RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXX CASE: PD1201752 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130425 

SEPARATION DATE: 20080101 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SSG/E-6 (42A/Human Resource Specialist) medically 
separated for knee pain. The CI first complained of bilateral knee pain in 2001 during 
treatment for Cushing’s syndrome. Despite medication, physical therapy, and education the 
knee condition could not be adequately rehabilitated to meet the requirements of her Military 
Occupational Specialty (MOS) or physical fitness standards. She was therefore issued a 
permanent L3 profile and referred for a Medical Evaluation Board (MEB). The knee condition, 
characterized as “bilateral knee pain” was forwarded to the Physical Evaluation Board (PEB) 
IAW AR 40-501. The MEB also identified and forwarded three other conditions (see rating chart 
below) that met retention standards. The PEB adjudicated “pain, chronic bilateral knee 
(slight/occasional)” as unfitting and rated 0% IAW US Army Physical Disability Agency (USAPDA) 
pain policy. The remaining conditions were determined to be not unfitting. The CI made no 
appeals and was medically separated with that 0% disability rating. 

 

 

CI CONTENTION: The CI elaborated no contention in her 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. The rating for the unfitting knee condition is 
addressed below; no additional conditions are in the 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 consideration by the Board for Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service PEB – Dated 20070928 

VA - (~4 Mos. Post-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Pain, Chronic Bilateral 
Knee…Slight/Occasional 

5099-5003 

0% 

Left Knee Strain 

5257 

10% 

20080422 

Right Knee Strain 

5257 

10% 

Right Knee Painful Motion 

5260 

10% 

Cushing’s Disease 

Not Unfitting 

Cushing’s Syndrome 

7907 

0% 

Hyperlipidemia 

No VA Entry 

 

 

Bilateral 2nd Hammer Toe 

NSC, no Diagnosis 

 

 

Anemia 

No VA Entry 

 

 

No Additional MEB/PEB Entries 

Other x 12 

20080422 

Combined: 0% 

Combined: 70% 



Derived from VA Rating Decision (VARD) dated 20090212. 

 

 

ANALYSIS SUMMARY 

 

Bilateral knee pain. The PEB combined the chronic bilateral knee pain conditions under a single 
disability rating, coded analogously to 5003. Although the Veterans Administration Schedule 


for Rating Decisions (VASRD) §4.71a permits combined ratings of two or more joints under 
5003, it allows separate ratings for separately compensable joints; and, IAW DoDI 6040.44, the 
Board must follow suit if the PEB combined adjudication is not compliant with the latter 
stipulation. The Board’s initial charge in this case was therefore directed at determining if the 
PEB’s combined adjudication was justified in lieu of separate ratings. If the members judge that 
separate ratings are indicated IAW VASRD §4.7 (higher of two evaluations), however; each 
unbundled condition must be reasonably justified as separately unfitting to remain eligible for 
rating. 

 

The narrative summary (NARSUM) notes that the CI began experiencing knee pain bilaterally 
around October 2001 as she was undergoing evaluation and treatment for Cushing’s syndrome. 
There was no precipitating injury. Her knee pain worsened as her weight increased secondary 
to her Cushing’s syndrome. Her endocrine situation returned to normal following surgery 
(transsphenoidal hypophysectomy) in January 2002 and she was able to lose the weight she 
had gained. However, the bilateral knee pain persisted. X-ray studies of the knees were 
consistently normal except for one done in September 2005 which showed “probably 
projectional lateral joint space loss, otherwise normal knees.” At the MEB exam, 6 months 
prior to separation, the CI reported continued pain anteriorly in both knees. It was described as 
a dull, continuous ache rated 3-9/10. It was exacerbated by running, walking, climbing stairs, 
walking carrying a load greater than 20 pounds, weather changes, and standing or sitting for 
prolonged periods. She denied instability, locking, falls, numbness and tingling. The MEB 
physical exam noted non-antalgic gait. Bilateral lower extremities were neurovascularly intact. 
There was no joint effusion, bony crepitus or ligamentous instability but there was tenderness 
anteriorly over both knees. Range-of-motion (ROM) was recorded as follows: right knee 
flexion to 128 degrees (normal 140 degrees) limited by pain, and left knee flexion 130 degrees 
“limited by mechanical.” Extension in both knees was to 0 degrees (normal 0 degrees). There 
were no instability or meniscal findings. A medical statement dated about 3 weeks prior to the 
PEB reports no changes as of that time. At the VA Compensation and Pension (C&P) exam 
performed 5 months after separation, the CI reported bilateral weakness, stiffness, giving way 
and lack of endurance. The pain was characterized as aching and dull and relieved sufficiently 
with Motrin to enable function. Physical exam revealed tenderness and guarding on the right. 
Tenderness was also present on the left. Repetitive movement led to pain in both joints which 
limited joint function by 4 degrees on the right (ROM 0-135 degrees), and by 2 degrees on the 
left (ROM 0-138 degrees). Testing for stability of the anterior and posterior cruciate ligaments 
revealed slight instability of the right knee. Medial and lateral collateral ligament stability 
testing of the right knee also showed instability. Testing of the medial and lateral meniscus was 
normal. There was no ligamentous instability noted in the left knee. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB, while acknowledging bilateral chronic knee pain and profile restrictions preventing the CI 
from performing basic soldiering skills, also noted the negative Lachman exam (stability) and 
full ROM. It combined chronic left knee pain and chronic right knee pain as bilateral knee pain, 
coded analogously to 5003 and rated 0% characterizing the pain as slight/occasional. The PEB 
relied on the USAPDA pain policy for not applying separately compensable VASRD codes. The 
Board first considered if the right knee pain and the left knee pain, having been de-coupled 
from the combined PEB adjudication, remained unfitting as established above. Members 
agreed that the functional limitations in evidence justified the conclusion that the right knee 
and left knee conditions were each integral to the CI’s inability to perform her MOS; and, 
accordingly a separate rating for each knee is recommended. The VA, basing its decision on the 
C&P exam, coded left knee strain 5257 (Recurrent subluxation or lateral instability) and, citing 
Deluca criteria, rated it as slight, 10%. VA coded right knee strain with ligament instability as 
5257 as well and rated it at 10%. Lastly, VA also coded right knee strain as 5260 (limitation of 
flexion) citing painful motion and rating it at an additional 10%. The Board considered the 
frequent documentation of pain with activity bilaterally in the treatment record and concluded 


that there was adequate evidence to concede functional loss due to painful motion of both 
knees. However, joint instability was denied by the CI herself and found to be absent by the 
examiner at the MEB exam. Although the C&P exam which demonstrated slight instability on 
exam occurred only 4 months after separation, the Board concluded that this finding was not 
more probative than the numerous exams in evidence which took place up to the time of 
separation, including the MEB exam reported one month prior to separation, which found it to 
be absent. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
(reasonable doubt), §4.59 (painful motion), and §4.40 (functional loss), the Board recommends 
that the bilateral knee condition be rated for two separate unfitting conditions as follows: right 
knee pain coded 5299-5260 rated 10% and left knee pain coded 5299-5260 rated 10%. 

 

 

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 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 
bilateral knee pain condition, the Board unanimously recommends that each joint be separately 
adjudicated as follows: an unfitting right knee pain coded 5299-5260, rated 10% and an 
unfitting left knee pain syndrome coded 5299-5260, 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 her prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Right Knee Pain 

5299-5260 

10% 

Left Knee Pain 

5299-5260 

10% 

COMBINED (w/BLF) 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120907, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130009093 (PD201201752) 

 

 

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 xxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)