RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201190 SEPARATION DATE: 20021225 

BOARD DATE: 20130306 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty 1LT (13A/Artillery), medically separated for diabetes 
mellitus (DM) requiring oral hypoglycemic and chronic pain, left knee. The CI reports having 
blurred vision, frequent urination and nocturia in January 2002. He was tested and diagnosed 
with diabetes in March 2002 and prescribed daily medication. Though his diabetes was 
controlled with medication the CI was unable to perform his Military Occupational Specialty 
(MOS) duties due to possible hypoglycemic reactions of the medications required to control his 
diabetes. Additionally, the CI reports having non-traumatic left knee pain first occurring in 
November 2001; after playing football during physical training. CI was diagnosed with a medial 
meniscus tear and received arthroscopic surgery in January 2002. The CI did not respond 
adequately to operative and rehabilitative treatment to meet the physical requirements of his 
MOS or satisfy physical fitness standards. He was issued a permanent P3/L3 profile and 
referred for a Medical Evaluation Board (MEB). DM and left knee pain were forwarded to the 
Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. There were no 
other conditions forwarded to the PEB. The PEB adjudicated the DM as unfitting rated 20% 
with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD), while the 
chronic pain, left knee was rated 0%, with cited application of the US Army Physical Disability 
Agency (USAPDA) pain policy. The CI made no appeals, and was medically separated with a 
20% disability rating. 

 

 

CI CONTENTION: “Type II diabetes, renal insufficiency secondary to diabetes; left knee 
meniscus tear repair; degenerative arthritis lumbar spine; blurred vision secondary to 
diabetes.” 

 

 

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 DM and left knee conditions 
requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview, 
and are accordingly addressed below. The contended blurred vision and renal insufficiency 
secondary to diabetes are considered by the Board only with regard to rating the unfitting 
diabetes and are otherwise outside the scope of the Board. 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 20021016 

VA (~2-3 Mos. Pre-Separation) – All Effective Date 20021226 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

DM 

7913 

20% 

Renal Insufficiency Secondary to DM 

7541 

60%* 

2021004 

DM Type II 

7913 

20%* 

20021004 

Blurred Vision secondary to DM 

6099 

NSC* 

20020902 

Chronic Pain, Left 
Knee 

5099-5003 

0% 

Residuals of Left Knee Meniscus Tear 
Repair 

5262 

10%* 

20021004 

No Additional MEB/PEB Entries 

Degenerative Arthritis Left Spine 

5010 

10% 

20021004 

Combined: 20% 

Combined: 70% 



*No rating changes found in subsequent VARDs 

 

 

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 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 (DVA), 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. 

 

Diabetes Mellitus Condition. The CI was diagnosed with DM, Type II, in January 2002. He was 
treated with an oral hypoglycemic agent and referred to nutrition consult for diet modification. 
Although the CI's activities were restricted for diabetes control, there was no regulation of his 
activities and he was able to continue being active in his personal and professional life. The CI 
never experienced any ketoacidosis and was never hospitalized due to the diabetes. He had 
some blurred vision likely related to transient elevations in blood sugar; ophthalmological 
examinations on 29 March 2002, and 2 September 2002 showed he only required eyeglasses 
and that he had no eye complications of diabetes. Tests to evaluate kidney complications of his 
diabetes had revealed no microalbumin in the urine and blood kidney tests have been normal 
or at worst showing minimal effect on the kidneys. The CI was not treated with Insulin. At the 
MEB physical exam on 27 August 2002 (4 months prior to separation), the CI's diabetes was 
well controlled and he was being treated with oral medications. At the VA Compensation and 
Pension (C&P) evaluation on 4 October 2002 (2 months prior to separation), it was noted that 
the diabetes was well controlled and treated with oral hypoglycemic agent and diet and activity 
restriction. His hemoglobin A1C level was normal (indicating good diabetes control). His eye 
exam was normal. His urinalysis was normal. Blood tests related to kidney function showed 
values of BUN at 20 (normal range 9-21) and creatinine at 1.31 (normal range 0.7-1.4); these 
values were just at the upper limits of normal and at the most suggested only minimal adverse 
effect on the kidneys as a complication of the diabetes. Two ophthalmological examinations 
within one year of separation revealed no eye complications of diabetes. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB rated the DM 20% coded 7913. The VA rated the DM Type II 20% coded 7913. Under the 
applicable code 7913 of the VASRD, the Board noted that the CI's DM was treated with diet and 
oral hypoglycemic agent (did not require Insulin), and was in good control. The Board adjudged 
that the CI’s activity restriction did not reach the VASRD code 7913 level of “regulation of 
activities.” The Board adjudged that the CI had no ocular complications due to diabetes and 
that there was little evidence to support any significant renal complications from diabetes. The 
Board concluded that the DM warrants a 20% rating under diagnosis code 7913 and the higher 


rating of 40% is not supportable since the CI was not treated with Insulin. After due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of 
reasonable doubt), the Board concluded that there was insufficient cause to recommend a 
change in the PEB adjudication for the DM condition. 

 

Chronic Pain, Left Knee Condition. The CI reported left knee pain first occurring in November 
2001 after playing football during physical training (PT). He was diagnosed with a medial 
meniscus tear and received arthroscopic surgery in January 2002. At an orthopedics evaluation 
on 14 May 2002, the CI's range-of-motion (ROM) was flexion to 140 degrees and extension to 0 
degrees; however this exam was not probative since the CI was still recovering from knee 
surgery. The CI received physical therapy; however he did not respond adequately to the 
operative and rehabilitative treatment and was referred for a Medical Evaluation Board (MEB). 
At the MEB physical exam on 27 August 2002 (4 months prior to separation), the CI had 
tenderness of near the left kneecap, no left knee instability, and a normal gait; his ROM was not 
measured. At the C&P exam on 4 October 2002 (2 months prior to separation), the CI stated he 
developed occasional swelling of the knee; however, he experienced pain in the knee with 
running or walking which usually lasted all day. His posture and gait were normal. ROM was 
140 degrees flexion and 0 degrees extension (normal 0-140 degrees). He also had pain with 
motion of the left knee. The knee joint had no instability. X-ray of the left knee showed no 
abnormality. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB applied the USAPDA pain policy in effect at the time and rated the left knee, chronic pain as 
0% using diagnosis code 5099-5003. The VA rated the residuals of left knee meniscus tear 
repair 10% coded 5262. The Board considered the applicable codes for the left knee condition: 
5257 knee instability, 5259 removal of semilunar cartilage, 5260 limitation of flexion, 5261 
limitation of extension, and 5003 degenerative arthritis. Based on the ROM noted above, and 
the absence of any left knee instability, the Board concluded that the CI would be rated 0% 
under 5257, 5260, and 5261. With involvement of only one major joint and no limitation of 
motion, the CI would also rate 0% under code 5003. The Board then considered code 5259, 
removal of symptomatic cartilage. The Board concluded that in addition to the underlying left 
knee cartilage pathology requiring surgery under this code, application of VASRD §4.59 (Painful 
motion) and VASRD §4.40 (Functional loss of the left knee due to limitation of activities like 
running and walking) combined to support a rating of 10% coded analogously as 5099-5259. 
The Board notes that the PEB's 0% rating was supported by the USAPDA pain policy in effect at 
time of PEB's adjudication, however it was not consistent with VASRD §4.71a rules based on 
information provided by the MEB and C&P examinations. 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 10% for the chronic pain, 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 chronic pain, left knee was operant in this 
case and the condition was adjudicated independently of that policy by the Board. In the 
matter of the DM condition and IAW VASRD §4.119, the Board unanimously recommends no 
change in the PEB adjudication. In the matter of the chronic pain, left knee condition, the 
Board unanimously recommends a disability rating of 10%, coded 5099-5259 IAW VASRD §4.40, 
§4,59, and§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; and, that the discharge with severance pay be recharacterized to reflect permanent 
disability retirement, effective as of the date of his prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Diabetes Mellitus 

7913 

20% 

Chronic Pain, Left Knee 

5099-5259 

10% 

COMBINED 

30% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120603, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxx, 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 xxxxxxxxxxxxxxxxxxxxx, AR20130007833 (PD201201190) 

 

 

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 30% effective the date of the individual’s original medical 
separation for disability with severance pay. 

 

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: 

 

 a. Providing a correction to the individual’s separation document showing that 
the individual was separated by reason of permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 

 

 b. Providing orders showing that the individual was retired with permanent 
disability effective the date of the original medical separation for disability with 
severance pay. 

 

 c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will 
account for recoupment of severance pay, and payment of permanent retired pay at 
30% effective the date of the original medical separation for disability with severance 
pay. 

 

 d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 
and medical TRICARE retiree options. 

 

 

 

 

 

 

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)