RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

SEPARATION DATE:  20021025 

 
NAME:  XXXXXXXXXXXXXXX                                                            BRANCH OF SERVICE:   ARMY  
CASE NUMBER:  PD1200622 
BOARD DATE:  20121102    
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SSG/E-6  (31S/Satellite  Communications  System 
Operator/Repairer), medically separated for left knee pain.  The condition began as a result of 
injury  in  1996.    Despite  initial  surgery,  rehabilitation  and  later  arthroscopy,  the  CI  did  not 
improve  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  Medical  Evaluation  Board  (MEB).    The  MEB  forwarded  anterior 
knee  pain  to  the  Physical  Evaluation  Board  (PEB)  as  medically  unacceptable  IAW  AR  40-501.  
The MEB forwarded no other conditions for PEB adjudication.  The PEB adjudicated the chronic 
left  knee  pain  condition  as  unfitting,  rated  10%  with  application  of  the  US  Army  Physical 
Disability Agency (USAPDA) pain policy.  The CI made no appeals, and was medically separated 
with a 10% disability rating.   
  
 
CI CONTENTION:  “The initial PEB only rated my left knee injury while several serious medical 
conditions existed at the time of separation.”  
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (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 unfitting left knee condition meets the criteria prescribed in DoDI 6040.44 for 
Board purview, and is accordingly addressed below.  The remaining conditions rated by the VA 
at  separation  and  listed  on  the  DD  Form  294  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 
Correction of Military Records. 
 
 
RATING COMPARISON:   
 

VA (1 Mo. Pre-Separation) – All Effective Date 20021026 

0% X 3 
Combined:  50%* 
*Rating decision 20100511 added diabetes, coded 7913 at 20%, effective 20090420; combined 60%. 

Combined:  10% 

Service IPEB – Dated 20021010 
Condition 

Code 

Chronic Left Knee Pain 

5099-5003 

↓No Additional MEB/PEB Entries↓ 

Rating 
10% 

Condition 

Anterior Cruciate Ligament Tear 
Left Knee Degenerative Changes 
Lumbosacral Strain 
Right Shoulder Strain 
Deviated Nasal Septum 
Tinnitus 

Code 
5257 
5010 
5295 

6502 
6260 

5099-5024 

Rating 
10% 
10% 
10% 
10% 
10% 
10% 

Exam 

20020919 
20020919 
20020919 
20020919 
20020919 
20020830 
20020919 

 
 
 
ANALYSIS SUMMARY:   
 
Left Knee Condition.  Open surgical repair of a left anterior cruciate ligament (ACL) avulsion was 
performed in January 1996.  A post-operative note after the first arthroscopy reported that the 
left knee displayed a Lachman test equivalent to a Grade IA (minimally abnormal ACL integrity 
test).  The orthopedist opined that this likely represented the CI’s normal baseline because the 
unaffected right knee ACL showed the same findings.  Because of recurrent pain and symptoms 
of  giving  way  (indicating  possible  knee  ligament  instability),  a  diagnostic  arthroscopy  was 
performed in 1999.  This revealed an intact ACL, but some scarring of the anterior fat pad was 
present  that  required  surgical  release.    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. 
 

PT ~2 Mo. Pre-Sep 

VA C&P ~1 Mo. Pre-Sep 

135⁰ 
0⁰ 

140⁰ 
0⁰ 

ROM additionally limited by  

pain; slight anterior 
subluxation with some 

instability 

 

10% 
10%* 

Left Knee ROM 

Flexion (140⁰ Normal) 
Extension (0⁰ Normal) 

Comment 

§4.71a Rating 

5099-5003 or 5010 

5257 

+painful motion and 

tenderness; 1A Lachman, 

+anterior drawer 

 

10% 
10%* 

          *If instability conceded 

 
 
At  the  narrative  summary  (NARSUM)  examination  performed  3  months  prior  to  separation 
(2 August  2002),  the  CI  reported  sharp  anterior  knee  pain  when  twisting,  and  occasional 
swelling and “very occasionally giving way.”  Pain occurred daily.  There were no symptoms of 
locking.  Over the counter pain medication was partially helpful for pain.  Physical exam showed 
a  Grade  IA  Lachman  test  and  a  negative  pivot  shift  test  (normal  ACL  integrity  test).    Painful 
motion and tenderness were present.  X-ray revealed post-surgical changes.  The MEB examiner 
noted painful motion and  no knee laxity.  At the VA Compensation and Pension (C&P) exam 
performed a month prior to separation, the CI reported that he had some limitation in walking 
because of pain in his knee joints.  He occasionally required pain medication.  Exercise caused 
the pain to flare up.  He also noted that his left leg would occasionally give way.  Examination 
revealed  a  normal  gait.    Although  ROM  was  additionally  limited  by  pain,  the  degree  of 
additional limitation was not specified.  Muscle strength was normal and there was no muscle 
atrophy. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
10% rating by the PEB under an analogous 5003 code (degenerative arthritis) was consistent 
with  VASRD  §4.71a  standards  for  rating  a  painful  joint  with  noncompensable  limitation  of 
motion.  A 10% rating was also justified under §4.40 (functional loss) or §4.59 (painful motion), 
an approach reflected in the VA’s 10% rating under the 5010 code (traumatic arthritis).  The VA 
however  assigned  an  additional  10%  rating  for  instability  using  the  5257  code  (Knee,  other 
impairment of: recurrent subluxation or lateral instability).  Although the dominant symptom 
was clearly pain, the CI also complained of occasional giving way (a possible symptom of knee 
instability).  Board members debated the significance of multiple exams showing a minimally 

positive Lachman test present before and after an arthroscopy that documented a normal ACL.  
The  Board  concluded  that  the  occasional  symptom  of  giving  way  was  not  due  to  ligament 
instability and therefore that additional disability under the 5257 code was not justified.  The 
Board also considered rating under the 5262 code (Tibia and fibula, impairment of), but agreed 
that “slight” knee disability was the most accurate descriptor of the condition under this code; 
thus  a  rating  higher  than  10%  was  not  justified  via  this  pathway.    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 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.  As discussed above, PEB 
reliance on the USAPDA pain policy for rating chronic 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  chronic  left  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:   
 

Chronic Left Knee Pain 

UNFITTING CONDITION 

VASRD CODE  RATING 
5099-5003 
COMBINED 

10% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120608, 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 
XXXXXXXXXXXXXXXXXXXXXX, AR20120020588 (PD201200622) 
 
 
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)