RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201376 SEPARATION DATE: 20011024 

BOARD DATE: 20130313 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty PFC/E-3 (74B/Information Systems Operator/Analyst), 
medically separated for chronic bilateral knee pain. This 27 year old CI developed bilateral 
anterior shin and knee pain during basic training. He was evaluated and treated with 
medications and given brief profiles with minimal to no significant relief. Despite his pain, he 
was able to pass his PT test at basic training and his diagnostic Army Physical Fitness Test (APFT) 
at Advanced Individual Training (AIT) at Fort Gordon. He graduated in July 2001 from AIT but 
was unable to pass the APFT portion of his graduation requirements. Pain medications did not 
provide significant relief. His chronic bilateral knee pain condition 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 Physical 
Evaluation Board (PEB) adjudication. The PEB adjudicated the chronic bilateral knee pain due 
to retropatellar pain syndrome condition as unfitting, rated 0%, with cited application of the US 
Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was 
medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “The condition had a secondary condition which is permanent in nature and 
affects all aspects of daily life, including driving, working & being able to care for myself. These 
conditions also affect my family, to include marital intimacy because of chronic pain which can 
flare-up, rendering me immobile until the flare-up subsides. I have now endured years of this.” 

 

 

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 the unfitting bilateral knee pain 
due to retropatellar pain syndrome condition is addressed below. The requested complex 
regional pain syndrome (CRPS) condition (implied in the contention as the “secondary 
condition”) was not identified by the PEB, and thus is not within the DoDI 6040.44 defined 
purview of the Board. 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 20010910 

VA (3 Mos. Post-Separation) – All Effective Date 20011025 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Bilateral Knee 
Pain 

5099-5003 

0% 

Right Retropatellar Pain 
Syndrome with Tibial Stress 
Reaction 

5262 

10% 

20020204 
& 
20020131 

Left Retropatellar Pain 
Syndrome with Tibial Stress 
Reaction 

5262 

10% 

.No Additional MEB/PEB Entries. 

Varicose Veins, Left Leg 

7121 

10% 

0% X 0 / Not Service-Connected x 2 

Combined: 10% 

Combined: 30%* 



Includes bilateral factor of 2.7% 

 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impact that his service-incurred condition has had on his current 
earning ability and quality of life. It is a fact, however, that the Disability Evaluation System 
(DES) has neither the role nor the authority to compensate members for anticipated future 
severity or potential complications of conditions resulting in medical separation. This role and 
authority is granted by Congress to the Department of Veterans Affairs (DVA). The Board 
utilizes DVA 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. The 
Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES 
fitness determinations and rating decisions for disability at the time of separation. Post-
separation evidence therefore is probative only to the extent that it reasonably reflects the 
disability and fitness implications at the time of separation. 

 

Chronic Bilateral Knee Pain Condition. The PEB combined right and left knee pain due to 
retropatellar pain syndrome 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 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. The bilateral knee pain condition began in January 2001 
and was not a consequence of injury. Bone scanning showed no changes in either knee, and X-
rays of the knees were normal. There were three 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 ~5 Mo. Pre-Sep 

VA C&P ~3 Mo. Post-Sep 

VA C&P ~3 Mo. Post-Sep 

Left 

Right 

Left 

Right 

Left 

Right 

Flexion (140° Normal) 

110° 

110° 

110° 

100° 

110° 

110° 

Extension (0° Normal) 

0° 

0° 

“Full” 

“Full” 

“Full” 

“Full” 

Comments 

Slightly antalgic gait. 
+Bilateral tenderness, painful 
motion 

+Bilateral crepitance, 
tenderness, painful motion 

+Bilateral patellar 
tenderness 

§4.71a Rating 

10% 

10% 

10% 

10% 

10%* 

10%* 



 *Conceding painful motion 


At the narrative summary (NARSUM) exam on 12 July 2001 (3 months prior to separation), the 
CI stated that he was unable to run, jump, crawl, squat, kneel or stand more than 10 minutes in 
any one position without experiencing moderate pain. Physical examination revealed an 
inability to squat due to pain. Palpation of the medial patella borders caused him to grimace. 
Ligament stability was normal in both knees and signs of meniscal injury were absent. Mild 
tenderness was present in each shin. At the VA Compensation and Pension (C&P) exam on 
31 January 2002 (3 months after separation), the CI reported that both knees were equally 
affected. He took over the counter anti-inflammatory medication for relief. Aching was 
constant and swelling occurred if he over-extended himself. Standing for long periods of time, 
walking or climbing stairs caused pain. He did not require a brace or assistive devices for 
ambulation. Examination noted him to walk “reasonably well.” There was no instability of 
either knee. There was no significant tenderness of the tibias. Knee X-rays were normal. At a 
second C&P exam 4 days later, the CI described the knee pain as intermittent, and worse in cold 
weather. A limp occurred “at times.” He experienced swelling and popping. Examination 
revealed a “slight effusion.” Limited ligament testing was negative for instability. Magnetic 
resonance imaging (MRI) of the knees was normal except for small bilateral effusions. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
Board first considered if each knee, having been de-coupled from the combined PEB 
adjudication, remained independently unfitting as established above. All members agreed that 
right and left retropatellar pain syndrome, as isolated conditions, would have rendered the CI 
incapable of continued service within his MOS; and, accordingly merit separate ratings. The VA 
assigned a 10% rating for each knee under the 5262 code (tibia and fibula, impairment of; 
“slight” knee or ankle disability). Although non-compensable limitation of knee motion was 
present on all exams, the Board deliberated if sufficient evidence of functional loss (§4.40) or 
painful motion (§4.59) was present to justify a 10% rating under §4.71a. Board members 
agreed that the evidence does support this approach, but further concluded that there was no 
route to a rating higher than 10% for each knee under any applicable knee coding pathway. 
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), the Board recommends a disability rating of 10% for the right knee pain due to 
retropatellar pain syndrome condition and 10% for the left knee pain due to retropatellar pain 
syndrome condition, coded 5099-5003. 

 

 

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 chronic bilateral knee pain 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 retropatellar pain syndrome condition, the 
Board unanimously recommends that it be rated for two separate unfitting conditions as 
follows: chronic right knee pain due to retropatellar pain syndrome condition coded 5099-5003 
and rated 10%, and chronic left knee pain due to retropatellar pain syndrome condition coded 
5099-5003 and rated 10%; both IAW VASRD §4.71a. 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 Due to Retropatellar Pain Syndrome 

5099-5003 

10% 

Chronic Left Knee Pain Due to Retropatellar Pain Syndrome 

5099-5003 

10% 

COMBINED (w/ BLF) 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120718, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for XXXXXXXXXXXXXXXXX, AR20130006117 (PD201201376) 

 

 

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 XXXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)