RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

SEPARATION DATE:  20040311 

 
NAME:  XXXXXXXXXXXXXX                                                                      BRANCH OF SERVICE:   ARMY 
CASE NUMBER:  PD1200306 
BOARD DATE:  20121026 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  mobilized  National  Guard,  SPC/E-4  (62E/Heavy  Equipment 
Operator), medically separated for left knee pain.  An initial injury in 1998 resulted in a patellar 
dislocation and intermittent pain.  Recurrent patellar dislocations and worsened pain occurred 
after re-injury while deployed in 2003, and required medical evacuation.  He did not respond 
adequately  to  operative  and  rehabilitative  treatment  and  was  unable  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 left knee pain status post patellar stabilization to the Physical Evaluation Board 
(PEB)  as  medically  unacceptable  IAW  AR  40-501.    Left  shoulder  impingement  syndrome  and 
hyperlipidemia,  identified  in  the  rating  chart  below,  were  also  forwarded  by  the  MEB  as 
conditions  meeting  retention  standards.    The  PEB  adjudicated  the  chronic  left  knee  pain  as 
unfitting,  rated  0%  with  likely  application  of  the  Department  of  Defense  Instruction  (DoDI) 
1332.39.    The  remaining  conditions  were  determined  to  be  not  unfitting.    The  CI  made  no 
appeals, and was medically separated with a 0% disability rating. 
 
 
CI CONTENTION:  “I feel it should be changed due to the fact that when I was discharged from 
the Army I was discharged as disabled but only given 0% rating.  And due to the fact my knee is 
not or will never be the same and I am still having trouble with it.  I did not get a chance to 
appeal the decision.  I feel that I deserve a medical retirement considering due to my injury I 
can not and will not have a chance to get my 20 yrs in to retire and have the benefits me and 
my family deserve for me serving my country honorably as well as putting my life on the line.” 
[sic] 
 
 
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.    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:   
 

Condition 

Left Knee Pain 
Left  Shoulder Impingement 
Hyperlipidemia 

Service IPEB – Dated 20040211 

VA (1 Mos. Post-Separation) – All Effective Date 20040312 

Code 

Rating 

5099-5003 

0% 

Condition 

Left Patellar Dislocation, 
Meniscal Tear 

Code 

5010-5260* 

Rating 
10% 

Exam 

20040429 

 
 

20040429 

Not Unfitting 
Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Combined:  0% 

NO VA ENTRY 
NO VA ENTRY 

Not Service-Connected x 3 

Combined: 10%** 

*VA decision 20110922 added 5257 (left knee instability) at 10%, effective 20110331 
**VA decision 20090825 added PTSD at 30%, effective 20090521; combined 40% 
 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which his service-aggravated condition continues to 
burden him.  It is a fact, however, 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.  This role and authority is granted 
by Congress to the Department of Veterans Affairs (DVA).  The DVA, operating under a different 
set  of  laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  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 utilizes 
DVA  evidence  proximal  to  separation  in  arriving  at  its  recommendations;  and,  DoDI  6040.44 
defines a 12-month interval for special consideration to post-separation evidence.  The Board’s 
authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES fitness 
determinations  and  rating  decisions  for  disability  at  the  time  of  separation.    Post-separation 
evidence therefore is probative only to the extent that it reasonably reflects the disability and 
fitness implications at the time of separation. 
 
intra-articular 
Left  Knee  Condition. 
osteochondral  defect. 
instability  surgery  was  performed  on  
17  October  2003  because  of  recurrent  episodes  of  patellar  dislocation.    There  were  two 
goniometric range-of-motion (ROM) evaluations in evidence, with documentation of additional 
ratable  criteria,  which  the  Board  weighed  in  arriving  at  its  rating  recommendation;  as 
summarized in the chart below. 
 

  Magnetic  resonance 
  Subsequent  patellar 

imaging  (MRI)  revealed  an 

Left Knee ROM in degrees 

Ortho ~2 Mo. Pre-Sep 

VA C&P ~1.5 Mo. Post-Sep 

Flexion (140 Normal) 
Extension (0 Normal) 

Comment 

120 

Not recorded 
+ antalgic gait 

100 
0 

+painful motion 

§4.71a Rating 

10% 

10% 

 
The orthopedic narrative summary (NARSUM) addendum states that the CI had minimal pain, 
but felt that the knee was very tight.  He walked with a patellar tracking brace and a cane due 
to feelings of knee weakness.  Examination revealed an antalgic gait, mild soft tissue swelling 
anteriorly,  a  well-healed  surgical  scar  and  thigh  muscle  atrophy.    There  was  no  patellar 
instability  and  no  sign  of  other  knee  ligament  instability.    The  MEB  examiner  on  14  January 
2004  noted  that  pain  continued  at  an  average  severity  of  4-5  on  a  1-10  scale.    Walking  and 

stairs aggravated the pain, and he could not run, jump, march, wear a backpack or take the 
fitness test.  Examination revealed left knee “puffiness” and significantly limited ROM with mild 
tenderness.  There were no signs of cruciate ligament instability.  Atrophy of the medial thigh 
muscle was present.  X-rays showed early degenerative changes.  At the VA Compensation and 
Pension (C&P) exam performed on 29 April 2004, the CI reported that there were no patellar 
dislocations  since  the  surgery.    He  complained  of  left  knee  pain,  fatigability  and  weakness.  
Climbing steps and prolonged walking or standing exacerbated his pain.  He denied locking, but 
did experience giving way due to thigh muscle weakness.  He was not using a cane or brace.  
Examination  revealed  a  mildly  antalgic  gait  and  a  mild  effusion.    There  were  no  signs  of 
ligament  instability.    Loss  of  knee  motion  was  considered  to  be  due  to  pain  and  not  muscle 
weakness. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB and VA chose different coding options for the condition, but this did not bear on rating.  
The PEB assigned a 0% rating under an analogous 5003 code (degenerative arthritis).  The VA 
used  a  5010-5260  code  (traumatic  arthritis,  limitation  of  flexion)  and  assigned  a  10%  rating.  
Sufficient evidence is present to support a 10% rating for noncompensable limitation of motion 
under 5003, or with application of §4.40 (functional loss) or §4.59 (painful motion).  Because of 
the  pathology  in  this  case,  the  Board  considered  rating  under  the  5257  code  (recurrent 
subluxation or lateral instability), and whether dual coding for pain and instability was justified.  
However  the  Board  agreed  that,  because  patellar  dislocations  resolved  after  surgery,  these 
pathways  were  not  defensible.    A  higher  rating  under  the  5258  code  (dislocated  semilunar 
cartilage) was also not supported by the evidence.  After due deliberation, considering all of the 
evidence  and mindful  of  VASRD  §4.3  (reasonable  doubt), the  Board  recommends  a  disability 
rating of 10% for the 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 DoDI 1332.39 for rating left knee pain 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 
condition,  the  Board  unanimously  recommends  a  disability  rating  of  10%,  coded  5099-5003 
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, effective as of the date of his prior medical separation:   
 

VASRD CODE  RATING 
5099-5003 
COMBINED 

10% 
10% 

Left Knee Pain 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120221, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 

 
 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

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 XXXXXXXXXXXXXXXXXXXXX, AR20120021432 (PD201200306) 
 
 
1.  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 to modify the individual’s disability rating to 10%  without recharacterization 
of the individual’s separation.  This decision is final.   
 
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.    
 
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 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)