RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-05184 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050228

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E9, First Sergeant, medically separated for “bilateral knee degenerative joint disease (DJD)” rated 10% for each knee, with a combined disability rating of 20%.

CI CONTENTION: He should have had knee replacement surgery prior to separation. Review of all conditions requested. The complete submission is at Exhibit A.

SCOPE OF REVIEW: The panel’s scope of review is defined in DoDI 6040.44. It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable. Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20041221	VARD - 20051209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee DJD	5099-5003	10%	DJD Bilateral Knees	5003	10%	STR	
	5099-5003	10%					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Bilateral Knee DJD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s knee condition began in approximately 1994 “while doing some arduous duty,” and worsened after being recalled and deployed. He had a history of arthroscopic surgery on each knee. X-rays on 26 October 2004 showed bilateral knee DJD with bone on bone in the medial compartments as well as DJD in the patellofemoral component.

During the 3 November 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported pain in both knees. Physical examination showed the CI had pain with  knee flexion  bilaterally.  The 26 October 2004  orthopedic  consult  and  18 November 2004 MEB NARSUM examination accomplished by the same specialist noted complaints of bilateral knee pain and inability to walk without pain or do any aggressive activities. Physical examination of each knee showed bony osteophytes and some mild effusion without warmth or erythema. There was some medial joint line tenderness on both knees and complaints

of patellar grind or anterior knee pain. Bilateral knee range of motion (ROM) was flexion of 125 degrees (normal 140) and extension of 0 degrees (normal). The diagnosis was bilateral knee DJD with bone-on-bone arthritis. The specialist offered use of a cane if one knee became worse than the other, Synvisc or cortisone injection with flares, and opined that the CI would probably need total joint replacement on each knee, but noted the CI was “still fairly young for this procedure and conservative measures right now are maintaining his activity levels as needed.”

VA records documented 19 September 2005 right knee replacement (TKA) , 7 months after separation,) and left knee TKA on 9 January 2006, 10 months after separation. The VA rating was increased to 60% effective March 2007 subsequent to a temporary 100% beginning in September 2005 with the CI’s first TKA.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated each knee condition separately at 10%, analogously coded 5099-5003 (degenerative arthritis), for a combined 20% rating. The VA rated the bilateral knee condition 10%, coded 5003 (degenerative arthritis), based on the STR, citing X-ray evidence of DJD of both knees, and as the CI failed to report for the VA joints examination the examiner was unable to determine any further severity of the condition. There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating for each knee (based on §§4.59, 4.40 and 4.45). The CI did not have knee replacement surgery prior to separation. The panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating. There was therefore no VASRD §4.71a rating higher than the combined 20% rating adjudicated by the PEB under any applicable code. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral knee condition.

BOARD FINDINGS: In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends no modification or re- characterization of the CI’s disability and separation determination.

2	PD-2017-05184

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.