RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXXX                                                                        BRANCH OF SERVICE:  ARMY  
CASE NUMBER:  PD1200600                                                                   SEPARATION DATE:  20030930 
BOARD DATE:  20130125    
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty, SGT/E-5, (91R/ Veterinary Food Inspector), medically 
separated for right knee and low back pain (LBP).  In 1998, the CI injured his right knee and 
subsequently underwent arthroscopic repair of a torn anterior cruciate ligament.  He also was 
found to have a herniated disc (HNP) on magnetic resonance imaging (MRI) in 2003 during an 
evaluation for LBP.  Despite duty limitations and physical therapy, neither the right knee nor 
low back conditions improved 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 MOS Medical Retention Board (MMRB).  The MMRB 
referred  to  a  Medical  Evaluation  Board  (MEB)  which  determined  that  each  condition  was 
medically unacceptable and forwarded the conditions to the Physical Evaluation Board (PEB) for 
adjudication.  Obesity was also forwarded to the PEB as a medically acceptable condition.  The 
PEB  adjudicated  the  right  knee  and  low  back  conditions  as  unfitting,  each  rated  10%,  with 
application  of  the  Veterans  Affairs  Schedule  for  Rating  Disabilities  (VASRD).    The  remaining 
condition was determined to be not unfitting and not ratable.  The CI made no appeals and was 
medically separated with a 20% combined disability rating.   
 
 
CI CONTENTION:  “It’s getting harder to walk and less hours at work due to pain in back, knees, 
shoulder.”    
 
 
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  knee  and  back  conditions,  as 
requested for consideration,  meet the criteria prescribed in DoDI 6040.44 for Board purview 
and  are  addressed  below.    The  other  requested  condition,  the  shoulder,  is  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 Correction of Military Records.   
 
 
RATING COMPARISON:   
 

VA (1.5 Mos. Pre-Separation) – All Effective Date 20030808 
Condition 
R Knee int derangement 
R Knee Osteoarthritis 
DDD Lumbar Spine 
R Shoulder 
NO VA ENTRY 

Exam 
20030813 
20030813 
20030813 
20030813 
 

Rating 
20% 
10% 
10% 
10% 

Code 
5257 
5010 
5292 
5203 

Service IPEB – Dated 20030519 
Condition 
R  knee  limited  extension 
s/p ACL reconstruction 
LBP 
No entry 
Obesity 

Code 
5261 
5293-5299-5295 

Rating 
10% 
10% 

Not Unfitting 

↓No Additional MEB/PEB Entries↓ 
Combined:  20% 

0% X 1 / Not Service-Connected x 3 
Combined:  40% 

20030813 

 
 
ANALYSIS SUMMARY:   
 
Right  Knee  Condition.    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.    

Knee ROM 

Flexion (140⁰ Normal) 
Extension (0⁰ Normal) 
Comment 
§4.71a Rating 

 

Left 

115⁰ 
0⁰ 
Obese 

 

 

MEB ~6 Mo. Pre-Sep 
(20030310) 

VA C&P ~1.5 Mo. Pre-Sep 
(20030813) 

Right 

Left 

90⁰ 
10⁰ 
No 
instability 
10% 

 
 
NO ROM 

 

Right 

110⁰ 
0⁰ 
Significant 
varus laxity 
10% 

On 7 December 1998, the CI injured his right knee playing football.  He was noted to have an 
effusion and thought to have injured his ACL.  Conservative management was not sufficient for 
return to full activities and he underwent arthroscopic repair of the ACL on 24 June 1999.  A 
lateral meniscal tear was also noted and treated.  No other pathology, including the collateral 
ligaments, was noted.  He continued to have knee pain.  On 4 January 2002, he was noted to 
have crepitus without atrophy.  The ROM was  135 degrees of flexion and (-) five degrees of 
extension.  Testing for meniscal irritation was positive, but the ligaments were intact.  An MRI 
on 9 January 2002 was negative other than for the post-operative changes and osteoarthritis.  
He  was  given  a  brace  for  possible  ACL  insufficiency.    The  MEB  physical  examination  and 
narrative  summary  (NARSUM)  were  accomplished by  the  same examiner  on  10 March  2003, 
6 months  prior  to  separation.    The  CI  reported  daily  pain  which  restricted  running,  walking, 
driving a truck and bending.  He was noted to be obese and to wear a knee brace, but to move 
about  the  room  without  difficulty.    A  surgical  scar  was  noted  as  was  soft  tissue  swelling.  
Provocative testing for instability was negative.  Toe and heel walk were normal although he 
was  not  able  to  deep  knee  bend.    At the  VA  Compensation  and  Pension  (C&P)  examination, 
6 weeks  prior  to  separation,  the  CI  reported  constant  pain  and  that  he  walked  with  a  limp.  
Significant varus (bowlegged) laxity of the lateral collateral ligament was noted.  The anterior 
drawers test was one mm, but no comment made regarding the other knee.  This is most likely 
a  normal  test.    The  test  for  meniscal  irritation  was  normal.    The  Board  noted  the  disparity 
between  the  finding  of  varus  laxity  of  the  knee  on  this  examination  compared  to  normal 
ligamentous integrity on the previous examinations in the record.  It noted that there was no 
history  of  additional  injury  to  explain  the  deterioration.    The  Board  then  reviewed  the  C&P 
examination from 22 November 2011, 8 years after separation.  This examination was by an 
orthopedic  surgeon.    No  significant  intervening  history  was  documented  other  than  he  had 
needed to decrease his hours from 40-60 to 35-40 hours (assume per week) as a letter carrier.  
He noted that it sometimes gave way and locked up, but that the last time had been 2 years 
prior.  He was noted to be obese, but to walk without difficulty or use of assistive devices.  He 
was able to cross his knees to 90 degrees while taking off his shoes.  There was some crepitus of 
the  right  knee  with  discomfort,  but  no  instability  with  the  cruciate  and  collateral  ligaments 
intact.  The ROM was 0-118 on the right and 0-130 on the left without DeLuca.   
 

The  Board  directs  attention  to  its  rating  recommendation  based  on  the  above  evidence.    It 
noted that the VA rated the right knee for both instability and for osteoarthritis using the codes 
5257,  internal  derangement,  and  5010,  traumatic  osteoarthritis,  rated  at  20  and  10%, 
respectively.  The PEB coded the knee 5261, limitation of extension, and rated it at 10%.  The 
Board  noted  that  no  examination  documented  collateral  ligament  laxity  other  than  the  C&P 
examination  proximate  to  separation  and  that  examinations  by  orthopedic  surgeons  both 
before  and  after  separation  did  not  show  this  laxity.    The  Board  determined  that  the 
preponderance of evidence does not support collateral ligament laxity and secondary instability 
at the time of separation.  The Board then considered the different coding options.  Provocative 
testing  of  the  menisci  was  negative  as  was  testing  of  the  ACL.    Limitation  of  extension  was 
found on the MEB examination, but not on other examinations before or after separation.  The 
preponderance  of  evidence  does  not  support  a  limitation  in  extension  at  separation.    The 
limitation in flexion did not rise to a compensable level.  The Board determined that the most 
accurate  coding  option  at  separation  would  be  for  5010,  traumatic  arthritis,  but  that  this 
provided  no  advantage  to  the  CI  as  it  would  only  achieve  a  10%  disability  rating.    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 right knee condition.   
 
Low Back Conditions:  The record shows one visit for LBP, in 1992, prior to 7 January 2002.  At 
that visit he was noted to have full ROM and thought to have mechanical LBP.  There are no 
other visits for the LBP in evidence.  Per the NARSUM, he had an MRI on 2 April 2003 which 
showed a L5-S1 HNP with a partial tear.  The MEB physical examination and narrative summary 
(NARSUM)  were  accomplished  by  the  same  examiner  on  10  March  2003,  6  months  prior  to 
separation.  The CI was noted to be obese and to move about the room without difficulty.  Toe 
and  heel  walk  were  normal  and  he  could  forward  flex  to  his  mid-thighs.    At  the  C&P 
examination 6 weeks prior to separation, the CI reported a constant ache in the lower back and 
that his back “went bad from wear and tear and lifting and exercising.”  Deep tendon reflexes 
(DTR)  were  normal  and  provocative  testing  for  nerve  root 
irritation  was  negative.  
Measurements of ROM showed reduced flexion, extension, and R/L lateral bending at 85, 20, 
20, and 20 degrees.  The normal values are 90, 30, 30, and 30 degrees, respectively.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB rated the back at 10% using the coding options of 5293, intervertebral disc syndrome, and 
5299-5295, analogous to lumbosacral strain.  The VA also rated the back at 10%, but used the 
5292 code for lumbar limitation of motion.  The Board notes that these are older coding options 
and that the new spine rules took effect 26 September 2003, 4 days prior to separation.  The 
Board accordingly adjudicated this case under the new rules which rely on ROM measurements.  
The  Board  considered  the  different  coding  options,  but  with  the  minimal  ROM  limitation  in 
evidence and no history of incapacitation, none provided an avenue to a higher rating than the 
10%  adjudicated  by  both  the  PEB  and  VA.    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 back 
condition.   
 
Contended PEB Conditions.  The contended shoulder condition was not considered in the DES 
process process and is therefore not within the purview of the Board.   
 
 

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.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were exercised.  In the matter of the right knee and back conditions 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. 
 

UNFITTING CONDITION 
S/P  Right  Anterior  Cruciate  Ligament  Reconstruction  without 
Residual Instability 
Chronic Lower Back Pain with L5-S1 Herniated Nucleus Pulposus 

VASRD CODE  RATING 
5261 
5293  5299-
5295 
COMBINED 

10% 
20% 

10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120606, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           xxxxxxxxxxxxxxxxxx, DAF 
           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 xxxxxxxxxxxxxxxx, AR20130002020 (PD201200600) 
 
 
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 
 
 
 

     xxxxxxxxxxxxxxxxxxxxx 
     Deputy Assistant Secretary 
         (Army Review Boards)