RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX CASE: PD1201601 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130423 

SEPARATION DATE: 20030713 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (52C/Utility Equipment Mechanic) medically 
separated for a bilateral knee condition. She experienced an onset of knee pain in 1998. After 
undergoing several treatment modalities, the condition could not be adequately rehabilitated 
to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy 
physical fitness standards. She was issued a permanent U2/L3/P2 profile and referred for a 
Medical Evaluation Board (MEB). The knee condition, characterized as bilateral retropatellar 
pain syndrome was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other 
conditions were submitted by the MEB. The PEB adjudicated chronic knee pain due to bilateral 
retropatellar pain syndrome as unfitting, rated 0%, citing criteria of the US Army Physical 
Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated. 

 

 

CI CONTENTION: “My rating only focused on my chronic knee pain. The rating did not include 
my severe decrease in visual acuity, my chronic instability of both ankles, my chronic carpal 
tunnel in both wrists, or my abdominal pain from my C-section. I also have severe migraines 
caused my visions issues. I am still suffering with back pain and my weight. The injury to my 
right breast and cysts caused a deformity in my right breast. This deformity causes great body 
image issues that I am still struggling with today. I also still have occasional painful ovarian 
cysts.” [sic] 

 

 

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. IAW DoDI 6040.44, the Board’s authority is 
limited to making recommendations on correcting disability determinations. The Board’s role is 
thus confined to the review of medical records and all evidence at hand to assess the fairness of 
PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities 
(VASRD) standards, based on ratable severity at the time of separation. The rating for the 
unfitting knee condition is addressed below. The requested eye, ankle, wrist, abdominal pain, 
migraine, and breast cyst conditions were not identified by the PEB, and thus are 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 Board for Correction of Military Records. 

 

 


RATING COMPARISON: 

 

Service IPEB – Dated 20030404 

VA - (4 Days Pre-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Knee Pain Due To 
Bilateral Retropatellar 
Pain Syndrome 

5099-5003 

0% 

Retropatellar Pain Syndrome, 
Right Knee 

5260 

10% 

20030414 

Retropatellar Pain Syndrome, 
Left Knee 

5260 

10% 

20030414 

No Additional MEB/PEB Entries 

Other x 8 

20030417 

Combined: 0% 

Combined: 60% 



Derived from VA Rating Decision (VARD) dated 20030709. 

 

 

ANALYSIS SUMMARY: 

 

Chronic Knee Pain Condition. The PEB combined the right and left knee conditions as a 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 reasonably justified 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 CI had a history of non-traumatic left knee pain in 1998 which became bilateral knee pain in 
2000. Pain was associated with running or jumping. Knee X-rays and a bone scan were 
completely normal. Serial physical examination findings led to a diagnosis of bilateral 
retropatellar pain syndrome. Despite long-term profiling, anti-inflammatory medications, 
aggressive physical therapy (PT), and activity modification, bilateral knee pain persisted. Some 
service treatment record notes also documented bilateral hypermobile patella, bilateral 
patellar grinding, crepitus, and apprehension. Clinical notes consistently documented a normal 
gait. The range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving 
at its rating recommendation, with documentation of additional ratable criteria, are 
summarized in the chart below. 

 

 

Knee ROM 

(Degrees) 

 

Ortho ~14 Mo. Pre-Sep 

 

 

NARSUM ~ 5 Mo. Pre-Sep 

 

 

VA C&P ~ 3 Mo. Pre-Sep 

 

Left 

Right 

Left 

Right 

Left 

Right 

Flexion (140 Normal) 

130 

130 

“FROM” 

100 

105 

Extension (0 Normal) 

0 

0 

0 

5 

Comment 

No instability 

 

+Crepitus 

§4.71a Rating 

0% 

0% 

0-10% 

0-10% 

0% or 10% 

0% or 10% 



 

The narrative summary (NARSUM) examiner, 5 months prior to separation, notes the CI having 
daily pain in her knees. Pain was aggravated by stooping or running despite being compliant 
with prescribed PT exercises. She described difficulty with sports activities, dancing and biking; 
and could not stand for more than 20 minutes without experiencing knee pain. The physical 
examination noted bilateral normal knees with no effusions, ecchymosis, swelling, joint line 
tenderness, or instability. Grind test was negative. Poor tone and conditioning of quadriceps 
muscles was present bilaterally. The examiner rated the frequency and severity of the CI’s pain 
as “occasional” and “minimal” respectively. At the VA Compensation and Pension (C&P) 


examination performed 3 months prior to separation, the CI reported bilateral knee pain on a 
regular basis with symptoms initiated by running or carrying heavy loads over a long distance. 
She complained of difficulty standing for long periods and standing up from a kneeling position. 
Additionally, the CI reported swelling, redness, aching, and “crackle and pop noises” about each 
knee. She took non-prescription medication to help reduce her symptoms. The VA examiner 
specifically stated that her impairment at that time was: “…she can’t run, dance, and can’t get 
up from a kneeling position.” She lost no time from work due to the condition. The physical 
examination revealed bilateral slightly positive McMurray’s test (a possible indicator of 
meniscal damage). There was no evidence of joint effusion, instability, ankylosis, or 
subluxation. Painful motion was absent. Gait was normal and no assistive device was required. 

 

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 
there was reasonable justification that each knee, as an isolated condition, would have 
rendered the CI incapable of continued service within her MOS; and, accordingly merits a 
separate rating. The VA assigned a 10% rating for each knee under the 5260 code (limitation of 
flexion), presumably with application of §4.40 (functional loss) or §4.59 (painful motion) since 
limitation of flexion noted on the VA exam was non-compensable. The Board agreed that there 
was no compensable limitation of motion on any exam; and that there was no radiographic 
evidence of degenerative changes, and no painful motion supporting application of §4.59. The 
Board debated whether a normal gait and generally unremarkable physical examination 
findings depicted a sufficiently severe objective functional impairment to warrant application of 
§4.40 or §4.59. The Board also carefully considered the option of rating both lower extremities 
together. A bilateral rating of 10%, coded 5099-5003, is a good analogy to both the pathology 
and disability in this case. Since rating analogously defaults to 5003 rating criteria without 
regard to confirmed radiographic findings, a 10% rating for two major joints is supported. 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 bilateral lower extremity 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 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 knee pain due to bilateral retropatellar pain syndrome condition, the Board 
unanimously recommends a disability rating of 10%, coded 5099-5003 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 her prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Bilateral Retropatellar Pain Syndrome 

5099-5003 

10% 

COMBINED 

10% 



 

 

 

 

 


The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120701, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

 

SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxx, AR20130011070 (PD201201601) 

 

 

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 10% 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 xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)