RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

SEPARATION DATE:  20070122 

 
NAME:  XXXXXXXXXXX                                                                           BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200049 
BOARD DATE:  20121106 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  National  Guard  SGT/E-5  (52D/Generator  Mechanic),  medically 
separated  for  left  knee  pain  and  arthritis.    The  CI  had  a  motorcycle  accident  in  1991  and 
underwent  left  knee  surgery,  with  a  re-injury  and  second  surgery  in  1992  (anterior  cruciate 
ligament  (ACL)  repairs)  which  were  not  service-connected.    In  2003  while  in  Kuwait  he  re-
injured his left knee while running to a shelter.  He was diagnosed with ligament tears (ACL and 
MCL), meniscus tears and osteoarthritis and underwent two more surgical repairs in May and 
November  2004.    A  planned  third  left  knee  surgery  was  considered  in  2006,  but  was  not 
performed (prior to the Physical Evaluation Board (PEB)) due to poor prognoses; however, the 
possibility of later knee replacement was indicated by orthopedic specialists.  The CI’s left knee 
pain  and  arthritis  condition  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 P2, L3 profile and referred for a Medical Evaluation Board (MEB).  
Eleven other conditions, identified in the rating chart below, were also identified and forwarded 
by the MEB.  The PEB adjudicated the left knee pain and arthritis condition as unfitting, rated 
0%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The 
CI appealed to the USAPDA, which affirmed the PEB findings; and was then medically separated 
with a 0% disability rating.   
 
 
CI CONTENTION:  “PTSD, Mild TBI, Left Leg, broken neck, bad back, poor hearing and tinnitus, 
left hip, left ankle, right knee, flat feet or fallen arches, migraines, sleep apnea, no night vision, 
incontinence, acid reflux, problems urinating, high blood pressure, erectile dysfunction.  I was 
discharged with just under 18 years in service.  I had my letter;” and continues in block 13 with 
“My medical hold unit took the one thing that could put me out of the service and didn’t take 
(any other service connected injury’s into account.  CBHCO in Rock Island, Ill.  Handled my med 
board and did a sloppy job.  I was told at Fort McCoy, Wis. If I didn’t sign my DD214 to separate 
me  they  would  put  the  paperwork  in  as  soldier  wasn’t  present  to  sign,  also  before  I  could 
receive full benefits from the VA I had to pay back all of my severance.)” {sic; and difficult to 
read}   
 
 
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 conditions migraine, posttraumatic 
stress disorder (PTSD), right shoulder impingement, and lower left extremity (LLE) tarsal tunnel 
syndrome  (including  left  foot)  as  requested  for  consideration  meet  the  criteria  prescribed  in 
DoDI  6040.44  for  Board  purview;  and,  are  addressed  below,  in  addition  to  a  review  of  the 
ratings for the unfitting left knee condition.  The other requested conditions are 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 for the Correction of Military Records.   
 

VA (9+ Mos. Post-Separation) – All Effective Date 20070123 

Condition 
Left Knee Instability 
Arthritis, Left Knee w/Limited 
Flexion 
Left knee, Limitation of 
Extension 
Migraine Headaches 

5003-5260 

Code 
5257 

5261 
8100 

R/Shoulder Impingement 
Syndrome 
PTSD 
GERD 
Sinusitis 

High Blood Pressure 
Tinnitus 

No VA Entry 

5299-5201 

No VA Entry 

9411 
7346 
6510 

7101 
6260 

No VA Entry 
No VA Entry 

Rating 
20% 
20% 

Exam 

20071024 
20071024 

10% 
30% 

20071024 
20071108 

20% 
50%* 
10% 
10% 

0% 
10% 

20071024 
20071211 
20071024 
20071024 

20071024 
20071108 

RATING COMPARISON:   
 

Service PEB – Dated 20061109 

Condition 

Code 

Rating 

Left Knee Pain and 
Arthritis 

5003 

0% 

Migraine Cephalgia 
Hyperglycemia 
Impingement R/Shoulder 
PTSD 
GERD 
Chronic Sinusitis 
Hyperlipidemia 
Hypertension 
Tinnitus 
LLE Tarsal Tunnel 
Syndrome 
Obesity 

Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

R/Hip Strain Associated 
w/Arthritis, L/Knee w/Limited 
Flexion 
DDD L4-5 and L5-S1 Lumbar 
Spine 
Patellofemoral Syndrome 
R/Knee 

5099-5003 

10% 

20071024 

5242 

4299-5003 

20% 

10% 

20071024 

20071024 
20071024 

Combined:  0% 

2% X 0 / Not Service-Connected x 1/ Deferred X 5 

Combined:  90% 

* PTSD decreased to 30% effective 20100511 based on exam of 20100511.   
 
 
ANALYSIS  SUMMARY:    The  Board  acknowledges  the  CI's  contention  suggesting  that  ratings 
should have been conferred for other conditions documented at the time of separation, some 
of which were evaluated and determined not to be individually unfitting for continued service.  
The Board also acknowledges the CI’s assertions that there were potential irregularities in his 
disability processing.  It is noted for the record that the Board has neither the jurisdiction nor 
authority to scrutinize or render opinions in reference to the CI’s statements in the application 
regarding  suspected  improprieties  in the processing  of his  case.    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.  The DES is responsible for maintaining a fit and vital fighting 
force.  While the DES considers all of the service member's medical conditions, compensation 
can only be offered for those medical conditions that cut short a service 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  re-
evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the 
degree  of  impairment  vary  over  time.    The  Board  is  empowered  to  evaluate  the  fairness  of 
fitness  determinations,  and  to  make  recommendations  for  rating  of  conditions  which  it 
concludes  would  have  independently  prevented  the  performance  of  required  duties  (at  the 
time of separation).  The Board’s threshold for countering DES 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.   
 
Left Knee Condition.  The 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.   
 

   2                                                           PD1200049 
 

MEB ~5 Mo. Pre-Sep 

VA C&P ~9 Mo. Post-Sep 

110⁰ 

- 

110⁰ 

10⁰ (lacking) 

Normal gait; Ext 115⁰; sig 
quad weakness; orthotics 

bilaterally (see text) 

20% (PEB 0%) 

Pronounced limp with cane; 
swollen, tender and grossly 
unstable; painful motion; 4-
5/10 strength (see text) 
30% (VA 20% + 20% +10%) 

Left Knee ROM 

Flexion (140⁰ Normal) 
Extension (0⁰ Normal) 

Comment;  Surgery 

20061026 

PT ~6 Mo. Pre-Sep 
122⁰, 120⁰, 121⁰ 

-6⁰, -5⁰, -5⁰ 

Significant quad 

weakness on left 50% 

§4.71a Rating 

20% (see text) 

 
At the MEB exam, 5 months prior to separation, the CI reported some instability, swelling, and 
pain of the left knee with unable to run or do two mile walk.  He had chronic pain with difficulty 
walking or standing for long periods of time.  The MEB physical exam noted significant thigh 
weakness and limited flexion with ROMs from the PT evaluation as summarized above.  There 
were no tests for instability.  Civilian orthopedic evaluation the same month as the narrative 
summary (NARSUM) indicated bone on bone degenerative changes and recommendation for 
tennis shoes versus boots to decrease knee pain.  The CI was on narcotic pain medication and 
provided quarters (24 hrs) for knee pain.  The CI was seen September 2006, 4 months prior to 
separation  with  objective  findings  of  “Left  knee  is  really  unstable.    He  really  needs  to  be 
wearing a brace,” and he was referred for re-evaluation of his brace.  The CI was seen “for pain 
to L knee secondary to fall from unstable L knee.  (CI) in quarters for 3 days due to L knee joint 
instability and high risk of fall.”  Radiographs indicated multiple surgical devices including plates 
which  were  in  place  and  sclerotic  changes  with  “some  lateral  subluxation  of  the  tibia  with 
respect  to  the  femur  which  is  more  pronounced  than  seen  on  the  3/16  exam.”    The  record 
indicates the CI was approved for, and underwent, arthroscopic surgery on 26 October 2006 (3 
months  prior  to  separation,),  with  decrease  in  knee  pain.    He  was  still  wearing  a  brace  for 
support and his knee was swollen per “MHO report” dated 20 November 2006.   
 
At the VA Compensation and Pension (C&P) exam, performed 9 months after separation, the CI 
reported no post-separation re-injury.  He had continued pain with swelling.  History indicated 
an  arthroscopic  surgery  in  2006  for  cleaning  out  the  knee  which  provided  transient  relief.  
There was continued pain requiring narcotic pain medication, and the CI was using a scooter at 
work.  The exam findings are summarized above.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
CI’s primary injury and pathology was to the ligaments and meniscus of the knee with bone on 
bone arthritis causing knee pain.  The service exams were very scant for any objective testing of 
knee instability.  The VA exam was more detailed, but was 9 months remote from separation 
and presented a worsened picture with swelling and a limp.  It is obvious that there is a clear 
disparity between these examinations, with very significant implications regarding the Board's 
rating recommendation.  The Board thus carefully deliberated its probative value assignment to 
these conflicting evaluations, and carefully reviewed the file for corroborating evidence in the 
12-month  period  prior  to  separation.    Treatment  notes  indicated  complaints  of  instability, 
prescription of a knee brace, and instability on exam.  The PEB rating was for limited flexion and 
arthritis and did not apply or did not concede painful motion IAW VASRD §4.59 (painful motion) 
or  §4.40  (functional  loss).    The  PEB  determination  was  also  within  2  weeks  of  arthroscopic 
surgery  and  NARSUM  information  was  prior  to  surgery.    The  VA  provided  three  left  knee 
ratings:    flexion  limited  to  110⁰  (10%)  and  weakness  (10%)  for  20%  for  limited  flexion;  knee 
instability 20%; and limited extension to 10⁰ for a 10% rating.   
 
The  Board  deliberated  on  the  left  knee  evaluations  including  the  totality  of  the  record  and 
determined that there was moderate left knee instability at the time of separation as well as 
painful motion with functional loss.  There was not sufficient evidence of both limited flexion 
and limited extension on any examination for compensable ratings under both of the specific 
ROM-limited knee codes.  After due deliberation, considering all of the evidence and mindful of 

   3                                                           PD1200049 
 

VASRD  §4.3  (reasonable  doubt),  the  Board  recommends disability  ratings  of  20%  for the  left 
knee condition for instability, coded 5257 and 10% for the left knee for painful motion coded 
5003-5260, without any other disability coding.   
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were  migraine  cephalgia,  impingement  R/shoulder,  PTSD,  gastro  esophageal  reflux  disease 
(GERD), hypertension, tinnitus and LLE tarsal tunnel syndrome (foot/ankle).  The Board’s first 
charge with respect to these conditions is an assessment of the appropriateness of the PEB’s 
fitness  adjudications.    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.   
 
Aside  from  the  unfitting  left  knee  condition,  only  migraine  cephalgia  was  judged  to  fail 
retention standards by the MEB.  The CI had a P2 profile that listed migraine cephalgia with no 
headache-specific  duty  limitations.    The  commander’s  statement  implicated  only  injury 
impairments preventing climbing and kneeling, and indicated the CI “has been a model soldier 
and NCO.”  However, the commander indicated the CI had not returned to his unit since his 
injury  and  had  “been  assigned  to  the  Community  Based  Health  Clinic  Organization  (CBHCO) 
since returning from Iraq.  It is my understanding that he is limited to light duty only.”   
 
Migraine cephalgia began while the CI was in Iraq, with headache frequency diminished to 1 
episode  per  month  following  return  from  theater.    Migraine  syndrome  was  diagnosed  by  a 
neurologist and magnetic resonance imaging (MRI) was normal.  In February 2006, headaches 
increased to 2 per week and the CI complained of “increased headaches and severity which has 
caused  him  to  be  unable  to  attend  assigned  duty  site.”   Medication  (Maxalt)  provided  some 
relief.    The  NARSUM  (August 2006)  indicated the  benign  migraine  syndrome  was  considered 
“currently unstable.  (CI) states he is unable to perform basic soldier skills and MOS duties of a 
light  wheel  mechanic  because  of  persistent  migraines.”    There  had  been  two  episodes  of 
quarters for migraine headache pain or grogginess due to migraine medication use prior to the 
MEB, and there were three more similar episodes of quarters between the NARSUM and PEB.  
The PEB addressed migraine cephalgia with a specific determination as not being unfitting.   
 
The  CI  had  right  shoulder  impingement  with  arthroscopic  repair  in  April  2006.    Follow-up 
evaluations indicated normal ROM and strength although formal ROMs were slightly below the 
VA normal ROMs.   
 
PTSD was noted as “mild, resolved with meds and psychotherapy.”  VA examination and rating 
indicated post-separation worsening of mental health symptoms with diagnoses of PTSD, major 
depression, obsessive compulsive disorder, and panic attacks without agoraphobia.  GERD was 
noted  as  being  well  controlled  on  medication.    The  CI  had  hypertension  with  metabolic 
syndrome  and  was  being  treated  with  medications.    Tinnitus  had  subjective  complaints  of 
interfering  with  speech  discrimination  in  noisy  and  crowded  environments,  with  speech 
discrimination testing  100%/96%  with no  impact  on performing  MOS  and  soldier tasks.    It  is 
possible that the impairments from the unfitting left knee overshadowed the impairments from 
the  left  ankle/foot  condition  (LLE  tarsal  tunnel  syndrome);  however,  the  NARSUM  indicated 
resolution of complaints following orthotics.   
 
All  contended  conditions  were  reviewed  by  the  action  officer  and  considered  by  the  Board.  
There was no indication from the record that any of these conditions significantly interfered 
with  satisfactory  duty  performance. 
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 any of the contended conditions; 
and, therefore, no additional disability ratings can be recommended.   

  After  due  deliberation 

   4                                                           PD1200049 
 

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 left knee condition was operant in this case 
and the condition was adjudicated independently of that policy by the Board.  In the matter of 
the left knee pain and arthritis condition, the Board unanimously recommends disability ratings 
of  20%  for  the  left  knee  condition  for  instability,  coded  5257  and  10%  for  the  left  knee  for 
painful  motion  coded  5003-5260,  both  IAW  VASRD  §4.71a.    In  the  matter  of  the  contended 
migraine cephalgia, impingement R/shoulder, PTSD, GERD, hypertension, tinnitus and LLE tarsal 
tunnel syndrome (foot/ankle) conditions, the Board unanimously recommends no change from 
the PEB determinations as not unfitting.  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 

5257 

5003-5260 
COMBINED 

20% 
10% 
30% 

Left Knee Instability following Surgery  
Left Knee Pain and Arthritis  

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120107, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

   5                                                           PD1200049 
 

 
 

 
 

 
 
 

a.  Providing a correction to the individual’s separation document showing that the 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
For XXXXXXXXXXXXXXXXXXXXXXXX, AR20120021428 (PD201200049) 
 
 
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: 
 
 
individual was separated by reason of permanent disability retirement effective the date of the 
original medical separation for disability with severance pay. 
 
 
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. 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 

b.  Providing orders showing that the individual was retired with permanent disability 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

   6                                                           PD1200049