RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200969 SEPARATION DATE: 20030502 

BOARD DATE: 20130205 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (63W10/Wheel Vehicle Repairer), medically 
separated for chronic bilateral knee pain due to retropatellar pain syndrome (RPS). The CI 
returned to active duty in March 2002 after a break in service. When he came back on active 
duty, he returned to his Military Occupational Specialty (MOS) as a diesel mechanic, but began 
to experience knee pain in May 2002 due to the increase stress of unit physical training (PT) and 
running. He complained of bilateral knee pain and was on profile. The CI tried several courses 
of treatment, but could not be adequately rehabilitated to meet the physical requirements of 
his MOS or satisfy physical fitness standards. He was issued a permanent L3 profile and 
referred for a Medical Evaluation Board (MEB). The MEB forwarded bilateral knee pain due to 
RPS and hypertension for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated 
the chronic bilateral knee pain due to RPS condition as unfitting, rated 0%, with application of 
the US Army Physical Disability Agency (USAPDA) pain policy. The PEB determined the 
hypertension condition to be not unfitting. The CI made no appeals, and was medically 
separated with a 0% disability rating. 

 

 

CI CONTENTION: “Rating was too low. Disability affects his ability to work.” 

 

 

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. 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 20030218 

VA (~3 Mos. Pre-Separation) – All Effective Date 20030503 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Bilateral Knee 
Pain due to Retropatellar 
Pain Syndrome 

5099-5003 

0% 

Retropatellar Pain Syndrome, 
Right Knee 

5260 

0% 

20030213 

Retropatellar Pain Syndrome, 
Left Knee 

5260 

0% 

20030213 

Hypertension 

Not Unfitting 

Hypertension 

7101 

10% 

20030213 

.No Additional MEB/PEB Entries. 

Costochondritis 

5299-5297 

10% 

20030213 

Tinnitus 

6260 

10% 

20030213 

0% X 1 / Not Service-Connected x 3 

20030213 

Combined: 0% 

Combined: 30% 



 

 

ANALYSIS SUMMARY: The PEB combined the right and left knee conditions as a single unfitting 
condition coded analogously to 5003 and rated 0%. The approach by the PEB not uncommonly 
reflected its judgment that the constellation of conditions was unfitting, and there was no need 


for separate fitness adjudications or implied adjudication that each condition was separately 
unfitting. The Board also noted that “bundling,” the combining of two or more major joints is 
permissible under the VASRD 5003 rating requirements, and that this approach does not 
compromise the VASRD §4.7 directive to choose the higher of two valid ratings. The Board’s 
initial charge in this case was therefore directed at determining if the PEB’s approach of 
combining conditions under a single rating was justified in lieu of separate ratings. When 
considering a separate rating for each condition, the Board considers each bundled condition to 
be reasonably justified as separately unfitting unless a preponderance of evidence indicates the 
condition would not cause the member to be referred into the Disability Evaluation System 
(DES) or be found unfit because of physical disability. When the Board recommends separate 
fitness recommendations in this circumstance, its recommendations may not produce a lower 
combined rating than that of the PEB. 

 

Chronic Bilateral Knee Pain due to Retropatellar Pain Syndrome Condition. The Board 
considered whether the right and left knee conditions, when each considered alone were 
unfitting for continued military service. Review of treatment records indicates that the CI was 
treated for bilateral knee pain. Neither knee was determined to be more severe and each 
equally interfered with performance of duty. The Board concluded that the preponderance of 
evidence of the service treatment record (STR) supported a conclusion that the right and left 
knee pain conditions each standing alone would have caused the CI to be referred into the DES 
and to have been determined to be unfit. The Board then considered its rating 
recommendation for the unfitting knee pain condition at the time of separation. There were 
two range-of-motion (ROM) evaluations, one goniometric, 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 

(Degrees) 

MEB ~4 Mos. Pre-Sep 

(20021120) 

VA C&P ~3 Mos. Pre--Sep 

(20030213) 

Left 

Right 

Left 

Right 

Flexion (140 Normal) 

normal 

Normal 

140 

140 

Extension (0 Normal) 

normal 

normal 

0 

0 

Comment 

Bilaterall patellar 
tenderness 

Gait normal. 

Neg DeLuca 

§4.71a Rating 

0% 

0% 

0% 

0% 



 

The CI developed bilateral knee pain with running. There was no specific injury or trauma. A 
clinic evaluation 5 November 2002 noted bilateral knee pain with running, jumping, marching 
and walking. Examination of both knees was normal with full ROM, negative patellar 
compression, negative meniscus signs, and no instability. X-rays and a bone scan of both knees 
were normal. The MEB narrative summary (NARSUM), dated 10 January 2003, records the 
examination from the MEB history and physical examination performed approximately a month 
before in November 2002. The examiner noted that the patient had cracking and popping with 
ROM, however “range of motion is intact.” There was no evidence of effusion. There was also 
no joint line tenderness or patellar tenderness on either knee. On the MEB history and physical 
examination form DD Form 2808 the examiner noted “positive tenderness on medial aspect of 
bilateral patellar”. The VA Compensation and Pension (C&P) examination, 13 February 2003, 3 
months prior to separation, noted that the patient’s knee exam was within normal limits for 
both the left and right. Gait was normal, and ROM for both knees was equal and normal in 
flexion and extension. ROM was not additionally limited by pain, weakness, fatigue, lack of 
endurance or incoordination. There was no evidence of instability, recurrent subluxation, 
locking pain, joint effusion, or crepitus for both left and right. The VA adjudicated a zero 
percent rating for each knee based on the C&P examination. 

 


The Board directs attention to its rating recommendation based on the above evidence. The 
MEB examination and the C&P examination were similar, and examinations of the right and left 
knee were essentially identical showing full ROM without instability or meniscus signs. The 
ROM was non-compensable under the VASRD diagnostic codes for limitation of motion (5260 
and 5261), and there was no instability or meniscus problems to warrant rating under the 
respective codes (5257, 5258, 52959). The Board considered whether a minimum rating was 
supported with application of §4.59 (painful motion) or §4.40 (functional impairment). The 
Board agreed that the evidence of the pre-separation C&P examination was consistent with the 
0% rating adjudicated by the VA. The Board noted the VA examination was more proximate to 
the time of separation and time had elapsed since the CI engaged in aggravating military 
activities allowing for the apparent improvement and therefore best reflected the disability at 
the time of separation. After due deliberation, considering all of the evidence and mindful of 
VASRD §4.3 (reasonable doubt), the Board concluded that both knees were separately unfitting 
and were best rated 0% for each knee (5299-5260). Therefore, the Board concluded there was 
insufficient evidence to recommend a change in the PEB adjudication for the chronic bilateral 
knee pain 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 5099-5003 was operant in this case and the 
condition was adjudicated independently of that policy by the Board. In the matter of the 
chronic bilateral knee pain due to RPS condition, 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, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Bilateral Retropatellar Knee Pain 

5099-5003 

0% 

COMBINED 

0% 



 

 

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 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxx, AR20130005540 (PD201200969) 

 

 

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 and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of 
Congress who have shown interest in this application have been notified of this decision 
by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)