) 

MEB Addendum ~ 2.5 Mo. Pre-Sep 

VA C&P ~ 3 Mo. Post-Sep 

Flexion (90 Normal) 

70° 

90° 

Extension (30) 

5° 

10°* 

R Lateral Flexion (30) 

10° 

30°* 

L Lateral Flexion (30) 

15° 

30° 

R Rotation (30) 

30 °(35) 

30° 

L Rotation (30) 

30° 

30° 

Combined (240) 

160° 

220° 

Comment 

Measurements other than rotation made with baseline 
bubble inclinometer placed at L1; Rotation measured 
with goniometer; Toe walking, tandem gait normal; pain 
with heel walking; strength 5/5, sensation intact to light 
touch and pinprick; proprioception, vibratory normal; 
patellar and ankle reflexes normal 

*With pain; Negative straight leg raise; 
no tenderness; slight pain increase 
with repetitive motion of spine; no gait 
abnormalities; motor 5/5 bilateral, 
reflexes normal 

§4.71a Rating 

10% 

10% 



 

The CI was issued a permanent profile for chronic LBP. The commander’s statement indicated 
that the CI was physically incapable of performing his duties due to his LBP. The NARSUM 
examination approximately 4 months prior to separation noted a history of non-radiating LBP 
and a history of an epidural steroid injection. It also noted a positive straight leg raise at 45 
degrees bilaterally. A lumbar spine X-ray done at this time was negative. A NARSUM 
addendum was completed approximately 2 months prior to separation physical exam findings 
are summarized in the chart above. The C&P examination completed 3 months after 
separation indicated that the CI had undergone a trigger point injection. However, pain 
persisted and he had intermittent pain worse in the morning with stiffness and weakness that 
would progressively improve throughout the day. The examiner further noted that the CI could 
only walk approximately one-fourth of a mile without pain and that he had pain while walking 
up and down stairs. An X-ray performed at the time of this exam revealed spondylotic spaces 
between L4-S1 with normal lordosis. The C&P physical exam findings are summarized in the 
chart above. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB coded the chronic back pain without neurologic abnormality coded analogous to 5237 
lumbosacral strain and rated 10%. The VA coded the lumbar spondylosis analogous to 5295 
lumbosacral strain: With characteristic pain on motion rated at 10%. The Board cannot explain 
why the VA chose to code under the old spine rules when the CI’s VA exam was in April 2004 
and the new Spine rules went into effect September 26, 2003. The PEB and the VA chose 
different coding options. The PEB coding uses “The General Rating Formula for Diseases and 
Injuries of the Spine.” These rating criteria consider the CI’s pain symptoms “With or without 
symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine 
affected by residuals of injury or disease.” The MEB exam proximate to separation meets the 
10% criteria based forward flexion of the thoracolumbar spine greater than 60 degrees but not 
greater than 85 degrees. The VA exam also supports a 10% rating, but this rating is based on 
painful motion, not limited flexion. After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 Resolution of reasonable doubt and VASRD §4.59 Painful motion, the 
Board concluded that there was insufficient cause to recommend a change in the PEB 
adjudication for the chronic back pain without neurologic abnormality condition. 

 

 

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 the chronic pain right knee, right shoulder, and 
right elbow conditions bundled together was operant in this case and the conditions were 
adjudicated independently of that policy by the Board. In the matter of the chronic right knee 
pain condition and IAW VASRD §4.71a, the Board unanimously agrees that it was separately 
unfitting and unanimously recommends a disability rating of 10%, coded 5003 IAW VASRD 
§4.71a. In the matter of the chronic right shoulder pain condition and IAW VASRD §4.71a, 
Board consensus determined that it was not separately unfitting and therefore, no separate 
disability rating can be recommended. In the matter of the chronic right elbow pain condition 
and IAW VASRD §4.71a, Board consensus determined that it was not separately unfitting and 
therefore, no separate disability rating can be recommended. In the matter of the chronic LBP 
without neurologic abnormality, the Board unanimously recommends no change in the PEB 
adjudication. 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 

Chronic Right Knee Pain 

5003 

10% 

Chronic Back Pain without Neurologic Abnormality 

5299-5237 

10% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120606, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

xxxxxxxxxxxxxxxxxxxx, DAF 

Acting Director 

Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxx, AR20130004599 (PD201200822) 

 

 

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 description 
without modification of the combined rating or 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 xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)