RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201800 SEPARATION DATE: 20030626 

BOARD DATE: 20130418 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty PFC/E-3 (11B/Infantryman), medically separated for 
bilateral knee pain with history of right knee prepatellar septic bursitis, bilateral knee pain and 
right leg pain. On two occasions the CI was injured while performing training. He did not 
improve with anti-inflammatory medications and has pain with any activity. The bilateral knee 
pain with history of right knee prepatellar septic bursitis, bilateral knee pain and right leg pain 
conditions could not be adequately rehabilitated and did not improve adequately with 
treatment to meet the physical requirements of his Military Occupational Specialty (MOS) or 
satisfy physical fitness standards. He was issued a permanent UP3 profile and referred for a 
Medical Evaluation Board (MEB). The MEB forwarded the three conditions of: right knee pain 
status post (s/p) debridment of prepatellar septic bursitis; right leg pain secondary to shin 
splints; and left knee pain secondary to retropatellar pain syndrome for Physical Evaluation 
Board (PEB) adjudication. The PEB adjudicated the bilateral knee pain with history of right knee 
prepatellar septic bursitis, bilateral knee pain and right leg pain conditions as unfitting, rated as 
a single condition at 10%, with likely application of the US Army Physical Disability Agency 
(USAPDA) pain policy. The CI made no appeals, and was medically separated with a 10% 
disability rating. 

 

 

CI CONTENTION: “Can’t stand or walk for long periods of time. Injury worsened knees severly 
painful”. 

 

 

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 conditions bilateral knee pain with 
history of right knee prepatellar septic bursitis, bilateral knee pain and right leg pain as 
requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; 
and, are addressed below. 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 20030328 

VA (2 Mos. Pre & 5 Years Post-Separation) – All Effective Date 
20070911 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Knee Pain with a 
History of Right Knee 
Prepatellar Septic Bursitis 
with Debridement and 
Bilateral Knee Pain and 
Right Leg Pain 

5099-5003 

10% 

Patellofemoral Syndrome, Left 
Knee (claimed as bilateral stress 
fractures of the knees, shin 
splints, bilateral stress fracture 
of the legs, and right leg pain) 

5299-5260 

10% 

STR & 

20080130 

Patellofemoral Syndrome, Right 
Knee (claimed as bilateral stress 
fractures of the knees, shin 
splints, bilateral stress fractures 
of the legs, and right leg pain) 

5299-5260 

10% 

STR & 

20080130 

.No Additional MEB/PEB Entries. 

No Other VA Conditions 

Combined: 10% 

Combined: 20% 



 

 

ANALYSIS SUMMARY: 

 

Bilateral Knee Pain with a History of Right Knee Prepatellar Septic Bursitis with Debridement 
and Bilateral Knee Pain and Right Leg Pain Condition. The PEB combined the right knee pain s/p 
debridement of prepatellar septic bursitis; right leg pain secondary to shin splints; and left knee 
pain secondary to retropatellar pain syndrome conditions under a single disability rating, coded 
analogously to 5003. Although 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. When the Board recommends separate ratings in this circumstance, the result may not 
be lower than the overall combined rating from the PEB. 

 

The narrative summary (NARSUM) indicates that after initially injuring his right leg in a fall, the 
CI began experiencing right leg pain although there was no X-ray evidence of fracture. Shortly 
thereafter, following a crawling exercise, he developed bilateral knee pain and was found to 
have right knee prepatellar septic bursitis. Although that condition responded to treatment, 
bilateral knee pain and right leg pain persisted in spite of treatment with anti-inflammatory 
medications and profiling (including right leg, right knee and left knee). At the time of the MEB, 
the CI reported that he had pain with any activity and that it was specifically aggravated by 
kneeling, squatting or bending. MEB physical exam of the right knee showed a healed scar on 
the medial aspect of the patella. Range-of-motion (ROM) was “from 0°-120° without pain” 
(normal 0-140 degrees). There was tenderness to palpation. Strength and neurovascular 
testing were normal, and there was no instability. Left knee ROM was 0-120 degrees absent 
any mention concerning painful motion and there was normal strength. Neurovascular testing 
was normal, and there was no instability. The C&P exam most proximal to date of separation 
was performed in May 2008, more than 5 years post separation. That exam documented 
bilateral painful motion with additional findings of knee pathology that the VA rated at 10% for 
each knee. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB combined bilateral knee pain with a history of right knee prepatellar septic bursitis, and 
right leg pain as a single unfitting condition, coded analogously to 5003 and rated 10%. The PEB 
may have relied on AR 635.40 (B.24 f.) and/or the USAPDA pain policy for not applying 
separately compensable VASRD codes. The Board first considered if the right knee, the left 


knee and the right leg pain (shin splints), 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 his MOS; and, accordingly a separate rating for 
each knee is recommended. There was insufficient evidence that the right leg pain (shin 
splints) condition was separable from the right knee pain condition and it was considered not 
separately unfitting or ratable. 

 

The only C&P exam in evidence took place more than 5 years post separation. It coded both 
knees separately as 5299-5260 (limitation of flexion of the knee) and, citing painful motion and 
functional loss, assigned a rating of 10% to each knee for a total combined rating of 20%. 
However, since this falls well outside the 12-month window specified in DoDI 6040.44 regarding 
VA evaluations for Board consideration, and is very remote from separation, little probative 
value can be assigned to that exam. Both the MEB and VA examiners documented a consistent 
complaint of pain on use particularly with bending, squatting or kneeling. The MEB exam 
describes ROM of both knees limited to 120 degrees. The commander’s letter states that the CI 
is unable to function in his MOS which, as mentioned in the NARSUM, requires “a lot of 
technical maneuvers to include running, jumping or crawling.” VASRD §4.40 states “a part 
which becomes painful on use must be regarded as seriously disabled,” and the Board 
conceded applicability of VASRD §4.59, painful motion. The Board considered the VA choice of 
coding each knee analogous to 5260, loss of motion in flexion. This coding approach, or 
analogous use of 5003, would yield a minimal 10% compensable rating for each joint with 
application of §4.59 (painful motion). The CI had no history of surgery or meniscal injury to 
support use of disability codes 5258 or 5259 (cartilage, semilunar), and there was no route to 
additional rating for instability under code 5257. After due deliberation, considering all of the 
evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.40 (functional loss), the Board 
recommends that the bilateral knee condition be rated for two separate unfitting conditions as 
follows: right knee and leg pain coded 5299-5262 rated 10% and left knee anterior knee pain 
secondary to patellofemoral syndrome coded 5299-5003 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 
contended right leg pain condition, the Board unanimously recommends a determination as not 
separately unfitting. 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 
secondary to prepatellar septic bursitis coded 5299-5262 rated 10%, and an unfitting left knee 
pain secondary to retropatellar pain syndrome coded 5299-5003 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 

Right Knee Pain Condition Including Leg Pain 

5299-5262 

10% 

Left Knee Pain Condition 

5299-5003 

10% 

COMBINED (w/ BLF) 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20121004, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxxx, AR20130009534 (PD201201800) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)