RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20030505 

 
NAME:  XXXXXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200989 
BOARD DATE:  20130118 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  a  National  Guard  SPC/E-4  (91W10/Medical  Specialist),  medically 
separated  for  chronic  right  knee  pain  status  post  (s/p)  anterior  cruciate  ligament  (ACL) 
reconstruction.  In February 2000 the CI injured her right knee during basic training.  She had 
immediate  swelling  and  pain.  A  magnetic  resonance  imaging  (MRI)  study  was  performed  in 
April 2000, which revealed a slight meniscal tear.  She was treated with activity modification, 
physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs).  The CI continued to have 
right knee pain and swelling and in September 2001 her knee gave out after a jumping exercise.  
A  repeat  MRI  revealed  an  effusion,  medial  meniscal  tear,  complete  ACL  tear,  and  a  medial 
collateral ligament (MCL) tear.  In October 2001 she underwent surgery to reconstruct her right 
ACL and repair the medial meniscus; excision of a prepatellar lipoma was also accomplished.  
The  CI  continued  to  have  right  knee  swelling  and  pain  despite  post-operative  conservative 
management.    The  right  knee  condition  could  not  be  adequately  rehabilitated  to  meet  the 
physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness 
standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board 
(MEB).    The  MEB  forwarded  s/p  right  ACL  and  medial  meniscal  tear  repair  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  right  knee  condition  as 
unfitting, rated 0% with cited application of the US Army Physical Disability Agency (USAPDA) 
pain policy.  The CI made no appeals, and was medically separated with a 0% disability rating. 
 
 
CI  CONTENTION:    “I  was  injured  LOD  and  had  3  knee  surgeries  from  2001  to  2009.    I  have 
arthritis and have been told I will need a knee replacement in the future.” 
 
 
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:   
 

VA (7 years Post-Separation) – All Effective Date 20091118 

Condition 

Code 

Rating 

Exam 

Service IPEB – Dated 20030206 
Condition 

Code 

Rating 

Chronic Rt Knee Pain S/P 
Anterior Cruciate 
Ligament Reconstruction 

5099-5003 

0% 

Traumatic Arthritis Rt Knee 

5010-5260 

10% 

20100309 

↓No Additional MEB/PEB Entries↓ 

0% X 0 / Not Service-Connected x 0 

20100309 

Combined:  0% 

Combined:  10% 

 
ANALYSIS SUMMARY.  The Board acknowledges the sentiment expressed in the CI’s application, 
that the gravity of her condition and predictable consequences merit consideration for a higher 
service disability rating.  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. 
 
Right  Knee  Condition.    The  narrative  summary  (NARSUM)  examiner,  5  months  prior  to 
separation, reported that the CI experienced swelling and occasional giving way of the knee.  
The condition was aggravated by the first steps in the morning, temperature change, kneeling 
and prolonged standing or sitting.  Ascending or descending stairs caused pain, and she could 
not perform heavy lifting or running.  Physical examination revealed a right quadriceps muscle 
measurement  1.5  centimeters  (0.6  inches)  less  than  the  normal  left  side.    There  was  no 
effusion.    Medial  and  lateral  joint  line  tenderness  was  present.    Range-of-motion  (ROM) 
measurement  showed  flexion  of  130  degrees  (normal  to  140  degrees)  and  extension  of  0 
degrees (normal 0 degrees).  Two examination findings suggested ACL instability; while a third 
test (Lachman) was equivocal.  There was no medial or lateral instability. At the MEB exam 5 
months prior to separation, the CI reported continued swelling, stiffness, and pain in the right 
knee.  She used a knee sleeve.  The physical exam noted mild tenderness to palpation of the 
medial  right  knee  with  4/5  strength.    Although  27  months  remote  from  separation,  an 
orthopedist  stated  (20  July  2005)  that  the  CI  “has  done  pretty  well,  but  the  knee  has  been 
clicking” since her surgery in 2001.  Although the ACL graft appeared to be well functioning by 
physical examination (“solid Lachman”), at arthroscopy the following month debridement of a 
partial ACL tear was required.  The Board directs attention to its rating recommendation based 
on the above evidence.  The Board first considered the PEB’s rating of 0% under the analogous 
5003 code (degenerative arthritis).  The PEB’s DA Form 199 reflected application of the USAPDA 
pain policy, citing “slight/occasional” pain in support of its 0% rating.  However, given that a 
single major joint was involved with a noncompensable loss of ROM and objective findings of 
joint pain with pressure and manipulation, a higher rating of 10% can be achieved under this 
code IAW VASRD §4.71a and § 4.59 (painful motion).  The Board agreed that rating under 5258 
(Cartilage,  semilunar,  dislocated,  with  frequent episodes  of  “locking,”  pain,  and  effusion  into 
the joint) was not justified, and that rating under the 5259 code (Cartilage, semilunar, removal 
of, symptomatic; maximum rating 10%) provided no additional benefit to the CI.  However, the 
Board also debated if additional rating for instability was warranted under the 5257 code given 
the  history  of  ACL  injury,  subjective  complaints  of  occasional  “giving  way”  and  physical 
examination  findings  by  the  NARSUM  examiner  of  possible  ACL  insufficiency.    The  Board 
considered  that  the  only  reported  symptom  that  could  indicate  instability  (giving  way)  was 
“occasional,” and that examination findings of instability by the NARSUM were not consistent.  
Furthermore, although the next orthopedic evaluation was 27 months after separation, the CI 
reported that the persistent symptom since the time of surgery was “clicking,” which is not a 
symptom of instability.  The Board therefore concluded that additional rating under the 5257 
code was not justified.  After due deliberation, considering all of the evidence and mindful of 

VASRD  §4.3  (reasonable  doubt),  the  Board  recommends  a  disability  rating  of  10%  for  the 
chronic right knee pain status post anterior cruciate ligament reconstruction 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 chronic right knee pain condition was operant 
in this case and the condition was adjudicated independently of that policy by the Board.  In the 
matter  of  the  chronic  right  knee  pain  condition,  the  Board  unanimously  recommends  a 
disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a and §4.59.  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 her prior medical separation: 
 

UNFITTING CONDITION 

Chronic Right Knee Pain Status Post Anterior Cruciate Ligament 
Reconstruction 

VASRD CODE  RATING 
5099-5003 
COMBINED 

10% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120630, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXXX, DAF 
           Acting Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXX, AR20130003124 (PD201200989) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)