RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXXX                                                                  BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200694                                                             SEPARATION DATE:  20011127 
BOARD DATE:  20130206 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  PV2/E-2  (88M/Heavy  Wheeled  Vehicle  Operator), 
medically separated for chronic pain, left hip due to trochanteric bursitis and left knee due to 
patellar tendonitis.  In April 2000, the CI fell off a horse and landed on his left knee.  The CI 
reported  that  left  hip  pain  began  in  July  2001.    Despite  conservative  treatment  including 
physical therapy and medication, the CI failed 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 patellar 
tendonitis,  chronic  in  nature  and  left  trochanteric  bursitis  to  the  Physical  Evaluation  Board 
(PEB).  The MEB forwarded no other conditions for PEB adjudication.  The PEB adjudicated the 
chronic pain, left hip, due to trochanteric bursitis and left knee, due to patellar tendonitis as a 
single unfitting condition, rated 0%, with application of the US Army Physical Disability Agency 
(USAPDA)  pain  policy.    The  CI  made  no  appeals,  and  he  was  medically  separated  with  a  0% 
disability rating.   
 
 
CI CONTENTION:  “Disability has increased in severity and causing secondary health issues.”   
______________________________________________________________________________ 
 
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:   
 

Service IPEB – Dated 20011001 
Condition 
Chronic Pain, Left Hip due 
to  Trochanteric  Bursitis 
and  Left  Knee  due  to 
Patella Tendonitis 

Code 

↓No Additional MEB/PEB Entries↓ 

Rating 

0% 

5099-5003 

VA (3 years post-separation) – All Effective Date 20011128  
Condition 
Left Hip Trochanteric bursitis 

Code 
5099-5019 

Rating 
0%* 

Left Knee Patellar Tendonitis 
Low Back Strain 
Scar on left side of head 
0% X 2 / Not Service-Connected x 6 
Combined:  20%*** 

5299-5024 
5237 
7800 

0%* 
10%** 
10%** 

to 

Exam 
Failed 
show 
Failed 
show 
20041109 
20041109 
 

to 

Combined:  0% 
*0% ratings were assigned because the CI failed to show for original C&P exam scheduled for 16 April 2002.  First C&P exam 
was 6 July 2004 and after this exam, VA increased ratings to 10% for each effective 31 October 2003.  
**Low back and scar added on 20041227 VARD with effective dates back to 20011231 
***Increased to 20% effective 20011231 and 30% effective 20031031 
 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding  the  significant  impact  that  his  service-incurred  condition  has  had  on  his  current 

earning ability and quality of life.  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  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 PEB combined the chronic left hip and left knee pain as a single unfitting condition, coded 
analogously  to  5003,  and  rated  10%  IAW  the  USAPDA  pain  policy.    This  coding  approach  is 
countenanced by AR 635-40 (B.24 f.), but IAW DoDI 6040.44 the Board must apply only VASRD 
guidance to its recommendation.  The Board must therefore apply separate codes and ratings 
in its recommendations if compensable ratings for each joint are achieved IAW VASRD §4.71a.  
If the Board judges that two or more separate ratings are warranted in such cases, however, it 
must  satisfy  the  requirement  that  each  “unbundled”  condition  was  unfitting  in  and  of  itself 
using  a  reasonably  justified  standard.    The  Board  must  exercise  the  prerogative  of  separate 
fitness recommendations with the caveat that its recommendations may not produce a lower 
combined rating than that assigned by the PEB. 
 
Left  Hip  Trochanteric  Bursitis  Condition.    The  Board  first  considered  whether  the  left  hip 
trochanteric bursitis condition, having been de-coupled from the combined PEB adjudication, 
remained independently unfitting as established above.  In analyzing the intrinsic impairment 
for appropriately coding and rating the left hip trochanteric bursitis condition, the Board is left 
with a questionable basis for arguing that it was indeed independently unfitting.  Although it 
was  mentioned  on  the  permanent  profile,  it  is  not  clear  that  any  of  the  restrictions  would 
remain  if  the  left  knee  condition  were  not  present.    Neither  the  hip  raise  nor  hip  stretch 
exercises  were  prohibited.    The  commander’s  letter  specifically  mentions  the  left  knee 
condition as rendering the CI incapable of performing the duties required of his MOS but makes 
no mention of a hip condition.  The left hip trochanteric bursitis was diagnosed on the MEB 
narrative summary (NARSUM) examination in September 2001 but was not mentioned in the 
MEB exam completed in August 2001.  This examination does not include a hip examination.  
The NARSUM examination does not report any functional impairment related to the hip alone.  
There were no outpatient treatment records related to a left hip condition.  No profiles other 
than the latest one included a left hip condition.  Both X-rays and magnetic resonance imaging 
(MRI) of the left hip were completed by the VA in July 2004 and both were normal.  After due 
deliberation, the Board agreed that, with application of the reasonably justified standard, the 
evidence  does  not  support  a  conclusion  that  left  hip  trochanteric  bursitis  as  an  isolated 
condition,  would  have  rendered  the  CI  incapable  of  continued  service  within  his  MOS,  and 
accordingly cannot recommend a separate service rating for it.   
 
Chronic  Left  Knee  Patella  Tendonitis:    The  Board  first  considered  whether  chronic  left  knee 
patella  tendonitis,  having  been  de-coupled  from  the  combined  PEB  adjudication,  remained 
independently unfitting as established above.  All restrictions on the CI’s permanent profile are 
attributable to the left knee condition and the commander’s letter specifically states that the 
CI’s knee condition rendered him physically incapable of performing the duties required of his 
MOS.  All members agreed that chronic left knee patella tendonitis, as an isolated condition, 
would  have  rendered  the  CI  incapable  of  continued  service  within  his  MOS,  and  accordingly 
merit a separate rating.  
 

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There  was  one  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 
Flexion (140⁰ Normal) 
Extension (0⁰ Normal) 

MEB ~2 Months Pre-Separation 

No ROM’s 

TTP  over  patellar  tendon  and  tibial  tuberosity; 
medial  facet  tenderness;  some  bogginess  palpated 
presumed  to  be  edema;  positive  patellofemoral 
compression; negative varus or valgus instability  
10% 

VA C&P ~32 Months Post-Separation 
92⁰ 
0⁰ 
Tenderness  over  the  medial  joint  space, 
tibial 
tendon;  no 
effusion  or  ligamentous  laxity;  gait  is 
normal without a limp 
10% 

tubercle,  patellar 

Comment 

§4.71a Rating 

 
A left knee X-ray done at the time of the initial injury in April 2000 revealed an avulsion fracture 
of the left anterior tibial tuberosity.  An orthopedics evaluation in December 2000 noted pain 
with running, use of a hinged brace that relieved pressure and tenderness to palpation over the 
patellar tendon and tibial tuberosity.  The CI was diagnosed with left patellar tendonitis and 
was advised to continue using the brace.  The NARSUM examination completed approximately 
2 months prior to separation indicated that the CI had most of his pain around the kneecap and 
tibial  tubercle,  pain on  running, and  pain  with full  flexion.   The examiner  noted that  an MRI 
showed no meniscal or ACL tear or ligamentous damage.  The examiner diagnosed left patellar 
tendonitis,  chronic  in  nature.    The  MEB  physical  exam  findings  are  summarized  in  the  chart 
above.  Although the NARSUM examination is silent concerning painful motion, the totality of 
the record supports a finding a painful motion.  The commander’s statement documented that 
the chronic knee pain rendered the CI incapable of performing the duties required of his MOS.  
The CI failed to report for the scheduled VA Compensation and Pension (C&P) exam and the VA 
Rating Decision (VARD) stated the lack of any exam findings led to the 0% rating.  It was not 
based  on  findings  from  the  service  treatment  records  (STR).    The  C&P  exam  was  completed 
nearly 3 years after separation and noted that the CI had been in a knee brace regularly until 6 
months  prior  to  that  examination  and  still  used  it  occasionally.    The  CI  reported  pain  with 
increased activity, and pain occasionally at night and when it rained.  The CI had pain on both 
sides of the knee, in the front and deep in the knee.  The knee occasionally gave out and caused 
a fall.  Both X-rays and MRI of the left knee were normal. 
 
The  Board  directs  attention  to  its  rating  recommendation  based  on  the  above  evidence.    As 
described  above  the  PEB  bundled  the  left  hip  and  knee  and  rated  the  two  together  at  0% 
utilizing the USAPDA pain policy.  The VA rated the left knee patellar tendonitis analogous to 
5024  Tenosynovitis  rated  0%  because  the  CI  failed  to  show  for  his  C&P  examination.    The 
20041109  VARD  later  increased  the  left  knee  rating  to  10%  based  on  the  C&P  examination 
completed  in  July  2004.    Although  the  NARSUM  and  C&P  examinations  were  almost  3  years 
apart, both examinations support a 10% rating.  While the NARSUM examination was silent on 
painful motion, the clinical history in the NARSUM and the rest of the STR support a finding of 
painful motion.  The C&P noted pain-limited motion at the non-compensable level.  After due 
deliberation in consideration of the preponderance of the evidence, the Board concluded that 
the condition was separately unfitting and considering all of the evidence and mindful of VASRD 
§4.3 (Resolution of reasonable doubt), recommends a disability rating of 10% for the chronic 
left knee patellar tendonitis coded 5099-5003.   
 
 
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, the 
PEB bundled two separate conditions and assigned a single rating of 0% based on the USAPDA 
pain policy and the Board adjudicated this case independently of that policy by the Board.  In 

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the matter of the left hip trochanteric bursitis, the Board unanimously agrees that it was not 
separately unfitting and therefore, no separate disability rating can be recommended.  In the 
matter of the chronic left knee patellar tendonitis, the Board unanimously agrees that it was 
separately unfitting; and, unanimously recommends a disability rating of 10%, coded 5099-5024 
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 
5099-5024 
COMBINED 

10% 
10% 

UNFITTING CONDITION 
Chronic Left Knee Patellar Tendonitis 

 
 
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 
 
 
 
 
 

XXXXXXXXXXXXXXXXXX, DAF 
Director 
Physical Disability Board of Review 

   4                                                           PD1200694 
 

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 XXXXXXXXXXX, AR20130002787 (PD201200694) 
 
 
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 
 
 
 
 

     XXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

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