RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201073 SEPARATION DATE: 20021106 

BOARD DATE: 20130301 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Soldier, SGT/E-5(63B/Light Wheeled Mechanic), 
medically separated for bilateral knee pain secondary to retropatellar pain syndrome (RPPS). 
The CI injured his right knee when he struck a bedframe in June 1997. The CI did not improve 
adequately with treatment to meet the physical requirements of his Military Occupational 
Specialty (MOS). He was issued a permanent L3 profile (right knee only) and referred for a 
Medical Evaluation Board (MEB). The MEB adjudicated the bilateral knees, RPPS condition as 
medically unacceptable IAW AR 40-501. Intermittent low back pain (LBP) and intermittently 
elevated blood pressure (BP), identified in the rating chart below, were determined to meet 
retention standards. All were forwarded by the MEB to the Physical Evaluation Board (PEB). 
The PEB adjudicated bilateral knee pain secondary to RPPS as unfitting, rated 0%, with 
application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD), and adjudicated 
the other two MEB conditions as not unfitting. The CI made no appeals, and was medically 
separated with a 0% disability rating. 

 

 

CI CONTENTION: The CI elaborated no specific contention in his application. 

 

 

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 PEB – Dated 20021002 

VA (7 Days Post-Separation) – All Effective Date 20021107 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Knee Pain 

5099-5003 

0% 

L Knee RPPS 

5299-5260 

10% 

20021113 

R Knee RPPS 

5299-5260 

10% 

20021113 

Intermittent LBP 

Not Unfitting 

Lumbosacral Strain 

5295 

10% 

20021113 

Intermittently Elevated BP 

Not Unfitting 

Hypertension 

7101 

NSC 

20021113 

.No Additional MEB/PEB Entries. 

Tinnitus 

6260 

10% 

20021113 

R Elbow Tendinitis 

5206-5024 

10% 

20021113 

Residuals, Cervical Strain 

5290 

10% 

20021113 

Residuals, R Wrist Injury… 

5215-5024 

10% 

20021113 

0% X 2 / Not Service-Connected x 2 

20021113 

Combined: 0% 

Combined: 50%* 



*Includes bilateral factor of 1.9%. 

 

 

 


ANALYSIS SUMMARY: The PEB combined the right and left knee RPPS, under a single code 
analogous to 5003 (degenerative arthritis) and rated zero percent. IAW VASRD §4.71a, the 
Board must apply separate codes and ratings in its recommendations if compensable ratings for 
each condition are achieved. As elaborated below; separate compensable ratings for each 
condition are well supported by the evidence in this case. Having determined that separate 
ratings are warranted, however, the Board must also 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. The Board therefore 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. The Board’s threshold for countering Disability 
Evaluation System fitness determinations is higher than the VASRD §4.3 (reasonable doubt) 
standard used for its rating recommendations, but remains adherent to the same DoDI 6040.44 
standards referenced above. In this case, the right and left knee RPPS were well supported as 
unfitting by evidence from the narrative summary (NARSUM) and service treatment record 
(STR). As to the judgment as to whether each condition was independently unfitting, the 
commander’s statement specifically identified and implicated the right knee, and the profile 
identified the right knee retropatellar pain syndrome condition as a permanent L3. The 
NARSUM identified bilateral retropatellar knee pain, and the STR supports that description. 
The permanent L3 profile limited the CI to no lifting up to 30 pounds or wearing a backpack 40 
pounds, no KP/mopping/ mowing grass, or marching, nor running, no bicycling, no swimming, 
no walk or running in pool, with additional physical fitness testing limitations of no two mile 
run, swim, or bicycle. Separating the impairment related to the right or left knee requires 
undue speculation; and, there is clinical evidence of significant and similar functional 
impairment referable to each joint. After deliberation, all members agreed that (more likely 
than not) each of the conditions, in isolation, would have rendered the CI incapable of 
continued service within his MOS; and, accordingly each merits a separate disability rating. 

 

Bilateral Knee Pain: In reviewing the clinical record, the CI had an injury in 1997 to the right 
knee after hitting it on the corner of a bed, and then evaluated again that year for right knee 
pain while sitting, side straddling, and hops, not by running. He was next evaluated for bilateral 
knee pain, 8 months in duration, in 1998; a bone scan showed moderate stress changes (no 
report), but bilateral knee X-rays were normal. He was evaluated on 23 July 1998 by 
orthopedics and diagnosed with RPPS, left greater than right. On 5 June 2001, he was seen for 
bilateral knee pain for a year, right was more painful, no history of trauma this time. The 
narrative summary (NARSUM), 4 months prior to separation, noted the CI had received physical 
therapy without improvement. The condition improved, but flared up in October 1999 and 
again in June 2001. He was re-evaluated by orthopedics, and again diagnosed with RPPS. He 
followed up with orthopedics in June 2002; he again reported no improvement. The CI 
reported he could walk up to one and a half miles. The NARSUM stated limitations were no 
running, squatting, kneeling, or crawling. He used Acetaminophen for pain as needed. His 
commander’s statement confirmed he can no longer perform his MOS duties. The CI was 
limited by his permanent L3 profile form running, jumping, squatting, rucksack, marching and 
lifting more than 30 pounds. He could walk at own pace and distance for aerobic conditioning 
and walk as alternate aerobic event for Army physical fitness test. The accession profile and 
physical demands rating for the MOS of 63B are 222222 and very heavy. There were two 
goniometric 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. 

 

 


Knee ROM 

MEB ~4 Mo. Pre-Sep 

VA C&P ~7 Days Post-Sep 

Left 

Right 

Left 

Right 

Flexion (140° Normal) 

140 

140 

140 

140 

Extension (0° Normal) 

0 

0 

0 

0 

Comment 

Normal; 

Silent to painful 
motion 

Normal; 

Silent to painful 
motion 

RPPS; 

Silent to painful 
motion; 

No DeLuca 

RPPS; 

Silent to painful 
motion; 

No DeLuca 

§4.71a Rating 

0% 

0% 

0% 

0% 



 

At the VA Compensation and Pension (C&P) exam, 7 days after separation, the CI reported pain 
behind the kneecaps, increased by sitting to standing, squatting to standing, kneeling to 
standing, stairs, and that sometimes the knees seemed to give out. He reported flare-ups one 
to five times a month depending on activities. Physical examination was positive for RPPS, right 
more than left, with patellar pressure of 5 pounds applied. The knees had a normal appearance 
and motion; DeLuca criteria were negative upon performing squatting to standing and kneeling 
to standing testing, which were limitations stated on the NARSUM. The VA examiner 
speculated that there could be an additional five and ten degree loss in flexion for the right and 
left knee, respectively, in a flare-up. The action officer opined that the speculation on the part 
of the VA medical examiner as to the effects of pain from RPPS upon ROM was not supported 
by the evidence. The Board found no radiological or clinical evidence of pathology which would 
cause any temporary limitation of motion of the knee, such as a loose body in the knee joint, 
torn ligaments, severe inflammation, tendinitis, bursitis, osteoarthritis, or documented ROM 
measurements during an exacerbation. The Board concluded that a hypothesized limitation of 
motion during an exacerbation that could not be provoked by kneeling or squatting in the 
examination room could not be considered for a permanent disability rating by the Board. The 
Board directs attention to its rating recommendation based on the above evidence. The Board 
considered the VASRD diagnostic code 5099-5003 (rated analogous to arthritis) for both knees, 
used by the PEB for a zero percent adjudication. The board did not find any evidence of painful 
motion, or any abnormal x-rays for a rating in the CI’s favor for either the right or the left knee. 
The Board then considered 5299-5260 (rated analogous to limitation of flexion of leg). The 
Board found no evidence of flexion limited to 60 degrees or more for a compensable rating 
above zero percent for each knee. The Board also considered 5257 knee, other impairment, 
and found no evidence of recurrent subluxation or lateral instability of either knee, for a rating 
in the CI’s favor. The Board concluded that separating the bilateral knee condition into right 
and left knee conditions gave no rating advantage to the CI. The Board noted that while the VA 
based its adjudication of 10% disability for each knee based on the speculation by the C&P 
examiner that there would be some limitation in motion with a flare, none was in evidence at 
the examination including repetition of motion and provocative maneuvers. After due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the 
Board concluded that there was insufficient cause to recommend a change in the PEB 
adjudication for the bilateral retropatellar pain. 

 

 

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. The Board did not 
surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD 
were exercised. In the matter of the bilateral knee condition and IAW VASRD §4.71a, 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 Knee Pain Condition 

5099-5003 

0% 

COMBINED 

0% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120613, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, 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 xxxxxxxxxxxxxxxxxxx, AR20130005379 (PD201201073) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)