RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201216 DATE OF PLACEMENT ON TDRL: 20020208 

BOARD DATE: 20130228 DATE OF PERMANENT SEPARATION: 20050331 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was a Reserve SSG/E-6 (95B30/Military Police) medically separated for 
right knee instability following an injury with a physical exam that notes a 2+ Lachman's. He 
twisted his knee in August 1985 during a fall from a repelling tower while on active duty. In 
1987, he underwent an open medial meniscectomy and after a number of follow-on injuries; 
including an ACL tear. He had an anterior cruciate ligament (ACL) reconstruction using bone-
patellar-bone allograft. Despite physical therapy, he 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). Chronic low back pain (LBP) and atrial fibrillation/flutter conditions, identified in 
the rating chart below, were also identified and forwarded by the MEB. The original Physical 
Evaluation Board (PEB) adjudicated the right knee and atrial fibrillation conditions as unfitting, 
rated 20% and 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities 
(VASRD). The remaining conditions were determined to be medically acceptable. The CI was 
then placed on the Temporary Disability Retired List (TDRL) with ratings as reflected in the chart 
below. The final Informal PEB (IPEB) removing him from the TDRL adjudicated the right knee 
condition only as unfitting, rated 20% with application of the VASRD. The CI appealed to the 
Formal PEB (FPEB) which affirmed the IPEB findings. The CI was then medically separated with 
a 20% disability rating. The CI appealed to the Army Board of Correction of Military Records 
which denied his application. A congressional inquiry and USAPDA response are noted in the 
record. 

 

 

CI CONTENTION: “The contention is, the heart condition was removed from the MEB/PEB as no 
longer being an "unfit" condition, rendering a decrease in disability from 30% medical 
retirement to 20% medical separation with severance. The removal of the heart condition was 
contingent on an active duty (Cardiologist) calling and "requesting" medication be discontinued 
until further directed. Approximately 2 weeks later a letter of separation was received. To date 
there is continued use of sotolol.” 

 

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 heart condition requested for 
consideration and the unfitting knee condition meet the criteria prescribed in DoDI 6040.44 for 
Board purview, 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 Army Board for Correction of Military Records. 

 

 

 

 

 

 


TDRL RATING COMPARISON: 

 

Service FPEB – Dated 20050223 

VA* – All Effective Date 20050304 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

On TDRL – 
20020208 

 

TDRL 

Sep. 

Right Knee 
Instability 

5257 

20% 

20% 

Residuals Right Knee Injury, 
S/P Surgical Repair 

5257 

10% 

20050424 

Depressed Surgical Scar, 
Right Knee Assoc w/ 
Residuals 

7800 

10% 

20050424 

Atrial Fibrillation 

7010 

10% 

Medically 
acceptable 

Atrial Fibrillation 

7010 

0% 

20050424 

Chronic Low Back Pain 

Medically 
Acceptable 

Lumbosacral Strain w/ DDD 

5237 

10% 

20050424 

.No Additional MEB/PEB Entries. 

Not Service Connected x 1 

20050424 

Combined: 20% 

Combined: 30% 



* VA rating based on exam most proximate to date of permanent separation. VARD 20060509 atrial fib. NSC; VARD 20111028 
atrial fib 0% effective 20050304. 

 

 

ANALYSIS SUMMARY: 

 

Right Knee Instability and Atrial Fibrillation Conditions at TDRL Entry. At TDRL entry the 
narrative summary (NARSUM) notes the CI was about 14 months post ACL reconstruction 
surgery for a tear of the right knee ACL ligament. In the immediate post-operative period the CI 
experienced atrial fibrillation and flutter. He underwent radial ablation treatment which 
eliminated the flutter, but had persistent atrial fibrillation. 

 

At the MEB exam, the CI reported wearing a brace on the right knee and was unable to 
participate in any sports or return to his job in law enforcement. The MEB physical exam noted 
the knee was without effusion. Range-of-motion (ROM) was from full extension to 120 degrees 
of flexion (normal 140 degrees). Lachman and anterior drawer signs were 2+, indicating ACL 
instability. Right knee X-rays showed screws from the ACL reconstruction, otherwise were 
normal. The examiner stated that the CI had residual instability of his right knee that prevented 
him from participating in physically demanding activities and therefore, was disqualifying. 

 

The cardiology addendum stated that the CIs atrial fibrillation/flutter was managed with 
medications by a civilian cardiologist following reversion to dysrythmia post radial ablation 
treatment. The cardiology evaluation showed an irregular pulse, but the CI was noted to be 
asymptomatic. The heart exam was otherwise normal. Medications listed were Sotalol, 
Atenolol and Coumadin, but the MEB exam indicated the CI was on Flecainide at the time, with 
good control of his heart rhythm. An echocardiogram showed normal chamber size, trace 
mitral regurgitation, but no significant valve disease. The cardiologist opined that the CI was 
currently asymptomatic, but recurrent episodes of the atrial fibrillation/flutter were likely and 
would require indefinite medical therapy. 

 

The MEB referred the CI to the PEB with the medically unacceptable conditions of right knee 
instability and atrial fibrillation/flutter and the medically acceptable condition of chronic low 
back pain. The PEB placed the CI on TDRL with medically unfitting conditions of right knee 
instability and atrial fibrillation as charted above. 

 

Right Knee Instability and Atrial Fibrillation Conditions at End of TDRL. At the TDRL re-
evaluation exam, the NARSUM stated that since his knee surgery, the CI had done physical 
therapy but continued to complain of instability and pain. At the exam, the CI reported 
episodes of his knee locking up two to three times per week-shifting positions of his knee to 


unlock it, with no episodes where it remains locked. He described his pain as moderate, but his 
instability as more than moderate. He reported wearing a knee brace during activity. The MEB 
exam showed the right knee ROM was 0–140 degrees (normal), no varus-valgus laxity, negative 
anterior and posterior drawer signs, no joint line tenderness, but a 2+ positive Lachman with a 
soft endpoint. The examiner stated that the “right knee demonstrates residual instability which 
is more than moderate in degree…” 

 

A cardiology addendum indicated that in November of 2004 the CI had been symptom free 
since 2001 on medication and with no restrictions to physical activity. The service cardiologist 
stated that “I would consider the a-fib cured, with no symptoms or sequelae. No duty 
limitations.” He had decided to try a trial of stopping the CI’s rhythm control medication. A 
note in the record dated 12 April 2005 from the CI’s civilian cardiologist provides a clear 
chronology of the CIs treatment and course for the atrial fibrillation. The cardiologist had not 
seen the CI since August 2001. The cardiologist states that since mid-2001 (about 8 months 
pre-TDRL and almost 4 years prior to separation) the CI had been controlled with medication. 
Holter monitor in 2001 showed no further evidence of atrial fibrillation and the CI was removed 
from antithrombotic medication. A Holter in 2005 did not show any atrial fibrillation despite 
the presence of some palpitations. He further added that he did not have any “…history from 
the patient to suggest recurrence of his dysrhythmias.” At the end of TDRL the PEB adjudicated 
the CI’s right knee instability as unfitting and the atrial fibrillation condition as medically 
acceptable. 

 

At the first VA Compensation and Pension (C&P) exam; about 6 months after TDRL-exit 
(permanent separation), the CI reported constant knee symptoms of pain with activity and 
clicking in the knee. He reported pain with prolonged sitting, walking or running. He reported 
no lost time from work. On exam his gait was normal. ROM of knees was extension 0 degrees 
and flexion 140 degrees. No instability was noted. The examiner said “No DeLuca issue with 
pain, fatigue, weakness, lack of endurance or incoordination.” Right knee X-rays showed the 
screws status post surgery. A 2011 VARD accepted atrial fibrillation as service connected at 0%. 

 

The Right Knee Instability Condition. The Board directs attention to its rating recommendation 
based on the above evidence. At TDRL entry the PEB adjudicated the right knee as unfitting 
and rated as “right knee instability…” as 5257 (knee impairment, recurrent subluxation or 
lateral instability) at 20%. Ratings under 5257 are 10%, 20%, or 30% for slight, moderate, or 
severe impairment, respectively. The record supports rating the CIs right knee condition as 
moderate with limitation of being unable to participate in physically demanding activities being 
representative of his disability. After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient 
cause to recommend a change in the PEB adjudication for the right knee instability condition at 
TDRL entry. 

 

At the end of TDRL, the PEB adjudicated the right knee instability condition as unfitting and 
rated as 5257 at 20%. About 6 months post separation, the VA rated the right knee as 
“residuals, right knee injury” with code 5257 at 10%. The VA also rated a knee scar at 10% that 
they noted “does not restrict range of motion.” The Board deliberated on whether the MEB 
examiners description of the knee instability as more than moderate was inconsistent with the 
PEB rating of knee impairment due to subluxation or lateral instability as moderate at 20%, 
rather than severe at 30%. The Board opined that in the case of the examiner’s use of the term 
moderate it was clinically descriptive of a degree of joint instability. In the rating decision 
moderate is an assessment of disability that results from the knee instability condition. The 
NARSUM and the VA exam proximate to the date of separation did indicate ongoing problems 
with locking and pain, with pain that limited exertional activities. The evidence supports that 
functionally the CI’s right knee condition was not better or worse than at the entry into TDRL 
when the he was described as “unable to participate in physically demanding activities”. After 


due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), 
the Board concluded that there was insufficient cause to recommend a change in the PEB 
adjudication for the right knee instability condition at the end of TDRL. 

 

The Atrial Fibrillation Condition. The Board directs attention to its rating recommendation 
based on the above evidence. At TDRL entry, the PEB adjudicated the atrial fibrillation 
condition as unfitting and coded as 7010 (Supraventricular arrhythmias) at 10%. Rating criteria 
under 7010 require episodes of a supraventricular arrhythmia with a rapid heart rate either 1-4 
episodes; more than 4 episodes (documented by ECG or Holter monitor); or permanent atrial 
fibrillation. At the MEB exam, the CI was recently controlled on medication. The cardiology 
addendum noted an irregular pulse, but commented that the CI was asymptomatic. The CI’s 
condition at TDRL entry meets the criteria for a 10% rating under 7010 assuming the irregular 
pulse was rate controlled atrial fibrillation . Or, the PEB may have applied the 10% rating to the 
atrial fibrillation generously based on the cardiology opinion that the CI may have recurrences, 
allowing the TDRL period for stabilization of the condition. After due deliberation, considering 
all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that 
there was insufficient cause to recommend a change in the PEB adjudication for the atrial 
fibrillation condition at TDRL entry. 

 

Contended PEB Conditions. The contended condition adjudicated as not unfitting by the PEB at 
the end of TDRL was the atrial fibrillation condition. The Board’s first charge with respect to 
this condition is an assessment of the appropriateness of the PEB’s fitness adjudication. The 
Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 
(reasonable doubt) standard used for its rating recommendations, but remains adherent to the 
DoDI 6040.44 “fair and equitable” standard. 

 

The CI’s opinion that his atrial fibrillation had not improved over the course of his TDRL period 
was considered in the Board’s deliberations. The Board takes the position that subjective 
improvement or worsening during the period of TDRL should not influence its coding and rating 
recommendation at the time of permanent separation. The Board’s relevant recommendations 
are assigned in assessment of the permanent separation and rating determination, and the 
TDRL rating assignment is not considered a benchmark. It is recognized, in fact, that PEB’s 
across the services sometimes apply an overly generous initial rating in order to meet the DoD 
requirement of 30% disability for placement on TDRL. This is in the member’s best interest at 
the time and does not mean that a final lower rating is unfair, even if perceived as incongruent 
with subjective severity from one rating to the next. Thus the sole basis for the Board’s 
permanent disability recommendation is the appropriate fitness or VASRD rating for disability 
at the time the CI is permanently separated at exit from TDRL. 

 

At the end of TDRL, the CIs atrial fibrillation had been well controlled on medication for nearly 
four years. The cardiology addendum to the MEB at TDRL end indicated no duty restrictions. 
The CI contended that the reason his atrial fibrillation was found “not unfitting” at the time of 
separation was that the service cardiologist was taking him off medication. But, the fitness of 
his atrial fibrillation condition did not depend on taking medication; rather it was based on 
adequate control of the condition or symptoms. The civilian cardiologist’s 2005 note in the 
record corroborated the service cardiologist’s opinion that the atrial fibrillation was well 
controlled and asymptomatic at the end of TDRL. 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 contended atrial fibrillation 
condition at the time of permanent separation; and, therefore, no additional disability rating 
can be 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. The Board did not 
surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD 
were exercised. In the matter of the right knee instability condition and IAW VASRD §4.71a, the 
Board unanimously recommends no change in the PEB adjudication at TDRL entry or at the time 
of permanent separation. In the matter of the contended atrial fibrillation condition, the Board 
unanimously recommends no change from the PEB determinations as unfitting at 10% for TDRL 
entry, and not unfitting at the time of permanent separation. There were no other conditions 
within the Board’s scope of review for consideration. 

 

 

RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

PERMANENT 

Right Knee Instability 

5257 

20% 

Atrial Fibrillation 

7010 

Medically 
Acceptable 

COMBINED 

20% 



 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120628, 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 xxxxxxxxxxxxxxxxxxxxxxxxx, AR20130006152 (PD201201216) 

 

 

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 and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of 
Congress who have shown interest in this application have been notified of this decision 
by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)