RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200854 SEPARATION DATE: 20030102 

BOARD DATE: 20130213 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Reserve component First Lieutenant / O-1 (91A 
5P/General Ordnance Officer), medically separated for chronic bilateral knee, ankle and hip 
pain (rated as a single unfitting condition). While an enlisted soldier in an earlier period of 
service, the CI had a parachute accident in 1989. He incurred bilateral femur, tibial/fibula and 
feet fractures, with an open right tibia fracture. He had hardware placed in his ankles and 
tibia/fibula bilaterally, but never underwent a Medical Evaluation Board (MEB). He stayed in his 
original Military Occupational Specialty (MOS), served in Operation Desert Storm and separated 
in 1992. In order to subsequently qualify for a Reserve Officer Training Corps scholarship, the CI 
had his surgical hardware removed in about 1995. He eventually re-entered active duty as an 
officer in 2000. During training, he injured his knees and then had persistent pain. He was 
issued a permanent L3 profile for patellofemoral pain syndrome (PFPS) and was referred to a 
Military Medical Review Board shortly after 11 September 2001. He was retained. In early 
2002, due to continued problems with bilateral knee pain and to a lesser extent ankle and hip 
pain, and the CI’s continued inability to do his MOS, he was referred to a MEB. The MEB 
identified and forwarded bilateral chronic knee, ankle, and hip pain with a prior history of 
service-related multiple bony fractures with hardware placement and subsequent removal as 
being medically unacceptable. The Physical Evaluation Board (PEB) adjudicated chronic 
bilateral knee, ankle and hip pain (as a single unfitting condition), rated 10%, with cited 
application of the US Army Physical Disability Agency (USAPDA) pain policy and the Veteran’s 
Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically 
separated with a 10% disability rating. 

 

 

CI CONTENTION: “Increased pain due to Arthesitis (sic) from injuries. Increased mental pain / 
Depression from PTSD.” 

 

 

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, 
paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for 
continued military service and those conditions identified but not determined to be unfitting by 
the PEB when specifically requested by the CI. The ratings for unfitting conditions will be 
reviewed in all cases. The chronic bilateral knee, ankle and 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 condition posttraumatic stress disorder (PTSD) and any 
other conditions service-connected by the Department of Veterans Affairs at the time of 
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 20021101 

VA (8 Mos. Post-Separation) – All Effective Date 20030103 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic B/L Knee, 
Ankle & Hip Pain 

5099-5003 

10% 

Residuals Rt Tibia/Fibula Fracture 

5014-8523 

10% 

20030902 

Lt Patellofemoral Pain Syndrome 

5099-5014 

0% 

20030902 

Residuals Lt Hip Injury 

5099-5014 

0% 

20030902 

Residuals Rt Hip Injury 

5099-5014 

0% 

20030902 

Residuals Fracture Rt Ankle 

5099-5014 

0% 

20030902 

Residuals Fracture Lt Medial 
Malleolus 

5299-5271 

0% 

20030902 

Arthritis B/L hips, knees, & ankles 

5099-5010 

NSC* 

20030902 

.No Additional MEB/PEB Entries. 

PTSD 

9422 

10% 

20030902 

0% X 9*/ Not Service-Connected x 10* (*Includes Above) 

20030902 

Combined: 10% 

Combined: 20% 



 

 

ANALYSIS SUMMARY: The PEB combined chronic bilateral knee, hip, and ankle pain as the 
single unfitting and solely rated condition, coded analogously to 5003. Although this approach 
complies 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 unfitting in and of itself. 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 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. 

 

Chronic Bilateral Knee Pain Condition. The narrative summary (NARSUM) notes a parachuting 
accident in 1989 which resulted in bilateral femur, tibia/fibula, and foot fractures with clavicle, 
ribs, and spinal compression fractures. The CI sustained a fall in 2000 resulting in recurrence of 
his bilateral knee pain. The pain persisted despite conservative management and the CI was 
diagnosed with bilateral PFPS. The CI reported daily 6/10 pain in both knees reaching 10/10 at 
times. Magnetic resonance imaging (MRI) of his knees was negative. The NARSUM 
examination (6 months prior to separation) noted pain at the end of flexion and tenderness to 
palpation (TTP) along the lateral joint line. Stability and meniscal maneuvers were negative 
with 4/5 strength bilaterally to extension and flexion of the knees. At the VA Compensation 
and Pension (C&P) exam, 8 months after separation, the CI reported joint, back, and neck pain. 
The exam was silent regarding painful or limited motion. At a second C&P examination on the 
same day, a normal gait was noted. The 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 

(Measurements in 
Degrees) 

NARSUM ~ 6 Mo. Pre-Sep 

PT ~ 3 Mo. Pre-Sep 

Left 

Right 

Left 

Right 

Flexion (140 Normal) 

“FROM” 

“FROM” 

123 

103 

Extension (0 Normal) 

0 

0 

Comment 

+ painful motion, 
tenderness, antalgic gait 

 

 

§4.71a Rating 

10% 

10% 

0% 

0% 



 

The Board first considered if the knee pain conditions, having been de-coupled from the 
combined PEB adjudication, remained independently unfitting as established above. The STR 
documented multiple evaluations and treatment for bilateral knee pain. The CI had a 


permanent L3 profile for bilateral knee pain with restrictions including but not limited to no 
running, repetitive squatting/stooping/jumping; and no running or bicycling for his physical 
fitness testing. The commander’s statement referenced the CI’s multiple injuries and P3 lower 
extremity profile. All members agreed that right and left knee pain, as isolated conditions, 
would have rendered the CI incapable of continued service within his MOS and accordingly 
merit separate ratings. The Board then considered its rating recommendation for the unfitting 
bilateral knee pain condition at the time of separation. The evidence of record provided an 
accurate picture of the pathology and residual disability associated with the CI’s bilateral knee 
pain condition to rate within VASRD standards. The PEB’s record of proceedings reflected the 
application of the USAPDA pain policy for rating. There is sufficient evidence of painful motion 
(§4.59) and functional loss (§4.40) for each knee to justify individual 10% ratings IAW VASRD 
4.71a criteria. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
(reasonable doubt), the Board recommends a rating of 10% for the left knee condition and 10% 
for the right knee condition, coded 5099-5003. 

 

Ankle and Hip Pain Conditions. The NARSUM noted that the hip and ankle pain were less 
severe than the bilateral knee pain. The hip and ankle pain baseline was documented at 2-3/10 
reaching 10/10 with periodic exertion. The NARSUM was silent regarding hip and ankle 
examination findings. X-ray evaluations of the hips were “unremarkable” and the ankles 
revealed “no significant secondary degenerative changes.” At the C&P exam the CI reported 
joint, back and neck pain. X-ray evaluation documented normal bilateral hip, knee, and femur 
radiographs and an old healed fracture of the right ankle. At the C&P exam dated a normal gait 
was noted. As previously elaborated, the Board must first consider whether the bilateral hip 
and ankle conditions remain separately unfitting, having de-coupled them from a combined PEB 
adjudication. In analyzing the intrinsic impairment for appropriately coding and rating the hip 
and ankle conditions, the Board is left with a questionable basis for arguing that they were 
independently unfitting. Although the MEB forwarded the bilateral ankle and hip pain as 
medically unacceptable, the Board considered that while there were multiple evaluations and 
treatment for the bilateral knee pain, the STR was silent to repetitive complaints and treatment 
for hip and ankle pain. The NARSUM stated that the hip and ankle pain were to a lesser extent 
than the knee pain and solely addressed pathology and residual disability associated with the 
bilateral knee pain. The initial L3 temporary and permanent profiles were for bilateral knee 
pain. The hip and ankle pain conditions were added to the permanent profile upon initiation of 
the MEB. The Board also considered that the hip radiographs demonstrated no evidence of 
degenerative arthritis. After due deliberation, the Board agreed that evidence does not 
support a conclusion that the hips and ankles, as isolated conditions, would have rendered the 
CI incapable of continued service within his MOS and accordingly cannot recommend separate 
ratings for them. 

 

 

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 bilateral knee, hip and ankle pain was operant 
in this case and the condition was adjudicated independently of that policy by the Board. In the 
matter of the bilateral knee pain condition, the Board unanimously recommends that each joint 
be separately adjudicated as follows: an unfitting right knee pain condition coded 5099-50003 
and rated 10%, and an unfitting left knee pain condition, coded 5099-5003 and rated 10%, both 
IAW VASRD §4.71a. In the matter of the bilateral hip and ankle pain conditions, as combined in 
the PEB adjudication, the Board unanimously agrees that they could not be satisfactorily 
established as independently unfitting and therefore are not ratable for service disability. 
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 

5099-5003 

10% 

Left Knee Pain 

5099-5003 

10% 

Bilateral Hip Pain 

Not Unfitting 

Bilateral Ankle Pain 

Not Unfitting 

COMBINED (w/ BLF) 

20% 



 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120605, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxx, AR20130004606 (PD201200854) 

 

 

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 xxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)