RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201188 SEPARATION DATE: 20020212 

BOARD DATE: 20130308 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty, SGT/E-5, (92A/Automated Logistical Specialist), 
medically separated for chronic bilateral knee pain. The CI sustained a twisting type injury to 
her left knee in early 1999 and underwent an anterior cruciate ligament (ACL) reconstruction. 
The CI sustained another twisting type injury, this time to her right knee and again underwent 
an ACL reconstruction on the right knee. Since her last surgery she continued to complain of 
knee pain, mostly to her right knee. She was unable to progress in her rehabilitation and could 
not meet the physical requirements of her Military Occupational Specialty (MOS). Her profile 
allowed for an alternate aerobic event to satisfy physical fitness standards. She was issued a 
permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded 
no other conditions for Informal Physical Evaluation Board (IPEB) adjudication. The IPEB 
adjudicated the bilateral knee condition as unfitting, rated as a single unfitting condition at 
10%, with cited application of the US Army Physical Disability Agency (USAPDA) pain policy. The 
CI requested a Formal PEB (FPEB), but later accepted the IPEB findings and was medically 
separated with a 10% disability rating. 

 

 

CI CONTENTION: “I believe I should have gotten a 30% disability rating for my disability, 10% 
for left knee, 10% for right knee and 10% for my depression. I should have been given 
retirement benefits from Army. Instead they said that there was not enough evidence to rate 
my panic disorder when I had been treated for 2 years following a diagnosis. I feel I should 
have been found eligible for retirement.” 

 

 

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 left and right knees, as requested for 
consideration meet the criteria prescribed in DoDI 6040.44 for Board purview and are 
addressed below. The other requested condition, depression, is 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 
the Correction of Military Records. 

 

 


RATING COMPARISON: 

 

Service IPEB – Dated 20011105 

VA (STR used) – All Effective Date 20020213 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Knee Pain 

5099-5003 

10% 

R knee patellofemoral pain s/p 
ACL reconstruction 

5299-5260 

10%* 

STR 

L knee patellofemoral pain s/p 
ACL reconstruction 

5299-5260 

10% 

STR 

.No Additional MEB/PEB Entries. 

Panic Disorder 

9412 

10% 

STR 

0% X 1 / Not Service-Connected x 2 

 

Combined: 10% 

Combined: 30% 



*R knee 5299-5260 changed to 5299-5014, then temporary 100% (20070214-20070401) and added 20% laxity 5257 effective 
20070401 

 

 

ANALYSIS SUMMARY: The Board acknowledges the CI’s contention that suggests ratings should 
have been conferred for other conditions documented at the time of separation. 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. 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. However the Department of Veterans Affairs, operating under a different set 
of laws (Title 38, United States Code), is empowered to compensate all service-connected 
conditions and to periodically reevaluate said conditions for the purpose of adjusting the 
Veteran’s disability rating should the degree of impairment vary over time. 

 

The IPEB combined the right and left knee conditions as a single unfitting condition, coded 
analogously to 5003 (degenerative arthritis) and rated 10%. The Board first evaluated the IPEB 
coding approach of combining the conditions under the single analogous 5003 code. The IPEB 
relied on AR 635-40 for not applying separately compensable VASRD codes (and invoked the 
USAPDA pain policy for rating). 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. 

 

Bilateral Knee Pain. The CI had a history of bilateral knee pain; first left knee in 1999, diagnosed 
as ACL tear and underwent surgical reconstruction. Her right knee had the same diagnosis and 
surgical treatment in December 2000. Despite aggressive PT, she failed to adequately 
rehabilitate and remained with knee pain and thigh weakness of each knee. There was no 
objectively reported post-operative instability, locking, or effusion. The knee exams and 
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. 


 

Knee ROM 

(degrees) 

PT ~24 Mo. Pre-
Sep 

Ortho ~11 Mo. 
Pre-Sep 

MEB ~4 Mo. Pre-Sep 

Left 

Right 

Left 

Right 

Flexion (140) 

FAROM 

140 

135 

135 

Extension (0) 

FAROM 

0 

0 

2 

Comment 

“pain”; +1 
Lachman; quad 
weakness 

Poor quad tone; 
negative 
AD/Lachman 

no val/var instability; 

+ tender; weak quad/ 
atrophy; crepitus 

no val/var instability; 

+ tender; + painful 
motion; weak quad/ 
atrophy; crepitus 

§4.71a Rating 

10% 

0-10% 

10% 

10% 



 

At the MEB exam, (4 months prior to separation) the CI reported bilateral knee pain associated 
with difficulty ascending and descending stairs and the inability to run or perform exertional 
activities. The MEB physical exam noted bilateral patellar hypermobility, crepitus with ROM, 
weak and minimally atrophied thigh musculature, and tenderness. There was markedly positive 
Steinmann’s quadriceps inhibition test. Painful motion was noted on the right knee. 
Additionally, the examiner noted no lateral instability, but other stability tests of both knees 
indicated trace anterior drawer and trace Lachman’s test with firm endpoint on each knee. The 
VA Compensation and Pension (C&P) rating decision dated 21 March 2002 utilized service 
treatment records (STRs) from 1993 through 2002 as evidence for analogous coding 5299-5260 
(leg; limitation of flexion) at 10% rating for each knee. The STR had many outpatient notes 
from orthopedics and physical therapy that were unclear (hand-written) and lacked actual ROM 
measurements of either knee. The profile listed the right knee condition and the commander’s 
statement and NARSUM indicated both knees as limiting duty. There was no C&P exam 
performed proximate to separation. VA records remote from separation indicated right knee 
meniscal surgery 5 years post separation with an additional 20% rating of the right knee for 
laxity. 

 

The Board directs attention to its fitness and rating recommendation based on the above 
evidence. The earlier documented exam findings were left-knee specific whereas the later 
exam findings were right-knee specific. The left and right knee conditions were equivalent in 
diagnosis and clinical features with the right knee more severe than the left. The profile listed 
only the right knee condition; however, the commander’s comments, MEB and PEB noted both 
knees as productive of disability. All members agreed therefore that each knee condition was 
reasonably unfitting and, accordingly merits a separate rating. The Board concluded that 
application of VASRD §4.40 (functional loss) was supported independently for each knee in this 
case; and, separate rating recommendations pursuant to VASRD §4.71a would result. The right 
knee demonstrated specified painful motion and therefore would meet a 10% rating IAW 
VASRD §4.59 (painful motion). The left knee revealed tenderness with palpation, but no 
specified painful motion on exam. However, both knees revealed weakness and atrophy of the 
primary extensor muscles of the knee, crepitus and patellar hypermobility and apprehension. 
Therefore, the left knee would warrant a minimally compensable rating with application of 
§4.40 (functional loss). The VASRD §4.40 states “weakness is as important as limitation of 
motion, and a part which becomes painful on use must be regarded as seriously disabled. A 
little used part of the musculoskeletal system may be expected to show evidence of disuse, 
either through atrophy, the condition of the skin, absence of normal callosity or the like.” After 
careful consideration, all Board members agreed that a minimal compensable rating under 
either a specific joint code or an analogous 5003 code was therefore supported by application 
of §4.40. In this case, a compatible analogous clinical fit with continued post-operative pain is 
patellofemoral pain syndrome (as used by the VA), but coded as 5024 (tenosynovitis) and rated 
per 5003 criteria. 

 


After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), the Board recommends separate ratings of 10% for each knee condition, coded 5003-
5024 at 10% for the right and 5003-5024 at 10% for the left. 

 

 

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 bilateral knee pain condition was operant in 
this case and the condition was adjudicated independently of that policy by the Board. In the 
matter of the bilateral knee condition, the Board unanimously recommends that each joint be 
separately adjudicated as follows: an unfitting right knee condition coded 5003-5024 at 10%; 
and, an unfitting left knee condition coded 5003-5024 at 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 

Patellofemoral Pain Syndrome, Left Knee 

5003-5024 

10% 

Patellofemoral Pain Syndrome, Right Knee 

5003-5024 

10% 

COMBINED (Incorporating BLF) 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120624, 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 xxxxxxxxxxxxxxxxxxxxxx, AR20130007828 (PD201201188) 

 

 

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)