RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20031215 

 
NAME:XXXXXXXXXXXXXX 
CASE NUMBER:  PD1201109 
BOARD DATE:  20130208 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SGT/E-5  (92G/Food  Service  Specialist),  medically 
separated  for  chronic  bilateral  knee  pain.    The  CI  developed  knee  pain  in  1996  which  was 
aggravated  after  running  or  prolonged  weight  bearing.    The  chronic  bilateral  knee  pain 
condition  did  not  improve  adequately  to  meet  the  physical  requirements  of  her  Military 
Occupational  Specialty  or  satisfy  physical  fitness  standards.    She  was  issued  a  permanent  L3 
profile and referred for a Medical Evaluation Board (MEB) which found the bilateral knee pain 
to be medically unacceptable.  The bilateral knee pain was the sole condition forwarded by the 
MEB to the Physical Evaluation Board (PEB) for adjudication.  The PEB adjudicated the chronic 
bilateral  knee  pain  condition  as  unfitting,  rated  0%,  with  application  of  the  Veterans  Affairs 
Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated 
with a 0% disability rating.   
 
 
CI CONTENTION:  “While on active duty, I was in non-deployable status due to various medical 
conditions.  I was not allowed to wear any gear to keep added weight from further damaging 
my joints.  I had a permanent profile that stated that I could not do push-ups due to problems 
with my left wrist, and that I was to walk at my own pace.  In addition, I was not allowed to 
stand for extended periods of time and I was to eat every two hours to control (con't) low blood 
sugar levels.  The medical conditions diagnosed while I was on active duty have worsened, and 
some new conditions have been diagnosed.  I still can't jump or run and in order to avoid stiff 
joints, I have to constantly stand up, sit and move around in equal amounts throughout the day. 
The condition with my hips has gotten worse.  A recent MRI (May 2012) showed degeneration 
of the hips and fluid in one hip.  They are extremely painful, and the pain affects my overall 
quality of life.  In addition, both wrists become so painful that I can't open jars and bottles, and 
I'm unable to lift heavy objects.  My knees are also extremely painful. All affected joints swell 
and limit my range of motion.  In the last year, I started to experience the migraine headaches I 
was experiencing while on active duty.  I also have been diagnosed with cysts in the left sinus 
cavity,  left  wrists,  and  more  recently,  in  my  left  ovary.    The  situation  with  my  ovary  caused 
heavy bleeding and irregular and painful menstrual periods.  I'm in the process of being seen by 
an OB-GYN for a determination on how best to address the latter medical condition.” 
 
 
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 other requested conditions 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 service Board for Correction of Military Records. 
 

 
 
 
RATING COMPARISON: 
 

Service IPEB – Dated 20031104 
Condition 
Chronic  Bilateral  Knee 
Pain 
↓No Additional MEB/PEB Entries↓ 
Combined:  0% 

Code 
5099-5003 

Rating 
0% 

VA (4 Mos. Post-Separation) – All Effective Date 20031216 
Condition 
Left Knee Condition 
Right Knee Condition 
Left Wrist Tendinitis 
Not Service-Connected x 5 
Combined:  30% 

Rating 
10% 
10% 
10% 

Code 
5260 
5260 
5215 

Exam 
20040413 
20040413 
20040413 
20040413 

 
 
ANALYSIS  SUMMARY:    The  PEB  combined  the  right  and  left  knees  conditions  as  the  single 
unfitting  condition  and  rated  the  chronic  bilateral  knee  pain  at  0%,  using  code  5099-5003.  
However,  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, however,  it  must  satisfy the 
requirement that each unbundled condition was unfitting in and of itself.  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, rather than a judgment that each 
condition  was  independently  unfitting.    Thus  the  Board  must  exercise  the  prerogative  of 
separate 
its 
recommendations may not produce a lower combined rating than that of the PEB.  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  recommendation;  as 
summarized in the chart below.   

in  this  circumstance,  with  the  caveat 

fitness  recommendations 

that 

 

Knee ROM 

MEB ~2 Mos. Pre-Sep 

VA C&P ~4 Mos. Post-Sep 

Left 

Right 

Left 

Right 

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

140⁰ 
0⁰ 
No instability or pain 
on motion 
0% 

140⁰ 
0⁰ 
No instability or pain 
on motion 
0% 

140⁰ 
0⁰ 
No instability or pain 
on motion 
0% 

140⁰ 
0⁰ 
No instability or pain 
on motion 
0% 

 
Left Knee Pain:  The Board first considered if the left knee pain, having been de-coupled from 
the combined PEB adjudication, remained independently unfitting as established above.  The CI 
received profiles for both the knees to limit running, jumping, crawling.  The CI's commander 
wrote, in a memorandum dated 30 October 2003, that the CI is incapable of fully performing 
her duties due to her chronic knee pain.  The commander recommended the CI not be retained 
because continued military service would risk aggravating her medical condition.  At the MEB 
examination,  (2  months  prior  to  separation)  the  CI  had  normal  ROM.    She  had  no pain  with 
motion, instability or signs of meniscal irritation.  She did have some tenderness in the knee and 
a positive patellar grind test (a non-diagnostic finding).  At the VA Compensation and Pension 
(C&P) evaluation (4 months after separation), the CI had no tenderness or pain with motion.  
She had no knee instability.  The CI's X-rays have demonstrated no abnormalities.  In light of 
essentially  normal  findings  of  the  left  knee,  the  Board  members  concluded  that  the 

preponderance  of  evidence  did  not  show  that  the  left  knee  pain  condition  was  separately 
unfitting. 
 
Right  Knee  Pain:    The  Board  then  considered  if  the  right  knee  pain,  having  been de-coupled 
from the combined PEB adjudication, remained independently unfitting as established above.  
The history and findings were the same as for the left knee.  The Board members concluded 
that  the  preponderance  of  evidence  did  not  show  that  the  right  knee  pain  condition  was 
separately unfitting.   
 
Having concluded that the knees were not separately unfitting, the Board directs attention to 
its rating recommendation for the sole unfitting condition, chronic bilateral knee pain, based on 
the above evidence.  The PEB rated the bilateral knee condition 0% using the analogous code 
for degenerative arthritis, 5003.  The VA rated each knee separately at 10% for pain using the 
code 5260, limitation in flexion.  The Board noted that both the MEB and C&P examinations 
were normal as were the X-rays.  Painful motion was not documented and the use of VASRD 
§4.59 is not applicable.  The positive patellar grind test is non-specific.  There was no instability 
of the knees.  The Board considered the coding options available for the knees and determined 
that the code 5003 was the best fit as an analogous coding for the bilateral knee pain condition.  
There were no objective findings to support a higher rating than the 0% awarded by the PEB.  
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 chronic bilateral 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.    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  chronic  bilateral  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:   
 

VASRD CODE  RATING 
5099-5003 
COMBINED 

0% 
0% 

UNFITTING CONDITION 
Chronic Bilateral Knee Pain 

 
 
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 
 
 
 
 

 
 
 
 
 

           xxxxxxxxxxxxxxxxxxxxxxxxxx, DAF 
           Acting 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 xxxxxxxxxxxxxxxxxxx, AR20130002988 (PD201201109) 
 
 
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 
 
 
 

     xxxxxxxxxxxxxxxxxxx 
     Deputy Assistant Secretary 
         (Army Review Boards)