RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20030627 

 
NAME:  XXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200639 
BOARD DATE:  20130206 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SFC/E-7  (96B4H/Intelligence  Analyst),  medically 
separated for bilateral knee pain with history left knee lateral release and findings of Grade III 
chondromalacia of left patellofemoral joint.  The CI’s knee pain started in 1994 with no history 
of  trauma  or  prior  knee  pain.    He  was  diagnosed  with  patellofemoral  syndrome  (PFS)  and 
treated conservatively with anti-inflammatory medications and physical therapy (PT).  He had a 
left  knee  arthroscopic  evaluation  in  1998  which  revealed  chondromalacia  of  the  patella  and 
underwent  a  lateral  retinacular  release.    The  bilateral  knee  pain  condition  could  not  be 
adequately  rehabilitated.    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 left knee patella chondromalacia and bilateral knee pain conditions 
for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the bilateral knee pain 
condition  as  unfitting,  rated  10%,  with  likely  application  of  the  United  States  Army  Physical 
Disability Agency (USAPDA) pain policy and the Veterans Affairs Schedule for Rating Disabilities 
(VASRD).  The CI made no appeals, and was medically separated with a 10% disability rating.   
 
 
CI  CONTENTION:    “-  1994-1998  chronic  knee  pain  diagnosed  and  treated  as  Patella  Femoral 
Syndrome.; - Left knee patella chondromalacia was confirmed by arthroscopy in 1998, lateral 
release  was  performed.;  -  Right  knee  had  similar  symptoms  but  arthroscopy  was  not 
recommended.;  -  MMRB  proceeding,  18  July  2002,  found  that  my  knee  condition  did  not 
prevent  me  from  performing  the  physical  tasks  required  by  my  MOS  in  a  worldwide  field 
environment and recommended MEBD [SP] because I could no longer take the APFT.; - MEB, 13 
Nov 2002, determined that I was not able to participate in worldwide field deployment because 
of my.; -PEB proceedings, 02 Feb 2003, found me unfit and recommended a combined rating of 
10%.; - April 2003, post PEB, I was diagnosed with Type II Diabetes (NlDDM).  This condition was 
not  considered  as  part  of  the  combined  rating  by  the  PEB,  but  VA  has  granted  20% 
compensation as a service related disability.”  Remarks also commented on VA 40% disability 
rating and not offered pro-rated pension despite over 16 years active service. 
 
 
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  bilateral  knee  pain  conditions  as 
requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; 
and, are addressed below.  The other requested condition (Type II Diabetes) is not within the 
Board’s purview.  The remaining conditions rated by the VA at separation and listed on the DD 
Form  294  any  pension or  non-medical  retirement  issues  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:   
 

Service IPEB – Dated 20030226 
Condition 
Bilateral  Knee  Pain  with 
History  of  Lateral  Release 
Left Knee …  

Code 

5099 5003 

Rating 

10% 

↓No Additional MEB/PEB Entries↓ 

Code 

VA (~10 Mo. Post-Separation) – All Effective Date 20030628 
Condition 
Chondromalacia  and  Tendonitis 
of Left Knee, Postsurgical Lateral 
Retinacular Release 
Chondromalacia, Right Knee  
Non-Insulin Dependent Diabetes 
Mellitus Type 2 
Hypertension 
0% X 4 / Not Service-Connected x 1 
Combined:  30%* 

5299-5024 
7913 
7101 

0%* 
20% 
10% 

5259-5024 

Rating 

Exam 

0%* 

STR 

STR 
20040506 
20040506 
 

Combined:  10% 
*Initially rated at 0% then increased to 10% each effective 20050208 (combined 40%). 
 
 
ANALYSIS SUMMARY:  The MEB forwarded two medically unacceptable conditions to the PEB.  
The  PEB  combined  “left  knee  patella  chondromalacia”  and  “bilateral  knee  pain”  as  a  single 
unfitting and solely rated condition, coded analogously to 5099-5003.  Although this approach 
complies  with  AR  635.40  (B.24  f.);  the  Board  must  apply  separate  codes  and  ratings  in  its 
recommendations, if compensable ratings for each condition are achieved IAW VASRD §4.71a.  
If  the  Board  judges  that  two  or  more  separate  ratings  are  warranted  in  such  cases,  it  must 
satisfy  the  requirement  that  each  unbundled  condition  was  reasonably  unfitting.    Not 
uncommonly this approach by the PEB reflects its judgment that the constellation of conditions 
was unfitting; and, that there was no need for separate fitness adjudications, not a judgment 
that each condition was independently unfitting.  Thus the Board must exercise the prerogative 
of  separate  fitness  recommendations 
its 
recommendations may not produce a lower combined rating than that of the PEB.   
 
Bilateral Knee Pain Condition.  The narrative summary notes the CI’s knee pain started in 1994.  
Initially the CI presented with left knee pain, but gradually developed pain in the right.  The CI 
had  no  history  of  trauma.    He  was  diagnosed  with  bilateral  PFS  and  treated  with  activity 
modification,  anti-inflammatory  medications,  and  PT  without  relief  of  pain.    In  1998  the  CI 
underwent an arthroscopic evaluation of the left knee which revealed patella chondromalacia 
and  a  lateral release  was  performed.   The  CI  continued  to  have pain  in  both  knees  and  was 
placed on a permanent L3 profile with limitations for alternate aerobic event for Army Physical 
Fitness Test  (APFT), no knee  bender, hop,  high jump,  or running.    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.   
 

in  this  circumstance,  with  the  caveat  that 

Knee ROM 

Flexion (140⁰ Normal) 
Extension (0⁰ Normal) 

Comment  

§4.71a Rating 

MEB ~7 Mos. Pre-Sep 

VA C&P ~10 Mos. Post-Sep 

Left 

Right 

Left 

Right 

FROM “in both knees” 
+tenderness; 
crepitance 
L>R; 
significant  limitation  of 
patellar  motion  both 
knees; no instability 
10% 
10% 

0-140⁰ 

0-140⁰ 

Gait  slow  and  stiff;  cane  in 
hand;  no 
instability;  no 
tenderness; normal left and 
right knee x-rays 
0% 
0% 

 
At the MEB exam 7 months prior to separation, the CI reported pain with most activities related 
to  soldiering  and  recreational  sports.    He  related  increasing  locking  and  popping  in  his  right 
knee and occasional instability and giving way in both knees.  The MEB physical exam noted full 

2                                                           PD1200639 
 

ROM,  left  greater  than  right  knee  crepitance,  significant  limitation  of  patellar  motion  both 
knees, and tenderness to palpation both patella, but no tenderness along the joint line.  Tests 
for instability were negative.  Radiographs were normal.  At the VA Compensation and Pension 
exam 10 months after separation, the CI reported some improvement in his knee conditions 
with weight reduction.  He reported that the knees “give out occasionally after being on knees 
for more than 20 minutes.”  The VA exam noted no tenderness to palpation bilaterally.  The 
exam  ROM  was  0-140  degrees  (normal)  with  negative  tests  for  instability.    The  VA  exam  25 
months after separation indicated the CI was using a cane for instability, but had a normal gait 
without  his  cane.    There  was  slight  pain-limited  motion  (0-130⁰)  with  objective  findings  of 
weakened movement and incoordination.  Tests for instability were negative.  The Board first 
considered  if  the  left  and  right  knee  conditions,  having been  de-coupled  from  the  combined 
PEB adjudication, remained independently unfitting as established above.  The CI has multiple 
notations within the service treatment record of bilateral knee pain and was treated with PT, 
bracing and oral medications for both knees.  While the left knee pain was greater than the 
right and warranted surgical intervention, both knees prevented performance of service related 
duties and recreational activities.  The CI’s permanent L3 profile documented restrictions that 
could be attributed to both the left and right knee conditions including limitations for alternate 
aerobic event for APFT, no knee bender, hop, high jump, or running.  All members agreed that 
the  left  and  right  knee  conditions  were  each  reasonably  unfitting,  and  accordingly  merit 
separate ratings.   
 
The  Board  directs  attention  to  its  rating  recommendation  based  on  the  above  evidence.    As 
discussed  above,  the  PEB  combined  multiple  conditions  into  a  single  unfitting  rating  and 
assigned an overall 10% rating likely IAW AR 635-40.  The VA provided separate 0% ratings for 
the right and left knees, based on an improved post-separation exam of the knees.  There was 
no evidence of incapacitating episodes.  The preponderance of the record indicated crepitance 
and functional loss due to each knee condition at the 10% rating level coded analogously to 
5014 (Osteomalacia).  After due deliberation, the Board agreed that the preponderance of the 
evidence with regard to the functional impairment of the bilateral knee pain conditions favor its 
recommendation  as  separately  left  and  right  knee  unfitting  conditions  for  disability  rating.  
Considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), 
the Board recommends a disability rating of 10% for the left knee condition and 10% for the 
right knee condition IAW VASRD §4.40 (Functional loss) and §4.45 (The joints).   
 
 
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 USAPDA for rating the bilateral knee condition was likely operant in this case and 
the condition was adjudicated independently of that policy by the Board.  In the matter of the 
bilateral  knee  pain  condition,  the  Board  unanimously  recommends  that  it  be  rated  for  two 
separate unfitting conditions as follows:  left knee pain coded 5099-5014 and rated 10%, and 
right knee pain coded 5099-5014 and rated 10%; both IAW VASRD §4.71a.  There were no other 
conditions within the Board’s scope of review for consideration.   

3                                                           PD1200639 
 

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation:   
 

UNFITTING CONDITION 
Condition Left Knee Patella chondromalacia status post surgery 
Condition Right Knee Patellofemoral Syndrome 

VASRD CODE  RATING 
5099-5014 
5099-5014 

10% 
10% 
COMBINED (w/ BLF)  20% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120607, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

4                                                           PD1200639 
 

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 XXXXXXXXXXXXXXX, AR20130002788 (PD201200639) 
 
 
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 20% 
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 
 
 
 
 

     XXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

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