RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200887 SEPARATION DATE: 20060408 

BOARD DATE: 20130328 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a National Guard SGT/E-5 (63B20, Wheeled Vehicle Mechanic), 
medically separated for chronic low back pain (LBP), secondary to disc desiccation of L4/5 and 
L5/S1 without neurologic abnormality and chronic bilateral knee pain. The CI’s back pain was 
diagnosed by MRI as degenerative disc disease (DDD). The CI had surgery on the right knee in 
1999 for meniscal injury, followed by diagnostic arthroscopy of the left knee in 2001. He was 
diagnosed with osteoarthritis (OA) of both knees. The back and bilateral knee conditions could 
not be adequately rehabilitated 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 no other conditions for 
PEB adjudication. The PEB adjudicated the low back and bilateral knee conditions as unfitting, 
rated 0% and 0%, with application of the Army Physical Disability Agency (USAPDA) pain policy. 
The CI made no appeals, and was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “Because I was at retirement time, I has 15 years active duty time and 7 years 
national guard time. They wanted to pay a lump sum payment of 35,000.” 

 

 

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 Physical Evaluation 
Board (PEB).” The ratings for unfitting conditions will be reviewed in all cases. 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. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20060302 

*VA (9 Mos. Post-Separation) – All Effective Date 20060409 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic LBP 

5299-5242 

0% 

DDD Lumbosacral Spine 

5243 

40% 

20070122 

Chronic Bilateral Knee 
Pain 

5099-5003 

0% 

S/P Arthroscopic Repair of 
Medial Meniscal Tear Right 
Knee w/ Traumatic DJD 

5260-5010 

10% 

20070124 

Left Knee Injury 

5260 

NSC* 

20070122 

No Additional MEB/PEB Entries 

Other x 13 

20070122 

Combined: 0% 

Combined: 70% 



Derived from VA Rating Decision 20070308 (most proximate from the date of separation) 

*Rated 10% after the Line of Duty determination substantiated followed by evaluation of 2004-2006 VA treatment records 

 

 

ANALYSIS SUMMARY: The PEB bundled the left and right chronic knee pain conditions and 
rated as one unfitting condition coded as 5099-5003. The PEB may have relied on AR 635.40 
(B.24 f.) and/or the USAPDA pain policy for not applying separately compensable VASRD codes. 


The Board must apply separate codes and ratings in its recommendations if compensable 
ratings for each condition are achieved IAW Veterans Affairs Schedule for Rating Disabilities 
(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 
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. 

 

Low Back Condition. The MEB narrative summary (NARSUM) 7 February 2006, approximately 2 
months prior to separation, noted the CI had a history of back pain diagnosed by magnetic 
resonance imaging (MRI) 14 June 2002 as DDD without disc herniation or spinal canal stenosis. 
He had multiple episodes of back pain and was diagnosed with left sided sciatica while 
deployed. Lumbar MRI 22 September 2005 again showed only DDD of the lumbar spine. No 
surgery was recommended for his back. The electromyography (EMG) 5 January 2006 showed 
bilateral denervation of the lumbar paraspinal muscles indicative of “acute lumbar 
radiculopathy involving predominately L5/S1 posterior rami on the left and right side.” When 
physical therapy (PT) was not helpful, he was referred to pain management for treatment that 
included epidural steroid injections. At the MEB NARSUM exam the CI reported being limited 
by constant pain. He was using medications daily, as well as having a series of epidural steroid 
injections. The MEB physical exam noted “decreased active ROM” with lumbar flexion of 100 
degrees (normal 90 degrees with max VASRD reading 90 degrees); extension of 10 degrees 
(normal 30 degrees); right and left lateral flexion of 25 degrees (normal 30 degrees); right and 
left rotation 55 degrees (normal 30 degrees with max VASRD reading 30 degrees) totaling 210 
degrees which is less than the “greater than 240 degrees” cited by the IPEB. Painful motion 
was noted. A pain rating was given: “Minimal and constant.” A physical therapy (PT) note from 
the day of the MEB DD Form 2808 exam noted low back pain (LBP) with radiation of pain into 
the left lateral leg for a year and the CI reported that rehabilitation exercises, such as trunk 
rotations, increased his pain. Service treatment records (STR) near the date of separation 
indicated back pain radiating to the left leg with normal reflexes, sensation, and motor (except 
4/5 strength of left big toe dorsiflexion); with lumbar spine tenderness to palpation and painful 
lumbar motion. 

 

At the VA Compensation and Pension (C&P) exam 22 January 2007 approximately 9 months 
after separation, the CI reported chronic LBP rated as 6 to 7 out of 10; without significant 
radiation; aggravated by activity; with acute flare-ups weekly. He reported frequent bilateral 
lumbar muscle spasms and frequent use of a back brace. On exam there was decreased ROM 
with lumbar flexion of 20 degrees (normal 90 degrees); extension of 5 degrees (normal 30 
degrees); right and left lateral flexion of 15 degrees (normal 30 degrees). There were no 
DeLuca criteria. There was no motor or sensory impairment; muscle spasm; weakness or 
abnormal posture noted. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB rated chronic LBP as 5299-5242 (degenerative arthritis of the spine) at 0% citing no 
neurologic abnormality and ROM greater than 240 degrees; but actual total is 210 degrees. The 
VA rated as 5243 (intervertebral disc syndrome) at 40% for decreased thoracolumbar flexion 
less than 30 degrees. In the absence of incapacitating episodes as specified in the VASRD 
formula for rating intervertebral disc syndrome based on incapacitating episodes, codes 5242 
(degenerative arthritis of the spine) and 5243 (intervertebral disc syndrome) are both rated 
using the general rating formula for rating disease and injuries of the spine. There is no 
evidence of incapacitating episodes due to back pain in the record available. Thus rating with 
either code is equivalent, and the Board chose 5243 for DDD. The Board opined that near the 


date of separation, the evidence in the record of constant radiating back pain, increased by 
activity, lumbar flexion of 100 degrees (90 degrees max VASRD reading), and painful lumbar 
motion most nearly met the 10% rating under 5243. The Board deliberated as to whether the 
EMG findings of lumbar radiculopathy at the L5-S1 (sciatic) level, which were consistent with 
the CI’s reports of constant radiating back pain, indicated a separately ratable peripheral nerve 
disability. Board precedent is that a functional impairment tied to fitness is required to support 
a recommendation for addition of a peripheral nerve rating at separation. The pain component 
of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. The CI did 
not have abnormal reflexes or fixed motor or sensory deficits of either lower extremity. Since 
no evidence of functional impairment exists in this case, the Board cannot support a 
recommendation for additional rating based on peripheral nerve impairment. After due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the 
Board unanimously recommends a disability rating of 10% for the LBP condition coded as 5243. 

 

Bilateral Knee Condition. The narrative summary (NARSUM) 7 February 2006, approximately 2 
months prior to separation, notes the CI’s history of bilateral knee OA. The CI had arthroscopic 
surgery on knees, the right in 1999 and the left in 2001. The right knee had a torn meniscus, 
degenerative joint disease (DJD) and patellofemoral arthritis; the left had moderate 
degenerative changes, chondromalacia patella, and multiple loose bodies. There is a letter in 
the record dated 17 September 2001 from an orthopedic surgeon stating that the CI had severe 
DJD of the left knee which, in his opinion, rendered the CI not fit for full military duty. In 2004 
the CI was deployed without any limitations. During deployment the CI was seen five times for 
issues with his knees; four for the right knee and once for bilateral knee swelling. It was 
recommended to the CI to consider total knee replacement of the right knee. A temporary L3 
profile was issued while he was deployed for DDD and bilateral knee OA. The CIs knee X-rays 
taken on 20 September 2005, after his return from deployment, showed mild to moderate OA 
of both knees. The CI was treated for bilateral knee pain including injections without 
improvement. Right knee MRI 11 November 2005 showed a meniscal tear, degenerative 
arthritis and a moderate effusion. According to the NARSUM, these findings were the 
postoperative changes from the prior arthroscopy and confirmed the diagnosis as DJD of the 
knees. There was no joint instability of either knee noted and ROM was physically limited by 
pain described as constant. The MEB NARSUM physical exam noted only “lower extremities: 
crepitus on ROM.” Goniometric ROM performed by PT was knee flexion 130 degrees (normal 
140 degrees) and extension of 0 degrees (normal 0 degrees) bilaterally. Orthopedic notes near 
the time of the MEB exam (20 September – 28 December 2005) indicated bilateral knee pain 
that was aggravated by deployment. The CI reported anterior knee pain behind the patella that 
was aggravated by activities. The exams noted no instability or mechanical symptoms; full 
ROM; and mild right muscle atrophy; they did not clearly stated right or left knee symptoms or 
findings, but did indicate bilateral knee symptoms, OA, and treatment with knee injections. At 
the VA Compensation and Pension (C&P) exam 24 January 2007, approximately 9 months after 
separation, the CI reported using a right knee brace as needed. He reported chronic right knee 
pain rated 7 out of 10 aggravated by activity; with occasional flare-ups; without incapacitating 
episodes. He reported occasional buckling and locking of the right knee; mild weakness; and 
occasional difficulty with standing and ambulation. Regarding the left knee the CI reported 
occasional, mild left knee pain and swelling, but no weakness or instability. On exam there was 
a mild limp. ROM was left knee flexion 110 degrees(normal 140 degrees) and extension of 0 
degrees (normal 0 degrees) and right knee flexion 95 degrees and extension of 0 degrees; pain 
was increased with motion. There were no effusions or instability noted. There were no 
DeLuca criteria. Knee X-rays showed bilateral knee OA and patellofemoral arthritis. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB bundled the bilateral knee condition and rated as a single unfitting condition at 0%. The VA 
rated the right knee as 5260-5010 (limited ROM with arthritis) at 10%; left knee as 5260 – not 
service-connected. X-rays showed changes consistent with OA of both knees, more prominent 


on the right than the left. The Board noted, however, that neither pain severity nor functional 
loss of a joint is discernible from X-ray findings. The profile limitations shielded the right knee 
and left knee. The commander’s statement noted that the restrictions due to DDD and OA of 
both knees impaired duty performance. After deliberation, the Board agreed, based on the 
evidence in the record, it could not conclude that either knee of itself was not unfitting. There 
is reasonable doubt in the CI’s favor that the §4.59 threshold for painful motion was met for 
each knee at the time of separation. After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 (reasonable doubt), and VASRD § 4.4 (functional loss) the Board majority 
recommends a disability rating of 10% for the right knee chronic pain condition and 10% for the 
left knee chronic pain condition coded as 5099-5003, combined with bilateral factor to 20%. 

 

 

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 was operant in this case and the conditions were 
adjudicated independently of that policy by the Board. In the matter of the chronic LBP 
condition, the Board unanimously recommends a disability rating of 10%, coded 5243 IAW 
VASRD §4.71a. In the matter of the bilateral knee pain condition, the Board by a 2:1 vote 
recommends an adjudication as follows: an unfitting right knee pain condition at 10 % and an 
unfitting left knee condition at 10%, combined with bilateral factor to 20%; both coded 5099-
5003 IAW VASRD §4.71a. The single voter for dissent (who recommended an unfitting right 
knee pain condition at 10% and an unfitting left knee condition at 0%, combined at 10%) did 
not elect to submit a 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 Low Back Pain 

5243 

10% 

Chronic Right Knee Pain 

5099-5003 

10% 

Chronic Left Knee Pain 

5099-5003 

10% 

COMBINED (w/ BLF) 

30% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120320, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxxx, AR20130009071 (PD201200887) 

 

 

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed 
recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) 
pertaining to the individual named in the subject line above to recharacterize the individual’s 
separation as a permanent disability retirement with the combined disability rating of 30% 
effective the date of the individual’s original medical separation for disability with Reserve 
retirement. 

 

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: 

 

 a. Providing a correction to the individual’s separation document showing that the 
individual was separated by reason of permanent disability retirement effective the date of the 
original medical separation for disability with Reserve retirement. 

 

 b. Providing orders showing that the individual was retired with permanent disability 
effective the date of the original medical separation for disability with Reserve retirement. 

 

 c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will 
account for payment of permanent retired pay at 30% effective the date of the original medical 
separation for disability with Reserve retirement. 

 

 d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and 
medical TRICARE retiree options. 

 

 

 

 

 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)