RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201485 SEPARATION DATE: 20020211 

BOARD DATE: 20130409 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Specialist/E-4 (19D10/Cavalry Scout), medically 
separated for right shoulder pain with instability, right knee pain and left ankle pain, rated as a 
single unfitting condition. The CI’s right knee problem started during Basic Training in about 
November 1998. After conservative measures failed, the CI had two surgeries on his knee. In 
September 2001 the orthopedic surgeon who performed the surgeries recommended to 
proceed to a Medical Evaluation Board (MEB) due to persistent right knee pain. The left ankle 
pain started when the CI sprained it in October 1999. He had surgery in October 2000 due to 
ankle instability with recurrent symptoms and failure of conservative therapy. He still had pain 
in his left ankle after surgery. The CI sustained a dislocation of the left shoulder in December 
1998 and later underwent surgery and physical therapy with good results. However, the CI also 
had right shoulder instability per an orthopedic addendum to the MEB proceedings. The CI 
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 
U3/L3 profile and referred for the MEB. The Physical Evaluation Board (PEB) adjudicated the 
right shoulder pain with instability, right knee pain and left ankle pain, as a single unfitting 
condition, rated 10%, with application of the US Army Physical Disability Agency (USAPDA) pain 
policy and the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no 
appeals and was medically separated with a 10% disability rating. 

 

 

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

 

 

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. Service 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 respective Service Board for the Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20011116 

VA – All Effective Date 20020212 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Rt Shoulder Pain w/ 
Instability, Rt Knee Pain 
& Lt Ankle Pain 

5099-5003 

10% 

Rt Shoulder Cuff Tendonitis, Major 

5024 

10% 

STR 

Rt Knee MMT Residuals… 

5258 

20% 

STR 

Lt Ankle Post Traumatic Arthritis… 

5010-5271 

20% 

STR 

Lt Shoulder… 

Not Unfitting 

Lt Shoulder Pain… 

5201 

20% 

STR 

.No Additional MEB/PEB Entries. 

0% X # / Not Service-Connected x # 

STR 

Combined: 10% 

Combined: 60% 



 

 


ANALYSIS SUMMARY: The PEB combined the right shoulder, right knee and left ankle as a 
single unfitting condition, rated at 10% and coded analogously to 5003, degenerative arthritis. 
The PEB likely relied on the USAPDA pain policy for not applying separately compensable 
VASRD codes. 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, rather than a judgment that each condition was independently unfitting. If the 
Board judges that two or more separate “unbundled” conditions are unfitting in and of 
themselves, the Board must apply separate codes and ratings in its recommendations if 
compensable ratings for each condition are achieved IAW VASRD §4.71a for these unfitting 
conditions. 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. 

 

Right Shoulder Pain with Instability Condition. The first recorded visit for the right shoulder was 
at a 28 March 2001 follow-up orthopedic appointment for the right knee surgery. The 
examiner wrote “He additionally relates discomfort about the right shoulder…” He was next 
seen on 11 April 2001 when he reported subjective posterior subluxation becoming more 
symptomatic. He denied any trauma. On examination, he had a full active range-of-motion 
(ROM) with multidirectional instability. X-rays were normal. He prescribed an exercise 
program. The narrative summary (NARSUM) dictated on 24 August 2001 noted that the right 
shoulder abduction was slightly limited by pain and that there was a popping sensation on 
manipulation. X-rays, accomplished 28 March 2001 and most likely those referenced above, 
showed an overlap of the humeral head on the glenoid. A NARSUM orthopedic addendum was 
dictated on 26 September 2001. The examiner noted that the right shoulder instability limited 
both strengthening activities as well as load carrying. On examination, full ROM was noted 
without abnormal motion of the scapula. He continued to show posterior greater than anterior 
instability and voluntary subluxation. The orthopedist recommended separation for both the 
right shoulder condition and the right knee. At the MEB examination on 24 October 2001, the 
CI reported continued pain in the right shoulder. The MEB physical examiner noted the right 
shoulder was limited to 130 degrees abduction due to pain, tender over the top of the shoulder 
and that there was a “popping” sound on manipulation. The VA did not accomplish a 
Compensation and Pension (C&P) examination. The Board considered if the right shoulder pain 
was a separately unfitting condition. It noted that the treating orthopedist, who dictated the 
NARSUMs, did specifically cite the right shoulder as limiting the CI in load bearing activities and 
had recommended separation for both it and the right knee condition. The right shoulder 
instability was profiled and determined to not meet retention standards. However, the 
commander did not specifically attribute any duty limitations to his right shoulder. The profile 
did not restrict the CI from upper body weight training or carrying a weapon. There were no 
separate visits for the right shoulder in the service treatment record (STR). The treatment 
recommended was rotator cuff strengthening. After due deliberation in consideration of the 
evidence, the Board concluded that the right shoulder was not a separately unfitting condition. 

 

Right Knee Pain Condition. The CI first presented for right knee pain in 1999 stating that it had 
begun in basic training. He was referred to physical therapy (PT), but had persistent pain. On 
8 December 1999, he had a right medial meniscal repair and was referred to rehabilitation. 
Despite this, he had pain and was unable to meet duty requirements; MEB was initiated. On 
8 February 2001, he underwent revision of the partial meniscectomy. On 11 April 2001, it was 
noted that he was resuming activities and responding well to PT. The NARSUM dictated on 
24 August 2001 noted that the CI had persistent right knee pain. On examination, he had 
tenderness of the right patellar tendon with crepitation noted bilaterally. The ROM was to 130 
degrees flexion bilaterally (140 is normal) with normal extension. There were no postoperative 
X-rays in evidence. Pre-operatively, a magnetic resonance imaging (MRI) showed a tear of the 
posterior horn of the medial meniscus. Pre-operative X-rays were normal. At the orthopedic 
addendum examination 26 September 2001, there was a trace effusion and tenderness to the 


patellar grind. There were no signs of instability although he had a type 1A Lachmans. An 
anterior drawer test was normal. Testing for meniscal irritation was negative. The CI was 
thought to have persistent knee pain secondary to medial compartment arthrofibrosis and MEB 
was recommended. No history of locking or giving way was recorded. At the MEB examination, 
the CI reported persistent pain. The MEB physical examiner documented bilateral crepitus, but 
normal sensory and motor examinations and no atrophy. The CI was profiled for “failed right 
knee surgery.” The commander specifically noted duty limitations from the right knee. The 
Board considered if the right knee was a separately unfitting condition. It noted that the 
treating orthopedist, who dictated the NARSUMs, did specifically cite the right knee as limiting 
the CI and had recommended separation for both it and the right shoulder condition. After due 
deliberation in consideration of the evidence, the Board concluded that the right knee was a 
separately unfitting condition. 

 

The Board then directed its attention to its rating recommendation based on the above 
evidence. The VA coded the right knee as 5258, dislocated semilunar cartilage, and rated it 20% 
citing frequent episodes of “locking.” The Board did not find evidence in the record to support 
this history. The Board then considered the other coding options for the knee. There was no 
evidence for subluxation or lateral instability. The minimal limitation in flexion was symmetric 
and non-compensable. The trace effusion noted was within a year of surgery and consistent 
with ongoing healing and rehabilitation. The CI clearly did have a partial meniscectomy which 
remained symptomatic. The Board determined that the coding option 5259, removal of a 
meniscus, clinically best described the condition. After due deliberation, considering all of the 
evidence and mindful of VASRD §4.3 (reasonable doubt), the Board determined that a disability 
rating of 10% for the right knee condition coded 5259 best reflected it and was appropriate. 

 

Left Ankle Pain Condition. The CI first complained of left ankle pain in October 1999 after a 
sprain. Despite PT and duty limitations, he had persistent pain and was noted to have 
instability. On 4 October 2000, he underwent lateral reconstruction and osteophyte excision. 
He did well with rehabilitation although his pain persisted. ROM testing on 9 March 2001 
showed identical measurements of the right and left ankles other than dorsiflexion, 10 and 15 
degrees respectively, and inversion, 30 and 35 degrees, respectively. Plantar flexion was 
symmetric and normal. The NARSUM dictated on 4 June 2001 noted near normal ROM with 30 
degrees of dorsiflexion and 40 degrees of plantar flexion. A drawers test was 1+, but with a 
solid end point consistent with a good repair. A talar tilt test was ten degrees greater on the 
left than right under fluoroscopic examination. On X-ray, there was a mild osteophyte over the 
anterior distal tibia, but the joint space was preserved. He was noted to have pain with daily 
activities despite 6 months of rehabilitation and his prognosis for continuing on active duty 
considered limited. A second NARSUM was dictated on 24 August 2001, now over 10 months 
from surgery. The CI reported continued pain with “knotting and cracking” sensation. The 
examiner noted “significant findings only on the right knee joint and right shoulder.” The lower 
extremities were noted to have normal sensation and strength with no atrophy present. The 
pain, for all conditions, was noted as constant and slight, at times sharp. At the MEB 
examination, the CI reported continued pain. The MEB physical examiner noted positive 
findings for the right shoulder and knee, but documented nothing for the left ankle and 
checked that the feet were normal on examination. The left ankle condition was profiled only 
for pain. The commander did not cite specific limitations from the ankle condition. The Board 
considered if the left ankle was a separately unfitting condition. It noted that the examiners did 
not document any objective findings for the left ankle on the final two examinations, while the 
information for both the right shoulder and the right knee was detailed. The information in 
evidence supports continued improvement of left ankle after surgery with minimal or no 
limitations. After due deliberation in consideration of the evidence, the Board concluded that 
the left ankle was not a separately unfitting condition at the time of separation. 

 


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 right shoulder, right knee, and left ankle 
conditions was likely operant in this case and the conditions were adjudicated independently of 
that policy by the Board. As noted in the discussion above, the right shoulder and left ankle 
conditions were determined to not be separately unfitting. The right knee, which was 
separately unfitting, was unanimously determined to best fit a disability rating of 10%, coded 
5259 IAW VASRD §4.71a. However, this provided no advantage to the CI compared to the PEB 
adjudication. The Board therefore recommended no recharacterization. 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 

Right Shoulder Pain with Instability, Right Knee Pain, and Left 
Ankle Pain 

5099-5003 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120703, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 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 
xxxxxxxxxxxxxxxxxxxxxxxxx, AR20130009583 (PD201201485) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)