RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:   ARMY 
SEPARATION DATE:  20050325 

 
NAME:  XXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200352 
BOARD DATE:  20121130 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was a Reserve SGT/E-5 (21E/Heavy Construction Equipment Operator), 
medically separated for left knee pain status post (s/p) anterior cruciate ligament (ACL) repair.  
Despite post-operative extensive rehabilitation in physical therapy (PT), the CI did not improve 
adequately 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  no  other  conditions  for  Physical 
Evaluation  Board  (PEB)  adjudication.    The  PEB  adjudicated  the  left  knee  pain  condition  as 
unfitting, rated 20%, with application of the US Army Physical Disability Agency (USAPDA) pain 
policy.  The CI made no appeals and was medically separated with a 20% disability rating.   
 
 
CI  CONTENTION:    “The  military  could  only  rate  one  condition  pertaining  to  my  injuries  and 
received 20% for pain to my knee and i was prompted by the military to go to VA to receive 
total  compensation for the rest of the  knee  and  granted  40%  for that same  knee.    Also  had 
other  conditions  that  found  me  unfit.    Please  see  Letter  Of  Appeal  that  is  enclosed”.    The 
attached letter also addresses surgical scars, peroneal neuropathy and the hamstring graft. 
 
 
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 condition left knee pain s/p ACL repair 
as requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview.  
The Board determined that the surgical scars, peroneal neuropathy and hamstring graft were 
secondary to the ACL graft and therefore within the 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.   
 
 
RATING COMPARISON:   
 

VA (3 Mos. Post-Separation) – All Effective Date 20050326 

Service PEB – Dated 20050201 

Condition 

L Knee Pain S/P ACL Repair 

Code 

5099-5003 

Rating 
20% 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

Condition 

Post-op Residuals L Knee…  
Low Back Strain … 
Post-op Residuals of L Peroneal 
Nerve Damage 

Code 

5299-5261 

5237 
8521 

Rating 
40%* 
20%** 
10% 

Exam 

20050629 
20050629 
20050629 

0% X 0 / Not Service-Connected x 0 at Separation 

Combined:  60% 

*10% from 20090301/20% from 20100625.  **10% from 20090301/40% from 20100625.  Scars at 10% added 20070129 

 
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 his 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.    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.  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  DES  improprieties  in  the processing  of  his 
case.   
 
Left Knee Pain S/P ACL Repair Condition.  There were three 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.   
 

Left Knee ROM 

Degrees 

Flexion (140 Normal) 
Extension (0 Normal) 

Narsum~2 Mo. Pre-Sep 

VA C&P ~3 Mo. Post-Sep 

VA C&P ~6 Mo. Post-Sep 

110 
0 

 

10% 

110 
10 

Painful motion; limp; Dual 
codes for separate ratings 
for limitations in flexion 

and extension 

10% + 10% = 20% 

30 after repetition 

0 

Painful motion; muscle 
atrophy; antalgic gait 

20% 

Comment 

§4.71a Rating 

 
The  CI  twisted  his  knee  while  playing  basketball  in  January  of  2004.    He  was  noted  to  have 
diffuse  pain  with  full  ROM  (FROM)  and  no  ligamentous  instability.    The  narrative  summary 
(NARSUM) noted that he had returned to duty, but reinjured his knee, again playing basketball.  
Despite  conservative  treatment,  he  continued  to  have  pain  and  had  a  magnetic  resonance 
imaging (MRI) exam performed on 16 April 2004 which showed a complete tear of the ACL, a 
tear of the posterior horn of the medial meniscus and degeneration of the lateral meniscus.  On 
22 April 2004, he underwent ACL reconstruction with a hamstring tendon graft, repair of the 
medial  meniscus  and  partial  lateral  meniscectomy.    Post-operative  X-rays  showed  good 
alignment.  He then had rehabilitation in PT.  Two months after surgery, at the 17 June 2004 PT 
appointment, he did not have an antalgic gait.  Some atrophy was noted of the left thigh with a 
circumference one cm less than the right at both seven and ten cm above the knee.  A month 
later at the 21 July 2004 orthopedic appointment, he had full ROM and intact testing of the ACL 
after repair.  A PT noted on 4 August 2004 noted that he was slowly improving, but did not yet 
have  FROM  and  used  a  brace  when  walking.    Another  PT  note  on  20  August  2004  noted  a 

slightly  antalgic  gait.    The  7  October  2004  PT  noted  documented  a  normal  gait  and  steady 
improvement.  The 29 October 2004 PT note documented normal ROM, but reduced strength 
for flexion and extension for the left knee compared to the right.  However, a PT note 2 days 
later on 1 November 2004 annotated that flexion was limited to 100 degrees, strength reduced 
and gait abnormal.  Also noted were atrophy of the quadriceps and some laxity of the ACL in 
anterior drawers testing.  An orthopedic examination a month later on 3 December 2004 noted 
normal sensation and strength and intact ligaments.  The NARSUM was dictated on 25 January 
2005, 2 months prior to separation.  The CI reported weakness and decreased ROM in the left 
knee,  but  denied  numbness  or  tingling.    The  pain  was  aggravated  by  bending  or  prolonged 
standing  and  relieved  with  rest,  ice  and  medications.    On  examination  his  gait  was  mildly 
antalgic.  There was no redness, swelling, induration or effusion.  Mild distal quadriceps atrophy 
was noted as was hamstring tightness.  Medial joint line tenderness was noted.  There was no 
ligamentous instability, weight bearing was normal, crepitus absent and the scar well healed.  
Sensation, strength and reflexes were normal.  Flexion was limited to 110 degrees with pain 
and  extension  normal.    At  the  VA  Compensation  and  Pension  (C&P)  exam  on  29  June  2005, 
3 months after separation, the CI reported an ACL tear and as well as tears to the medial and 
lateral ligaments.  The Board noted that the medial and later ligaments were, in fact, intact, 
whereas the medial and lateral menisci were injured.  The CI was employed to stock shelves in a 
grocery store where he had worked prior to the military, but was impaired from his knee pain 
and  needed  to  rest  frequently.    On  examination,  the  scars  were  noted  without  further 
comment.  The knee was tender to palpation above, below and to both sides of the patella.  
Flexion and extension were both limited as noted above.  There was no effusion.  Strength was 
good, but he was unable to heel or toe walk on the left.  There was tenderness at the graft 
donor  site  of  the  hamstrings  and  some  residual  weakness.    Sensory  loss  was  present  in  the 
upper third of the left lateral leg.  The quadriceps reflex was reduced compared to the right 
side.    He  was  noted  to  limp.    No  comment  was  made  regarding  either  the  ligaments  or  the 
menisci.    The  VA  requested  a  second  joint  evaluation  which  was  on  21  September  2005, 
6 months  after  separation.    The  history  was  unchanged.    On  examination  though,  the  knee 
flexion was reduced to 40 degrees and to 28 degrees after three repetitions.  A 2 cm loss in 
thigh circumference was noted on the left compared to the right at 15 cm above the knee.  He 
was again noted to have sensory loss of the left lower leg which was attributed to a peroneal 
injury  during  surgery.    As  in  the  previous  C&P  examination,  no  comment  was  made  on  the 
ligaments or menisci.  The Board also looked at the C&P examination dated 29 March 2007, 
performed  2 years  after  separation,  due  to  the  loss  of  motion  seen  on  the  second  C&P  in 
September 2005.  On the 2007 examination, the flexion was 100 degrees and extension normal 
at zero degrees without additional loss from repetition.  Painful motion was present.  The CI 
was able to heel and toe walk, ligaments were intact and provocative testing of the menisci was 
negative.  Sensation, strength and reflexes were normal.  A suprapatellar effusion was noted on 
X-ray, but not documented on the physical examination.  Gait remained antalgic.  The Board 
directs attention to its rating recommendation based on the above evidence.  The PEB coded 
the left knee as analogous to degenerative arthritis, 5099-5003, and rated it 20% using the pain 
policy.  The VA coded the left knee as analogous to limitation of extension, coded 5299-5261, 
and rated  it 40%  based on the  second VA  C&P examination dated  21  September  2005.   The 
flexion measured at the September 2005 is an outlier of other measurements obtained both 
prior  to  separation  and  following  separation.    It  therefore  is  determined  to  be  of  reduced 
probative value and is not used for rating purposes.  The Board noted that the VA reduced the 
disability  rating  to  10%  and  then  20%  upon  review.    The  Board  first  considered  the  post-
operative scars.  No examination proximate to separation documented any impairment from 
these.  There is no indication in the record that the scars interfered with duty performance or 
the  wear  of  military  equipment.    By  precedent,  the  Board  does  not  recommend  separation 
rating for  scars unless their presence  imposes  a  direct  limitation  on  fitness.    The  Board  next 

considered  the  sensory  loss.    The  orthopedic  examination,  the  NARSUM  and  the  2007  C&P 
examination all noted normal sensation.  However the two C&P examinations noted loss in the 
distribution of the peroneal nerve.  Regardless, Board precedent is that a functional impairment 
tied to fitness is required to support a recommendation for addition of a peripheral nerve rating 
at  separation.    The  sensory  component  in  this  case,  if  indeed  present,  has  no  functional 
implications.  Since no evidence of functional impairment exists in this case, the Board cannot 
support a recommendation for additional rating based on peripheral nerve impairment.  There 
was no evidence in the record that the pain at the donor site for the ACL graft (hamstrings) was 
additionally unfitting.  The Board then considered the functional loss from both the pain and 
limitation in motion.  It noted that the use of the PEB code 5003, degenerative arthritis, would 
support a 10% disability rating for painful, reduced motion in which the limitation of motion 
was  not  separately  compensable.    Code 5259,  loss  of  a  meniscus,  would  also  support  a  10% 
rating.    While  the  use  of  both  codes  at  the  10%  level  could  be  supported,  this  provides  no 
advantage to the CI.  The Board prefers this coding route, but sees no point in recommending a 
change in the code utilized by the PEB since rating is unaffected.  The limitation in motion in 
evidence  does  not  support  a  higher  level  of  disability  than  awarded  by  the  PEB  using  the 
USAPDA  pain  rule.    There  is  no  instability  in  evidence.    As  already  noted,  the  40%  rating 
awarded by the VA was based on an examination not supported otherwise in the record and 
the rating was later reduced based on later examinations.  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 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 the USAPDA pain policy for rating the left knee was operant in this case and the 
condition was adjudicated independently of that policy by the Board.  In the matter of the left 
knee 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:   
 

VASRD CODE  RATING 
5099-5003 
COMBINED 

20% 
20% 

Left Knee Pain s/p Left Knee ACL Repair … 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120413, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 

 
 
 
 
 

           XXXXXXXXXXXXXXXXXXX 
           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 
XXXXXXXXXXXXXXXXXX, AR20130000032 (PD201200352) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)