RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200580 SEPARATION DATE: 20020729 

BOARD DATE: 20130205 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (31L10/Wire Systems Installer) medically 
separated for bilateral retro-patellar pain syndrome. She twisted her right knee in 1996 and 
reinjured the same knee again in 2000 and has had progressively worsening pain in both knees 
ever since. Despite being treated with non-steroidal anti-inflammatory medications and 
physical therapy, the CI could not be adequately rehabilitated to meet the physical 
requirements of her Military Occupational Specialty (MOS). She was issued a permanent L3/S2 
profile and referred for a Medical Evaluation Board (MEB). Major depressive disorder (MDD), 
identified in the rating chart below, was also identified and forwarded by the MEB. The 
Physical Evaluation Board (PEB) adjudicated the bilateral knee condition as unfitting, rated 0% 
with application of the US Army Physical Disability Agency (USAPDA) pain policy. The remaining 
condition was determined to be not unfitting and therefore not rated. The CI made no appeals 
and was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “The condition for which I was discharged have become WORSE! Especially 
migraine headaches and pain in my hips.” 

 

 

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 the unfitting bilateral retro-patellar pain syndrome condition will be reviewed. The other 
requested conditions of migraine headaches and hip pain 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 Army Board for 
Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20020523 

VA (3 Mos. Pre -Separation) – All Effective Date 20020730 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Retro-patellar 
Pain Syndrome 

5099-5003 

0% 

Lt Knee Strain w/ Arthritic 
Changes 

5010-5260 

0% 

20020502 

Major Depressive Disorder 

Not Unfitting 

NO VA ENTRY 

.No Additional MEB/PEB Entries. 

Bilateral Pes Planus 

5276 

10% 

20020502 

Lower Back Strain w/ DJD 

5292 

10% 

20020502 

Cluster Headaches 

8199-8100 

10% 

20020502 

0% x2 

20020502 

Combined: 0% 

Combined: 30% 



 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which her service-incurred condition continues to 
burden her. The Board wishes to clarify that it is subject to the same laws for service disability 


entitlements as those under which the Disability Evaluation System (DES) operates. 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. That role and 
authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under 
a different set of laws (Title 38, United States Code). The Board evaluates DVA evidence 
proximal to separation in arriving at its recommendations, but its authority resides in evaluating 
the fairness of DES fitness decisions and rating determinations for disability at the time of 
separation. The Board also acknowledges the CI's contention suggesting that ratings should 
have been conferred for other conditions documented at the time of separation and for 
conditions not diagnosed while in the service (but later determined to be service-connected by 
the DVA). 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 DVA, however, is 
empowered to compensate 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 PEB rated the bilateral retro-patellar pain syndrome under the single analogous 5003, 
degenerative arthritis, code. This coding approach is countenanced by AR 635-40 (B.24 f.) but 
IAW DoDI 6040.44 the Board must apply only Veterans Scheduling for Rating Disabilities 
(VASRD) guidance to its recommendation. The Board must therefore apply separate codes and 
ratings in its recommendations if compensable ratings for each joint are achieved 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 reasonably 
justified as unfitting in and of itself. Since §4.71a criteria are met for separate joint ratings in 
this case, the Board is pursuing separate rating and fitness evaluations as follows. The Board 
first considered if each knee individually, having been de-coupled from the combined PEB 
adjudication, remained independently unfitting as established above. The entirety of the 
record present for review indicated that the vast majority of the CI’s knee complaints were due 
to bilateral knee pain. Neither knee was identified as being individually responsible for the CI’s 
limitations. The CI’s commander’s statement contained the passage, “Her knee problem 
precludes satisfactory performance of primary MOS requirements….” Her final permanent 
profile listed retro-patellar pain syndrome as one of the medical conditions that caused her 
physical limitations. The Board’s threshold for fitness determinations is “reasonably justified” 
which is consistent with the VASRD §4.3 (Resolution of reasonable doubt) standard used for its 
rating recommendations, and remains adherent to the DoDI 6040.44 “fair and equitable” 
standard. The PEB’s adjudication specifically noted “bilateral” in the disability description of 
the unfitting retro-patellar pain syndrome and there is insufficient data to identify either knee 
as not unfitting. After due deliberation in consideration of the preponderance of the evidence, 
all members agreed that each knee individually would have rendered the CI incapable of 
continued service within her MOS, and accordingly merit a separate rating. 

 

Left and Right Retro-patellar Knee Pain. There were 2 range-of-motion (ROM) evaluations in 
evidence, with documentation of additional ratable criteria, which the Board weighed in 
arriving at its rating recommendations. Because each knee was similarly affected, evaluated 
and adjudicated, the physical exam findings regarding each knee will be summarized in the 
chart below. 

 

 

 

 

 

 

 


Bilateral Knee ROMs 

Ortho 11 Mos. Pre-Sep 

NARSUM 5.5 Mos. Pre-Sep 

VA C&P ~3 Mos. Pre-Sep 

Left 

Right 

Left 

Right 

Left 

Right 

Flexion (140° Normal) 

130° 

130° 

No ROM measurements 

140° 

140° 

Extension (0° Normal) 

0° 

0° 

0° 

0° 

Comment 

Full ROM Bilaterally 

Neg. effusion & valgus or 
varus laxity 

Neg. Drawer & Lachman’s 

Pos. Patellar grind 

Denied locking or giving out 

Bilateral Patellar 
Tenderness; Pos. grind test 
of both patella 

No effusion or edema 

Negative Drawer, McMurray 
& Lachman’s 

Good muscle strength 
bilaterally with normal gait 

 

Normal gait & standing 

Neg. Drawer & McMurry 
Bilaterally 

Bilateral ROM not additionally 
affected by pain, fatigue, 
weakness, lack of endurance or 
incoordination 

 

§4.71a Rating 

0%* 

0%* 

0%* 

0%* 

0%* (VA 0%) 

0%*(VA NR) 



* No specific documentation of painful motion IAW §4.59 contained in the service treatment records 

 

At the MEB exam accomplished 6 months prior to separation, the CI simply noted retro-patellar 
pain syndrome “RPPS” when answering the question concerning “knee trouble.” The MEB 
physical exam noted “positive grind test left knee, negative drawer and negative McMurry’s.” 
The narrative summary (NARSUM) prepared 5 months prior to separation noted that the CI 
reported she twisted her right knee during a training exercise in 1996 and reinjured her right 
knee when she hit it with a tailgate in November 2000. She reported continued intermittent 
right knee pain after these incidents, but over the past 18 months the knee pain progressed to 
both knees and became progressively worse. She reported treatment with non-steroidal anti-
inflammatories and a course of physical therapy, which had no lasting improvement. The CI 
was evaluated by orthopedics and was determined not to be a surgical candidate. She reported 
that she continued to have knee pain, especially after running, and worse in the mornings. A 
non-steroidal anti-inflammatory medication was prescribed. She was placed on a permanent 
profile in October 2001 and the last physical fitness test she completed was in January 2001. 
The physical exam findings are summarized in the chart above. Radiographic studies performed 
were a bone scan which was negative and plain film X-rays of both knees were also normal. 
Military specific duties within her MOS that she could not perform included: climbing poles, 
crawling, stooping, squatting, and getting in and out of manholes. She was also unable to run, 
jump, march or stand for a prolonged period of time. 

 

At the VA Compensation and Pension (C&P) exam accomplished 2 months prior to separation, 
the CI reported her condition was related to traumatic left knee injury in July 1998. Her left 
knee symptoms were pain, weakness, inflammation, locking, fatigue, and lack of endurance. 
She denied having swelling or instability or dislocation or stiffness or recurrent subluxation. All 
symptoms were present on a constant basis and were uncomfortable in nature. The CI could 
not function without distress and she denied constitutional symptoms of a joint condition such 
as anemia, weight-loss, fever, or skin disorder. She used non-steroidal anti-inflammatory 
medications for 4 years on an as needed basis. Within the past year, she had treatment with 
physical therapy three times a week for 6 weeks, with no response. The physical exam findings 
are summarized in the chart above. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB applied the analogous VASRD code of 5099-5003 for the bilateral retro-patellar pain 
syndrome and rated it 0% for minimal constant pain specifically citing the USAPDA pain policy. 
The VA applied the analogous code of 5010-5260 to the left knee strain with arthritic changes 
and code it 0% for non-compensable ROM and no documented pain, fatigue, weakness or 
incoordination during the VA C&P exam. There was no VA rating for the right knee. As 
determined above, each knee is adjudged to be separately unfitting and will be rated with 
application of VASRD only guidance as required by DoDI 6040.44. There was no documented 
knee disability due to compensable ROM measurements, cartilage abnormality, subluxation or 


instability as required for rating under the appropriate VASRD diagnostic codes for specific knee 
disabilities. The VASRD code 5003 allows for rating joints under the conditions present in each 
of the CI’s knees. The rating guidance for code 5003 states that a 10% evaluation is granted for 
each major joint affected by limitation of motion objectively confirmed by findings such as 
swelling, muscle spasm, or satisfactory evidence of painful motion. The evidence present in this 
case does not objectively confirm the presence of painful motion in the service treatment 
records. In addition, there was no X-ray evidence of involvement of these major joints with 
occasional incapacitating exacerbations that would warrant a 20% rating in this case. After due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of 
reasonable doubt), the Board recommends a disability rating of 0% for the right retro-patellar 
knee pain condition and a disability rating of 0% for the left retro-patellar knee pain condition 
IAW VASRD §4.31, a no-percent rating, which stipulates, “In every instance where the schedule 
does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation 
shall be assigned when the requirements for a compensable evaluation are not met.” 

 

 

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 retro-patellar pain syndrome was 
operant in this case and the condition was adjudicated independently of that policy by the 
Board. In the matter of the right retro-patellar knee pain condition, the Board, on a 2 : 1 vote, 
recommends a disability rating of 0%, coded 5099-5003 IAW VASRD §4.31. In the matter of the 
left retro-patellar knee pain condition, the Board, on a 2 : 1 vote, recommends a disability 
rating of 0%, coded 5099-5003 IAW VASRD §4.31. The single voter of dissent, who 
recommended rating each knee with a 10% disabling rating, elected not to submit a minority 
opinion. 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 Retro-patellar Knee Pain 

5099-5003 

0% 

Left Retro-patellar Knee Pain 

5099-5003 

0% 

COMBINED (w/ BLF) 

0% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120604, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 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 xxxxxxxxxxxxxxxxxxxxxxx, AR20130006186 (PD201200580) 

 

 

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 description 
without modification of the combined rating or 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)