RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201423 SEPARATION DATE: 20030729 

BOARD DATE: 20130314 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SGT/E-5 (77F20/Petroleum supply specialist); 
medically separated for profound mixed hearing loss, right ear and chronic bilateral knee pain. 
The CI began service as a heavy equipment mechanic. In 1998, he was diagnosed with 
cholesteatoma in his right ear. Despite a tympanomastoidectomy in February 1998, a surgery 
in December 1998 to remove a recurrent cholesteatoma and a third surgery in June of 1999, his 
otolaryngologist determined that it was not possible to reconstruct his ossicular chain. Three 
surgical procedures were required which resulted in profound hearing loss on the right. He was 
fitted with a cross-style hearing aid which he uses occasionally for meetings and conversational 
speech. During this period, he was re-classified as a petroleum supply specialist; however his 
assignment supporting helicopters still exposed him to loud noise on a regular basis. The risk to 
his left ear hearing was deemed significant and precluded him from continuing with this 
Military Occupational Specialty (MOS) or military service. In addition, the CI experienced 
intermittent shoulder pain and was diagnosed with retropatellar knee pain (RPPS). Radiographs 
of his knees showed bipartite patellae with perhaps some mild arthritic changes. He was sent 
to physical therapy and has received multiple temporary profiles for bilateral anterior knee 
pain. After his ear surgeries, his shoulders became intermittently painful. His right ear hearing 
loss and chronic bilateral knee pain conditions could not be adequately rehabilitated to meet 
the physical requirements of his MOS or satisfy physical fitness standards. He was issued a 
permanent L3H3 profile and referred for a Medical Evaluation Board (MEB). A history of 
cholesteatoma, right ear, gastroesophageal reflux disease (GERD), eczema, bilateral elbows, 
hypertriglyceridemia, and bilateral shoulder pain conditions, identified in the rating chart 
below, were also identified and forwarded by the MEB. The Physical Evaluation Board (PEB) 
adjudicated the profound mixed hearing loss, right ear and chronic bilateral knee pain 
conditions as unfitting, rated 10% and 10%, with the cited application of the US Army Physical 
Disability Agency (USAPDA) pain policy. The remaining conditions were determined to be not 
unfitting. The CI made no appeals, and was medically separated with a 20% disability rating. 

 

 

CI CONTENTION: Within one month of my military discharge, I was awarded a 30% rating by 
the Dept of Veterans Affairs for the same unfitting conditions that the Army gave me a 20% 
rating on (Retropatellar pain syndrome, right and left knee; hearing impairment, right ear). 

 

 

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 (in this case, profound mixed hearing loss, right ear and chronic bilateral 
knee pain) will be reviewed in all cases. 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. 


 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20030609 

VA (1 Mos. Post-Separation) – All Effective Date 20030730 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Profound mixed HL, R ear 

6100 

10% 

Hearing impairment, R ear 

6100 

10% 

STR 

Chronic bilateral knee 
pain, due RPPS 

5099-5003 

10% 

RPPS, right knee 

5299-5260 

10% 

STR 

RPPS, left knee 

5299-5260 

10% 

STR 

H/O cholesteatoma, R ear 

Not Unfitting 

NO VA ENTRY 

STR 

GERD 

Not Unfitting 

NO VA ENTRY * 

STR 

Eczema bilateral elbows 

Not Unfitting 

NO VA ENTRY * 

STR 

Hypertriglyceridemia 

Not Unfitting 

NO VA ENTRY 

STR 

Bilateral shoulder pain 

Not Unfitting 

NO VA ENTRY 

STR 

.No Additional MEB/PEB Entries. 

0% X 0 / Not Service-Connected x 0 

STR 

Combined: 20% 

Combined: 30% 



*VARD 20070427 awarded 0% for GERD and eczema, effective 20061220; there were also 7 NSC conditions. 

 

 

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. 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. The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or potential complications of conditions resulting in medical separation nor for conditions 
determined to be service-connected by the Department of Veterans Affairs (DVA) but not 
determined to be unfitting by the PEB. However the DVA, operating under a different set of 
laws (Title 38, United States Code), is empowered to compensate all service-connected 
conditions and to periodically re-evaluate said conditions for the purpose of adjusting the 
Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating determinations, compared to VASRD standards, based on severity at the time of 
separation. 

 

Profound Mixed Hearing Loss, Right Ear Condition. There were two audiometric evaluations 
proximate to separation in evidence, with documentation of additional ratable criteria, which 
the Board weighed in arriving at its rating recommendation; as summarized in the chart below. 

 

Audiometric 
Threshold (Hz) . 

500 

1000 

2000 

3000 

4000 

6000 

Comments 

§4.85/6 
Rating 

MEB Audio ~12 Mo Pre-Sep (20020822) 

S/P cholesteatoma & 3 surgeries 

10% 

Right 

NR 

NR 

NR 

NR 

NR 

NR 

Average R= NR, L=16 

Speech Discrimination N/A 

Left 

20 

20 

15 

20 

10 

10 

Audiology ~20 Mo Pre-Sep (20011116) 

S/P cholesteatoma & 3 surgeries 

0% 

(VA 10%) 

Right 

90 

85 

75 

80 

80 

90 

Average R=80, L=17 

 Speech Discrimination N/A 

Left 

25 

20 

25 

 15 

10 

 15 



NR=No response 

 

The CI was noted at accession to have had frequent ear infections and pressure equalization 
tubes (PET) as a child and had a mild hearing loss on examination, but met the standards for an 
H1 profile and was cleared for entry onto active duty. On 23 February 1998, he was diagnosed 
with a right ear cholesteatoma which was surgically removed. The CI was determined to have a 


profound mixed hearing impairment of his right ear and normal hearing on the left. In 
December 1998, he had a recurrence of the cholesteatoma; this resulted in exploratory surgery 
and an ossicular chain reconstruction. A third and final operation on 16 June 1999 revealed a 
large recurrent cholesteatoma which was removed. The CI was without recurrence or major 
complaints until, 1 June 2002 when he noted blood on his pillow and occasional problems with 
equilibrium. He was reevaluated by an otolaryngologist, who recommended repeat 
audiometrics (as shown in above chart) and a CT of both ears on 16 September 2002. It 
revealed extensive deformity of the right ear with a soft tissue finding that “might” represent 
recurrent cholesteatoma. The left ear was without abnormal findings. The otolaryngologist 
reviewed the CT scan and report and thought that there was no indication of a recurrence. A 
note from the CI’s otolaryngologist dated 18 February 2003, recommended that the CI not be 
exposed to loud noises and not be deployed, but, if so, he “remain in the rear as a support 
personnel.” The MEB examination, 23 May 2003 revealed a normal left tympanic membrane. 
The CI had a post-surgical mastoid bowl and a remnant tympanic membrane graft on the right. 
There was no obvious debris and no discharge noted on exam. Conduction testing was 
consistent with the mixed hearing loss on the right. The VA rating decision, 21 August 2003 
referenced the service treatment records (STR) in regards to evidence used to rate the right ear 
condition. The VA rated the condition based on an audiology examination, 16 November 2001, 
which has been shown in the chart above. 

 

The Board directed its attention to the rating recommendation based on the above evidence. 
Both the PEB and VA rated the right ear hearing impairment condition at 10%. IAW VASRD 
§4.85 & 4.86 and used VASRD code 6100 The Board reviewed the VASRD codes for diseases of 
the ear, including code 6200 and 6201 that are applicable to chronic cholesteatoma. There 
must be active suppuration for a minimum rating using code 6200; none was evident. VASRD 
code 6201, instructs the rater to rate the hearing impairment, as was done in this case. 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 profound mixed hearing loss, right ear condition. 

 

Chronic Bilateral Knee Pain Condition. The Board considered whether the right and left knee 
conditions were separately unfitting for continued military service. Review of treatment 
records indicates that the CI was treated for bilateral knee pain. Neither knee was determined 
to be more severe than the other; each equally interfered with performance of duty. The Board 
concluded that the preponderance of evidence of the STR supported a finding that each knee 
was separately unfitting. There were two range-of-motion (ROM) evaluations, one 
goniometric, in evidence, with documentation of additional ratable criteria, which the Board 
weighed in arriving at its rating recommendation; as summarized in the chart below. 

 

Knee ROM (Degrees) 

MEB ~2 Mos. Pre-Sep 

VA C&P ~3 Mos. Pre-Sep 

Left 

Right 

Left 

Right 

Flexion (140 Normal) 

Normal 

Normal 

140 

140 

Extension (0 Normal) 

Normal 

Normal 

0 

0 

Comment 

No instability 

Mild crepitus (bilateral) 

The VA used the MEB exam for 
their finding. 

§4.71a Rating 

0% 

0% 

0% 

0% 



 

The CI first complained of bilateral knee pain in October 2002. Previous complaints of hip and 
leg pain led to a bone scan, 21 April 1997, which revealed “minimal arthritic changes” of both 
knees as an incidental finding, along with bilateral shin splints. The 16 October 2002 X-ray of 


both knees, revealed minimal separation of bony fragments on the left, later diagnosed as a 
bipartite patella, a congenital condition, and an osteophyte formation on the right. The CI had 
a physical therapy (PT) consultation, 13 November 2002 and was found to have some popping 
in the right knee with flexing and deep squatting. The examiner noted bilateral crepitus with 
patellar grind, right greater than left. The ligaments were stable and the CI was able to hop 
with only signs of discomfort. There was no sign of meniscal tear on rotation of the legs. The CI 
was to begin a run program; however, when he returned to PT on 1 January 2003, it was noted 
that he had been “non-compliant” with treatment. The examination of the lower extremities 
on that date reported retropatellar crepitus and poor firing timing of one of the quadriceps 
muscles (vastus medialis oblique {VMO}), which could lead to abnormal patellar tracking and 
RPPS. “All else (was) unremarkable.” The recommendation was for the CI to return after a 3 
week exercise program. In November 2002, the knees were noted to have full active ROM. The 
CI’s gait was noted to be unremarkable but palpation yielded diffuse pain in and around the 
patella. Popping was noted with right knee flexion and deep squats. The ligaments were stable 
and signs of meniscal irritation absent. The CI was able to unilaterally hop with discomfort only. 
Crepitus occurred with patellar grind, the right more so than the left. The MEB narrative 
summary (NARSUM), 29 April 2003 notes that the CI reported bilateral knee pain for several 
years but the recorded visit was 9 months prior to separation. The CI reported to the examiner 
that his left knee was more painful than his right. The NARSUM included an orthopedic 
examination of both knees dictated, 20 May 2003. The examiner reported that there was full 
ROM present in both knees with mild crepitus noted. The examiner noted that “the patella 
appeared to track well” and “no ligamentous instability was noted,” indicating that the misfiring 
of the VMO noted by the physical therapist resulted in no significant impairment. Painful 
motion was not documented. The VA rating decision (VARD), 21 August 2003 referenced the 
service treatment records (STR) as the evidence used in the rating decision. The VARD reported 
that the rating of both knees was based on the complaints of bilateral knee pain and “bilateral 
bipartite patella with arthritic changes” noted on X-rays performed during service. However, as 
already noted, in the absence of trauma, a bipartite patella is a congenital condition; it is not 
arthritis. The VA further noted that although, the CI had normal ROM, they were assigning 10% 
to each knee for painful motion and functional loss. The Board also noted that X-rays done in 
for the 2 March 2007 VA Compensation and Pension (C&P) examination were normal bilaterally 
other than a left bipartite patella. 

 

The Board directed its attention to the rating recommendation based on the above evidence. 
The MEB examination, which was the only examination proximate to the time of separation, 
showed full ROM of both knees without instability or meniscus signs. The ROM was non-
compensable under the VASRD diagnostic codes for limitation of motion (5260 and 5261), and 
there was no instability or meniscus problems to warrant rating under the respective codes 
(5257, 5258, 5259). The Board then reviewed VASRD code 5003, degenerative arthritis for both 
knees as a combined rating. The VASRD instructs the rater that this code may be used for 
degenerative arthritis established by X-ray findings, in the absence of limitation of motion. The 
Board agreed that the evidence supported a minimum rating of 10% for bilateral knee pain with 
radiographic findings, but without limitation in motion. There was no evidence of 
incapacitating exacerbations (physician prescribed bed rest) to elevate the rating to 20%. 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 chronic bilateral knee pain 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. In the matter of the 
profound mixed hearing loss, right ear condition and IAW VASRD §4.85 and 4.86, the Board 
unanimously recommends no change in the PEB adjudication. As discussed above, PEB reliance 
on the USAPDA pain policy for rating chronic bilateral knee pain was operant in this case and 
the condition was adjudicated independently of that policy by the Board. In the matter of the 
chronic bilateral knee pain condition and IAW VASRD §4.71a, the Board unanimously 
recommends no change in the PEB adjudication. 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 

Profound Mixed Hearing Loss, Right Ear 

6100 

10% 

Chronic Bilateral Knee Pain, due to Retropatellar Pain Syndrome. 

5099-5003 

10% 

COMBINED 

20% 



 

 

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 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxx, 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 xxxxxxxxxxxx, AR20130007731 (PD201201423) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)