RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200815 SEPARATION DATE: 20030613 

BOARD DATE: 20130314 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4(95B/Military Policeman) medically separated 
for a right knee condition. The CI developed right knee pain, caused by a twisting injury, while 
doing physical training (PT) in March 2000. Despite multiple treatment modalities including 
three arthroscopic surgeries, the knee condition could not be adequately rehabilitated to meet 
the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board 
(MEB). The following conditions, characterized as chronic right knee pain with right patellar 
femoral pain syndrome (PFPS); intermittent low back pain (LBP), no radicular symptoms; and 
right inter trochanteric sclerotic lesion, likely fibrous dysplasia were forwarded to the Physical 
Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. No other conditions were 
submitted by the MEB. The PEB adjudicated right knee pain (PFPS) as unfitting rated 0% with 
likely application of the US Army Physical Disability Agency (USAPDA) pain policy and the 
Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions, 
intermittent LBP and right inter trochanteric sclerotic lesion were determined to be not 
unfitting. The CI made no appeals, and he was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “I am currently rated at 50% disabled by the Dept. of Veterans Affairs.” 

 

 

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. Additionally, the conditions of intermittent LBP and right inter trochanteric 
sclerotic lesion meet the DoDI 6040.44 scope requirements and are accordingly 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 respective 
Board for Correction of Military Records. 

 

 

 


RATING COMPARISON: 

 

Service IPEB – Dated 20030224 

VA - (1 Mo. Post-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

R PATELLOFEMORAL PAIN 
SYNDROME 

5099-5003 

0% 

RESIDUALS OF R KNEE INJURY, 
S/P MENISCAL REPAIR, 
PATELLOFEMORAL SYNDROME 

5257 

10%* 

20030730 

INTERMITTENT LBP 

Not Unfitting 

NO VA ENTRY 

 

 

 

R INTER TROCHANTERIC 
SCLEROTIC LESION 

Not Unfitting 

RIGHT FEMUR TUMOR, BENIGN 

5255-5015 

0% 

20030730 

No Additional MEB/PEB Entries 

Other x 1 

20030730 

Combined: 0% 

Combined: 10%* 



Derived from VA Rating Decision (VARD) dated 20031205 (most proximate to date of separation [DOS]). DRO Decision of 
3/22/05, changed the code to 5259-5257, increased the rating and combined to 30%, backdated to 6/14/03, the day after 
separation. Lower back strain 5237 was added at 0% effective 20041030 and increased to 10% effective 20070301. 

 

 

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 service and VA evidence proximal to 
separation in arriving at its recommendations and DoDI 6040.44 defines a 12-month interval for 
special consideration of 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. 

 

Right Patellofemoral Pain Syndrome. The goniometric 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. 

 

Right Knee ROM 

(Degrees) 

MEB ~5 Mo. Pre-Sep 

VA C&P ~1 Mo. Post-Sep 

Flexion (140 Normal) 

130 

120 

Extension (0 Normal) 

0 

0 

Comment 

Goniometer used; stable varus and 
valgus stress; Lachman’s with sharp 
end point; negative anterior and 
posterior drawer; pain with palpation 
of medial joint line; mild patellar 
crepitus with extension and positive 
patellar grind; negative McMurray’s; no 
antalgic gait 

No collateral ligament instability; negative 
Lachman’s and anterior and posterior 
drawer tests; right quadriceps and 
hamstrings slightly weaker than left and 
quads were 4.5/5; grind test positive; 
McMurray’s test uncomfortable 
medially>laterally 

§4.71a Rating 

10% 

10% 



 

The CI had three arthroscopic surgeries in his right knee, debridement of the superior medial 
patella in August 2000, medial plica ablation in April 2001, and debridement of the patellar 
tendon in April 2002. Despite these procedures, physical therapy, and medications, the CI’s 
pain continued. Right knee X-rays in September 2002 were normal. The MEB narrative 
summary (NARSUM) completed approximately 5 months prior to separation noted the CI was 
unable to stand longer than thirty minutes or run more than 1/8th of a mile. The CI stated his 
knee felt like it was going to give out and he had pain and swelling. The pertinent physical 
examination findings are in the chart above. At the VA Compensation and Pension (C&P) exam 
performed approximately 6 weeks after separation, the CI reported a similar clinical history and 
symptoms of constant pain, giving out, and increased pain and swelling with increased activity. 
The CI reported that his first arthroscopy included repair of a meniscal tear and the third one 
included an anterior cruciate ligament (ACL) repair. However, neither of these procedures was 


noted in the operative reports and the menisci and ACL were normal. The examiner’s diagnosis 
was patellofemoral syndrome (PFS). The pertinent physical examination findings are in the 
chart above. 

The Board directs attention to its rating recommendation based on the above evidence. Rating 
analogous to 5003, the PEB assigned a 0% disability stating the CI’s right knee was stable with 
normal ROM and that the condition was rated for pain. It is not clear whether the USAPDA pain 
rule was used or not. The VA rated Residuals of right knee injury, status post (s/p) meniscal 
repair, PFS using VASRD 5257 Knee, other impairment of: Recurrent subluxation or lateral 
instability and assigned a 10% disability rating for slight recurrent subluxation or lateral 
instability. The VA changed the code to 5259 in 2004 and did not change the rating percentage. 
A Decision Review Officer Decision dated 22 March 2005 that granted service-connection for 
lower back strain did not include any discussion of the right knee condition but included a new 
VASRD code, 5259-5257 and a 30% disability rating with the original effective date of 14 June 
2003. A future exam was scheduled for July 2006. A right knee C&P examination was done in 
January 2005, prior to this first notation of an increased knee rating. However, this 
examination does not support a rating greater than 10%. A subsequent right knee C&P 
examination in 2010 also did not support a rating greater than 10%. There is nothing in the 
record that either discusses or supports this 30% rating. In review in the examinations 
proximate to the date of separation, the Board notes that both examinations support a rating 
of 10% based on painful motion. No instability was noted on either examination and no 
acceptable rating scheme leads to a rating greater than 10%. After due deliberation, 
considering all of the evidence and mindful of VASRD §4.3 Resolution of reasonable doubt and 
4.59 Painful motion, the Board recommends a disability rating of 10% for the Right PFPS 
condition. 

 

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s 
determination that intermittent LBP and right inter trochanteric sclerotic lesion conditions were 
not unfitting. The Board’s threshold for countering fitness determinations is higher than the 
VASRD §4.3 Resolution of reasonable doubt standard used for its rating recommendations, but 
remains adherent to the DoDI 6040.44 “fair and equitable” standard. Neither contended 
condition was profiled or implicated in the commander’s statement. Although the MEB 
determined both conditions failed to meet retention standards, the PEB determined that 
neither condition was unfitting. The record available for review does not contain any evidence 
of functional impairment that was related to either one of these conditions and prevented the 
CI from performing the duties required of his MOS. The VA initially denied service-connection 
for low back arthritis because there was no clinical diagnosis of this condition at the time of the 
initial C&P examination in July 2003. It was later service-connected effective October 2004 the 
day a disability was identified by his chiropractor. Both conditions were reviewed by the action 
officer and considered by the Board. There was no performance-based evidence from the 
record that either of these conditions significantly interfered with satisfactory duty 
performance. After due deliberation in consideration of the preponderance of the evidence, 
the Board concluded that there was insufficient cause to recommend a change in the PEB 
fitness determination for the either of the contended conditions and no additional disability 
ratings are recommended. 

 

 

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 Right Patellofemoral 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 PFPS condition, the Board unanimously recommends a disability rating of 
10%, coded 5099-5003 IAW VASRD §4.71a. In the matter of the contended Intermittent LBP 
and right inter trochanteric sclerotic lesion, likely fibrous dysplasia conditions, the Board 
unanimously recommends no change from the PEB determinations as not unfitting. 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 Patellofemoral Pain Syndrome 

5099-5003 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120613, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxx, AR20130007730 (PD201200815) 

 

 

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 xxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)