RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201521 SEPARATION DATE: 20031113 

BOARD DATE: 20130117 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a Reserve (Individual Ready Reserve) CW4 (31A/Military Police), 
medically separated for chronic pain, left knee, status post (s/p) lateral tibial fracture. The CI 
injured his knee playing football during physical training while in an active duty status in May of 
2000. He underwent arthroscopic surgery and continued with physical therapy (PT) and 
rehabilitative treatment but continued to experience pain and discomfort. His chronic left knee 
pain condition did not improve adequately and he was unable to meet the physical 
requirements of his Warrant Officer Specialty or satisfy physical fitness standards. He was 
issued a permanent L3H3 profile and referred for a Medical Evaluation Board. The MEB 
forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The initial PEB 
adjudicated the CI “Fit by Presumption.” The CI submitted a rebuttal to the PEB and another 
PEB 2 weeks later changed the rating to an “unfitting” status for his chronic left knee pain. A 
final PEB revised for an administrative correction dated 18 March 2003 adjudicated the chronic 
pain, left knee condition as unfitting, rated 0% with application of the US Army Physical 
Disability Agency (USPDA) pain policy. The CI made no additional appeals and was separate 
with a 0% disability rating. 

 

 

CI CONTENTION: “Injury to left knee, ILOD (sic) and subsequent knee replacement surgery. 
Hearing Loss (tinnitus) Left Ear. Knee is not fully restored. Still cannot stand or sit for long 
periods of time. Continue to have painful “locking” cramps with certain knee movements. The 
Tinnitus has (is) become worse in the Left ear and is now in the right ear as well. Overall 
Hearing is now limited, especially certain words, number or letter sounds. I was given a “0” 
rating for hearing loss, and only 10% for Tinnitus of the left ear.” Please review the enclosed 
Audiology examination results dated 8 August 2012.” 

 

 

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. The rated condition chronic pain, left knee 
is the only condition that meets the criteria prescribed in DoDI 6040.44 for Board purview; and, 
is addressed below. The other requested conditions, hearing loss and tinnitus, are not within 
the Board’s purview. 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 service Board for Correction of Military Records. 

 

 


RATING COMPARISON: 

 

Service Admin PEB – Dated 20030318 

VA (3 Mos. Post-Separation) – All Effective Date 20030716 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Pain, Left Knee S/P 
Lateral Tibial Plateau Fracture 

5099-5003 

0% 

Posttraumatic Arthritis S/P 
Left Knee Replacement 

5055 

30% 

20040205 

.No Additional MEB/PEB Entries. 

Tinnitus 

6260 

10% 

20040203 

0% X 1 / Not Service-Connected x 2 

 

Combined: 0% 

Combined: 40% 



 

 

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. While the DES considers all of the member's medical conditions, 
compensation can only be offered for those medical conditions that cut short a member’s 
career, and then only to the degree of severity present at the time of final disposition. The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or potential complications of conditions resulting in medical separation nor for conditions 
determined to be service-connected by the Department of Veterans Affairs (DVA) but not 
determined to be unfitting by the PEB. However the DVA, operating under a different set of 
laws (Title 38, United States Code), is empowered to compensate all service-connected 
conditions and to periodically re-evaluate said conditions for the purpose of adjusting the 
Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating determinations, compared to VASRD standards, based on severity at the time of 
separation. 

 

Chronic Pain, Left Knee Status Post Lateral Tibial Plateau Fracture Condition. 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. 

 

Left Knee ROM 

(Degrees) 

PT 

~17 Mo. Pre-Sep 

(20020618) 

MEB NARSUM 

 ~10 Mo. Pre-Sep 

(20030107) 

VA C&P 

~3 Mo. Post-Sep 

(20040205) 

Flexion (140 Normal) 

125 

125 

120 

Extension (0 Normal) 

0 

0 

5 

Comment 

Right knee same. 

Normal gait. 

No atrophy. 

No instability. 

S/p partial knee replacement 
14Jan04, 2 mos post sep. 

 

§4.71a Rating 

10% 

10% 

30% 



 

The CI sustained a fracture of the lateral tibial plateau at the left knee while playing football in 
May 2000. He subsequently underwent treatment including arthroscopic surgery in September 
2000 with arthroscopic debridement of the medial and lateral menisci (radial tear of lateral 
meniscus, medial meniscus post tear). Magnetic resonance imaging (MRI) of the left knee on 
17 October 2001, noted the presence of the residuals of the fracture of the left lateral tibial 
plateau with fracture lines and a depressed area 1.5cm in size depressed by 0.3 to 0.4cm. An 
orthopedic evaluation 1 November 2001 noted left lateral knee compartment osteoarthritis as 
a result of the injury and discussed treatment options including surgery (distal femoral 
osteotomy to unload the lateral compartment; or knee replacement) and a brace (varus 
unloading brace to shift the weight bearing from the lateral to the medial compartment of the 
knee joint). A 20 March 2002 orthopedics appointment noted the CI was doing better with the 
brace. The CI was unable to run, jump or perform vigorous military activities but the brace 
allowed enough partial relief for normal daily activities. On examination, ROM was normal 
(extension, 0 degrees, flexion 135 degrees). The orthopedic surgeon initiated an MEB for the 


persisting knee pain due to isolated lateral compartment osteoarthrosis (secondary to the tibial 
plateau fracture). A PT ROM examination 18 June 2002 demonstrated full extension in both 
knees and symmetric flexion in both knees (left 125, right 120 degrees). At the MEB narrative 
summary (NARSUM) examination, performed on 7 January 2003 (10 months prior to 
separation), the CI reported knee pain and stiffness with prolonged sitting or standing, lifting 
heavy objects, and going up and down stairs. On examination, the CI was wearing a knee brace 
and exhibited a normal gait and strength. There was no muscle atrophy, joint line tenderness 
or instability. There was some patellar crepitus. The knee flexed to 125 degrees and extended 
to 0 degrees. At the VA Compensation and Pension (C&P) examination, 5 February 2004 (3 
months after separation), the CI reported he had had implants placed in his left knee for a 
unilateral knee replacement on 15 January 2004, 2 months after separation. He complained of 
constant knee pain, however he states his condition did not cause incapacitation or any time 
lost from work because he was retired. Physical exam evidenced no posture or gait 
abnormalities. No abnormal weight bearing seen on feet examination. ROM of the left knee 
was limited by pain (flexion 120 degrees, with 5 degrees loss of extension). 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB rated the condition 0% with application of the USAPDA pain policy (coded 5099-5003). By 
rating decision 15 March 2004, the VA rated the condition 30% based on the partial knee 
replacement surgery after separation (coded 5055). The Board noted that the CI underwent 
partial knee replacement surgery after separation, however ratings may not be based on events 
following separation. There was no limitation of motion or instability to warrant a minimum 
rating under the respective VASRD diagnostic codes (5260, 5261, and 5257). The Board agreed 
a 10% rating 5003 was supported with application of, §4.59 (painful motion) or §4.40 
(functional impairment) as well as under 5259, symptomatic s/p removal of semilunar cartilage. 
There was not a dislocated meniscus with locking to support a minimum rating under code 
5258 (dislocated meniscus). The Board noted the underlying cause for the left knee impairment 
was a fracture of the tibia, and considered rating using the VASRD diagnostic code 5262, 
impairment of tibia with knee disability. There was not a non-union with loose motion to 
warrant consideration of the 40% rating. All members agreed the knee disability was more 
than slight and considered whether the left knee disability was moderate or marked. At the 
time of the MEB NARSUM, the CI had pain and stiffness with going up and down the stairs, 
heavy lifting, and prolonged standing or sitting. Gait was normal, and muscle strength was 
normal without atrophy. All members agreed that the disability was best described as 
moderate and concludes the evidence supports a 20% rating under code 5262. After due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the 
Board recommends a disability rating of 20% for the chronic left knee pain condition (5299-
5262). 

 

 

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 knee condition was operant in this case and 
the condition was adjudicated independently of that policy by the Board. In the matter of the 
chronic pain, left knee condition, the Board unanimously recommends a disability rating of 20% 
coded 5299-5262 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 Pain, Left Knee 

5299-5262 

20% 

COMBINED 

20% 



 

 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120810, 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 XXXXXXXXXXXXXXXXXX, AR20130003940 (PD201201521) 

 

 

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)