RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX CASE: PD1201417 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130312 

SEPARATION DATE: 20040306 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was Reserve SGT/E-5 (92A/Automated Logistical Specialist), medically 
separated for bilateral hip and knee osteoarthritis (OA). He began experiencing joint pain in 
1997, which was aggravated by physical training; and, was subsequently diagnosed with 
bilateral OA of the hips and knees. He did not improve adequately with treatment 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 MEB forwarded right knee, left knee, right hip and left hip diganoses to the Physical 
Evaluation Board (PEB) as separate medically unacceptable conditions IAW AR 40-501. No 
other conditions were submitted by the MEB. The PEB adjudicated the four separate joint 
diagnoses as a single unfitting condition, rated 20%; with possible application of AR 635-40 in 
addition to the Veterans Administration Schedule for Rating Disabilities (VASRD). The CI made 
no appeals, and was medically separated with a 20% disability rating. 

 

 

CI CONTENTION: “Condition has advanced and interferes daily living greatly. [sic] Chronic pain 
has increased over a 7 year time period with stiffness, decreased physical activity, poor 
sleeping, limitations of mobility (continued) greatly affect standing, bending and lifting.” 

 

 

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 bilateral hip and 
knee condition(s) is addressed below; and, no additional conditions are within the DoDI 
6040.44 defined purview of the Board. 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. The Board acknowledges 
the CI’s information regarding the significant impairment with which his service-connected 
conditions continues to burden him; but, must emphasize that the Disability Evaluation System 
(DES) has neither the role nor the authority to compensate members for anticipated future 
severity or potential complications of conditions resulting in medical separation. That role and 
authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under 
a different set of laws. 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20031113 

VA - All Effective 20040307 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Hip and 

Knee Osteoarthritis 

5003 

20% 

Left Hip Condition 

5003 

20% 

STR* 

Right Hip Condition 

5003 

10% 

STR 

Left Knee Condition 

5299-5262 

10% 

STR 

Right Knee Condition 

5299-5262 

10% 

STR 

No Additional MEB/PEB Entries 

Other x 2 

STR 

Combined: 20% 

Combined: 50% 



*Service Treatment Record; no VA exam probative to separation. VARD 20040322 (most proximate to Date of Separation). 


ANALYSIS SUMMARY: The PEB combined the bilateral hip and knee OA conditions as a single 
unfitting condition rated as 5003 (degenerative arthritis) at 10%. The PEB may have relied on 
AR 635.40 (B.24 f.) and/or the United States Army Physical Disability Agency (USAPDA) pain 
policy for not applying separately compensable VASRD codes. The Board must apply separate 
codes and ratings in its recommendations if compensable ratings for each condition 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 unfitting in and of itself. Not uncommonly this approach by the PEB reflects its 
judgment that the constellation of conditions was unfitting, and that there was no need for 
separate fitness adjudications, not a judgment that each condition was independently unfitting. 
Thus the Board must exercise the prerogative of separate fitness recommendations in this 
circumstance, with the caveat that its recommendations may not produce a lower combined 
rating than that of the PEB. The Board acknowledges the dearth of medical records in the 
evidence before it; and, others could not be located after the appropriate inquiries. Further 
attempts at obtaining the relevant documentation would likely be futile and introduce 
additional delay in processing the case. The missing evidence will be referenced below in 
relevant context; and, it is not suspected that the missing evidence would significantly alter the 
Board’s recommendations. 

 

Bilateral Hip and Knee Osteoarthritis Condition. The Board notes that there are few treatment 
records in evidence and all address hip and knee pain conditions as bilateral. The narrative 
summary (NARSUM) notes the CI had a history of hip and knee pain for approximately 6 years 
with progressive worsening. He had no discrete injury. At the MEB exam the CI reported pain 
that was aggravated by activity and occasional give-way due to pain. He reported being unable 
to run, jump, or march. He reported difficulty going up or down stairs; climbing in and out of 
vehicles; carrying a rucksack; or wearing a flack vest due to the increased weight on the hip and 
knee joints. The MEB physical exam noted an antalgic gait. Passive range-of-motion (ROM) of 
the right hip was flexion (FL) to 100 degrees (normal 125); abduction (AB) 40 degrees (normal 
45); external rotation 40 degrees (normal 60); internal rotation 10 degrees (normal 40). PROM 
of the left hip was FL 90; AB 30 degrees; ER 30 degrees; IR 5 degrees. There was pain with 
resisted straight leg raise (SLR), and with a heeltap bilaterally. There was pain with maximal 
internal rotation. Motor strength and sensation were normal. Passive ROM of both knees was 
120 degrees. There was bilateral patellofemoral crepitus. The NARSUM stated that “He has no 
effusions. His ligaments are stable. He has both medial and joint line tenderness.” X-rays 
showed showed early OA of the right hip, severe OA of the left hip, mild OA of the right knee 
and moderate OA of the left knee. There is no VA Compensation and Pension (C&P) 
examination in the record; the initial VARD cited service treatment records (STRs) only. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB rated the combined bilateral hip and knee OA conditions as 5003 at 10%. The VA rated the 
left hip and the right hip separately code 5003 at 10% each with application of §4.59 for painful 
motion. The commander’s statement referred only to the CI’s “medical condition” and did not 
discriminate between the right or left hip conditions or the right or left knee conditions. The 
permanent L3 profile lists “both hip OA; both knee OA.” The NARSUM indicated X-rays showed 
mild OA of the right hip and severe OA of the left hip. The Board noted, however, that neither 
pain severity nor functional loss of a joint are not discernible from X-ray findings and the MEB 
forwarded each hip separately as not meeting retention standards. The profile limitations 
shielded the right hip and left hip, as well as the bilateral knee joints. The MEB examiner noted 
pain with internal rotation and did not specify one or both hip joints. Passive ROM of both hips 
was decreased. After deliberation, the Board agreed based on the evidence in the record, it 
could not conclude that either hip of itself was not unfitting. There is reasonable doubt in the 
CI’s favor that the §4.59 threshold for painful motion was met for each hip at the time of 
separation. Therefore, after due deliberation, considering all of the evidence and mindful of 


VASRD §4.3 (reasonable doubt), the Board recommends separate 10% ratings for each hip, 
coded as 5003 (degenerative arthritis). 

 

The Board directs attention to its rating recommendation for the knee condition based on the 
above evidence. The VA rated the left and right knee conditions separately as 5299-5262 
(analogous to impairment of the tibia and fibula) at 10% each, combined with the bilateral 
factor to 20%. The X-rays were reported to show mild OA of the right knee and moderate OA of 
the left knee. The Board noted, however, as noted for the hip conditions, that disability 
judgments based on X-rays findings would be overly speculative and that the MEB forwarded 
each knee separately as not meeting retention standards. The profile limitations would shield 
the right knee and left knee – as well as the bilateral hip joints. The MEB examiner noted an 
antalgic gait and did not specify whether it was due to hip or knee joint disability. The exam 
noted bilateral patellofemoral crepitus. Passive ROM of both knees was decreased. Occasional 
swelling occurred in both knees with “occasional give-way secondary to pain” noted; right or 
left knee was not specified. After deliberation, the Board agreed, based on the evidence in the 
record, it could not conclude that either of knees was not unfitting. There is reasonable doubt 
in the CI’s favor that the §4.59 threshold for painful motion was met for each knee at the time 
of separation. Therefore, after due deliberation, considering all of the evidence and mindful of 
VASRD §4.3 (reasonable doubt), the Board recommends separate 10% ratings for each knee, 
coded as 5003 (degenerative arthritis). 

 

 

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 noted the PEB may 
have relied on AR 635.40 (B.24 f.) and/or the USAPDA pain policy and this case was adjudicated 
independent of the instruction and policy by the Board. In the matter of the bilateral hip OA 
condition combined under a single 5003 rating by the PEB, the Board unanimously recommends 
that the right and left hip be individually unfitting and individually coded 5003 at 10%, IAW 
VASRD §4.71a. In the matter of the bilateral knee osteoarthritis combined under a single 5003 
rating by the PEB the Board unanimously recommends that the right and left knee be 
individually unfitting and individually coded 5003 at 10% 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; 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 

Left Hip Osteoarthritis 

5003 

10% 

Right Hip Osteoarthritis 

5003 

10% 

Left Knee Osteoarthritis 

5003 

10% 

Right Knee Osteoarthritis 

5003 

10% 

COMBINED (w/ BLF) 

40% 



 

 

 

 

 

 

 

 

 


The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120802, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxx, AR20130006227 (PD201201417) 

 

 

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 40% 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 
40% 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 xxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)