RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200749 SEPARATION DATE: 20030916 

BOARD DATE: 20130228 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty CPT/O-3 (25AD0/Maintenance & Automation Officer), 
medically separated for right shoulder and left knee pain. Despite physical therapy and 
medication, the CI did not improve adequately to meet the physical requirements of his Military 
Occupational Specialty (MOS) or to satisfy physical fitness standards. He was issued a 
permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded 
1) Right shoulder pain, status post distal clavicle fracture and acromioclavicular (AC) joint 
separation, status post distal clavicle resection and coracoclavicular ligament reconstruction 
and 2) Left knee pain, status post traumatic patellar tendon laceration and subsequent repair 
as the only conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated 
the right shoulder and left knee pain conditions as unfitting, rated 10%, with application of the 
US Army Physical Disability Agency (USAPDA) pain policy. The CI initially appealed but then 
withdrew his appeal and he was medically separated with a 10% disability rating. 

 

 

CI CONTENTION: “Speech and thought impairments due to head injury.” 

 

 

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 unfitting right shoulder and left knee 
pain conditions meet the criteria prescribed in DoDI 6040.44 for Board purview, and are 
accordingly addressed below. The requested speech and thought impairments due to head 
injury conditions are not within the Board’s purview. Any condition 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 20030115 

VA (~5 Mos. Pre-Separation) – All Effective Date 20030917 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Right 
Shoulder, Left 
Knee Pain 

5009-
5003 

10% 

Residuals Right Shoulder Injury with Clavicle 
Fracture and Joint Separation s/p Repair 

5201 

20% 

20030407 

Surgical Scar from Right Clavicle Resection 

7805 

0% 

20030407 

Residuals of Left Knee Injury with Reconstruction 
of Patellar Tendon 

5260 

10% 

20030407 

Surgical Scar of the Left Knee 

7805 

0% 

20030407 

Residual Scar, Left Knee Abrasion 

7805 

0% 

20030407 

No Additional MEB/PEB Entries 

Residuals of Right Knee Injury with LCL Strain 

5260 

10% 

20030407 

Scar due to Chest Tube Placement Right Trapezius 

7804 

10% 

20030407 

Tinea Versicolor 

7813-7806 

10% 

20030407 

Right Hand Impairment due to Head Trauma 

8045-8516 

10% 

20030407 

Left Hemisphere Traumatic Lesion 

8045-9304 

10% 

20030327 

0% X 5 others / Not Service-Connected x 1 

20030407 

Combined: 10% 

Combined: 60%* (BLF 1.9 for 5260, 5260) 



* No change to subsequent VARD ratings and effective dates 

 

 

ANALYSIS SUMMARY: The Board’s authority as defined in DoDI 6040.44, resides in evaluating 
the fairness of Disability Evaluation System (DES) fitness determinations and rating decisions for 
disability at the time of separation. The Board utilizes VA evidence proximal to separation in 
arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special 
consideration to post-separation evidence. Post-separation evidence is probative only to the 
extent that it reasonably reflects the disability and fitness implications at the time of 
separation. 

 

The PEB rated right shoulder pain and left knee pain 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 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. 

 

Right Shoulder Pain Condition. The Board first considered if the right shoulder pain condition, 
having been de-coupled from the combined PEB adjudication, was reasonably justified as 
independently unfitting. The permanent profile prohibited push-ups and limited lifting to forty 
pounds and the CI’s commander stated these limitations prohibited him from performing his 
required duties in a combat environment. The service treatment records (STRs) document 
ongoing treatment for type II distal clavicle fracture, chronic and type V AC separation, chronic 
with continued pain and decreased range-of-motion (ROM) both before and after surgical 
reconstruction. All of the members agreed that the right shoulder pain condition, as an isolated 
condition, would have rendered the CI incapable of continued service within his MOS, and 
accordingly merits a separate rating. 

 

The goniometric 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. 

 


 

Right Shoulder ROM 

PT ~17 Mo. Pre-Sep 

MEB NARSUM 

~10 Mo. Pre-Sep 

VA C&P ~5 Mo. Pre-Sep 

Flexion (0-180°) 

150 (pain at extremes) 

150 

150 (pain at 100) 

Abduction (0-180°) 

150 (pain at extremes) 

110 (limited by pain) 

110 (pain at 80) 

Comments 

Goniometer not noted; 
pain on extremes; 
motor trapezeii 3+/5, 
ER 4/5, IR 4+/5 

Goniometer not noted; TTP at 
clavicle but reduced and joint 
stable; strength 5/5 IR, ER, 
abduction; no deltoid atrophy 

Goniometer utilized; painful motion; 
tender to palpation at distal clavicle and 
AC area; significant pain with attempts of 
both apprehension and drop arm testing; 
repetitive motion produced fatigability 
and increased pain 

§4.71a Rating 

10% 

10% 

10% (20% VA rating) 



 

The CI was involved in a motorcycle accident in August 2000 and was treated with rehabilitation 
for right shoulder separation and pain. In March 2001, he underwent a right distal clavicle 
resection and reconstruction of coracoclavicular ligaments as treatment for his Type II distal 
clavicle fracture, chronic and type V AC separation, chronic. An evaluation by physical therapy 
completed 17 months prior to separation, noted decreased ROM and motor weakness. At the 
MEB narrative summary (NARSUM) exam, 10 months prior to separation, the CI reported pain 
in the right shoulder, primarily with overhead lifting and carrying heavy objects. He also 
complained of night pain, decreased ROM secondary to pain and easy fatigue in the trapezius 
muscle. Intra-operative and post-operative X-rays in 2001 confirmed appropriate reduction and 
the NARSUM noted the clavicle was well reduced and stable. Physical findings, including 
normal motor strength, are in the ROM chart above. The VA Compensation and Pension (C&P) 
exam approximately 5 months prior to separation noted pain, weakness, stiffness, fatigue, and 
lack of endurance of the right shoulder. ROM measurements and physical findings are in the 
chart above. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB combined the two conditions of left knee pain and right shoulder pain under 5099-5003 at 
10%, reflecting application of the USAPDA pain policy for rating. The VA rated the residuals of 
the right shoulder injury at 20% using VASRD code 5201 (Arm, limitation of motion) based on 
abduction limited to 110 degrees with painful motion at 80 degrees. The minimum 
compensable limitation of motion for the shoulder under 5210 is at shoulder level, or 90 
degrees, for both flexion and abduction. While the CI did have pain at 80 degrees of abduction, 
abduction to 110 degrees was possible. Therefore, the minimum compensable ROM is 
exceeded. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
Reasonable doubt and §4.59 Painful motion, the Board recommends a disability rating of 10% 
for the right shoulder condition. 

 

Left Knee Pain Condition. The Board first considered if the left knee pain condition, having 
been de-coupled from the combined PEB adjudication, was reasonably justified as 
independently unfitting. The permanent profile prohibited forced running, rucksack marching, 
and marching, and any type of jumping activity. It also limited marching to two miles and 
walking, running, bicycling, swimming, and walking or running in the pool to the CI’s own pace 
and distance. The CI’s commander stated these limitations prohibited him from performing his 
required duties in a combat environment. The service treatment records (STRs) document 
ongoing treatment for the left knee pain with physical therapy and activity limitations. All of 
the members agreed that the left knee pain condition, as an isolated condition, would have 
rendered the CI incapable of continued service within his MOS, and accordingly merits a 
separate rating. 

 


The goniometric 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. 

 

Left Knee ROM 

MEB NARSUM ~10 Mo. Pre-Sep 

VA C&P ~5 Mo. Pre-Sep 

Flexion (140° Normal) 

125 

130 (Pain at 120) 

Extension (0° Normal) 

0 

0 

Comment 

Goniometer not noted; patellar tendon 
intact; guard significantly during exam; 
positive patellar grind; no ligamentous 
instability; no effusion, meniscal or 
other intraarticular injury; excellent 
quadriceps tone 

Goniometer utilized; painful motion at 120 
degrees; tender to palpation inferior to patella, 
patella periphery, and patella tendon areas; no 
ligament instability; no effusion, no swelling; 
normal gait and posture; repetitive motion 
produced fatigability and increased pain 

§4.71a Rating 

10% 

10% 



 

The CI was involved in a motorcycle accident in August 2000 and underwent immediate surgical 
repair of a traumatic left patellar tendon rupture in a German hospital. No operative report is 
available for review. Left knee X-ray was normal in January 2001 and magnetic resonance 
imaging (MRI) of the left knee in April 2001 revealed a continued abnormality of the patellar 
tendon. The MEB NARSUM completed 10 months prior to separation noted the CI had anterior 
knee pain with prolonged sitting or standing, with running, and with climbing. A neoprene 
sleeve helped somewhat with his pain. The physical exam findings are noted in the chart 
above. Of note, while painful motion was not specifically mentioned, the examiner noted the 
presence of significant guarding during the examination. The C&P exam 5 months prior to 
separation noted pain, weakness, stiffness, fatigue, and lack of endurance of the left knee. The 
physical exam findings are noted in the chart above. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB combined the two conditions of left knee pain and right shoulder pain under 5099-5003 at 
10%, reflecting application of the USAPDA pain policy for rating. The VA rated the left knee 
pain condition at 10% using VASRD 5260 Leg, limitation of flexion of based on pain limited 
motion. Both the MEB NARSUM and the VA examinations support the finding of pain-limited 
motion and neither examination documented any joint instability. After due deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and VASRD §4.59 
(painful motion), the Board recommends a disability rating of 10% for the left knee condition. 

 

 

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 right shoulder and left knee was operant in 
this case and the condition was adjudicated independently of that policy by the Board. In the 
matter of the contended right shoulder pain condition, the Board unanimously agrees that it 
was separately unfitting and by a vote of 2:1 recommends a disability rating of 10%, coded 
5003-5024 IAW VASRD §4.71a. The single voter for dissent (who recommended a disability 
rating of 20% coded 5201) did not elect to submit a minority opinion. In the matter of the 
contended left knee pain condition, the Board unanimously agrees that it was separately 
unfitting and unanimously recommends a disability rating of 10%, coded 5260 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 Shoulder Pain 

5003-5024 

10% 

Left Knee Pain 

5260 

10% 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120605, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 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 xxxxxxxxxxxxxxxxxxxxxx, AR20130007513 (PD201200749) 

 

 

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 xxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)