DEPARTMENT OF THE AIR FORCE
WASHINGTON DC

Office of the Assistant Secretary

SAF/MRBD (PDBR)
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435
MEMORANDUM FOR THE ASSISTANT SECRETARY OF THE NAVY, MANPOWER AND RESERVE AFFAIRS

SUBJECT: Physical Disability Board of Review Recommendation on Case Number PD-2018-00177

In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual from the United States Navy. After carefully reviewing the application and medical separation case file, the PDBR recommended no re-characterization of the separation or modification of the disability rating previously assigned. I recommend you accept this proposed decision.

The covered individual (CI) was an active duty E6, Shore-Based Firefighter, medically separated for “bilateral knee DJD [degenerative joint disease]” with a combined disability rating of 20%. The PEB analogously coded the bundled condition 5299-5255 (impairment of femur), citing the right knee worse than left, with significant osteoarthritis, most in the medial compartment and patellofemoral joint. The VA initially rated each knee separately 0% each, but analogously coded 5299-5260 for the right knee and coded 5260 for the left (limitation of flexion of leg), based on the Compensation and Pension (C&P) examination one month after separation, citing no compensable disability upon examination.  Based on the September 2009 examination 8 months after separation, the VA changed the rating of the right knee condition to 20%, analogously coded 5005-5261 (pneumococcic arthritis - limitation of extension of leg), citing extension limited to 15 degrees. The VA noted right leg sepsis was considered part and parcel of the evaluation for mild DJD medial compartment of the right knee with residual scar. The VA also rated the right knee 30%, coded 5257, citing severe recurrent subluxation or lateral instability which is severe. The VA continued the 0% rating for the left knee condition.

Panel members agreed the evidence reasonably justified that the functional limitations of the right and left knee conditions contributed to the CI’s inability to perform his military duties, and accordingly separate disability ratings are recommended.  The panel first considered its rating recommendation for the right knee and noted that the limitation of extension of the right knee recorded at the September 2009 VA examination, 8 months after separation, met the threshold for a 20% rating. However, the panel assigned greater probative value to the narratve summary (NARSUM) and January 2009 VA examinations more proximate to separation, than the later VA examination. The NARSUM and first VA examinations noted “full” extension with pain and 0 degrees extension with no pain, respectively. Painful flexion of the right knee was noted at the NARSUM examination, but not at the VA examination. By the time of the second

VA examination the CI had reported recurrent problems with infection of the right lower extremity (LE) reportedly since November 2008. The CI reported no problems with joint infection at the first VA examination and had no swelling or warmth of the knee or right LE on examination. Although the reported first episode of right LE infection occurred just prior to separation, right knee ROM at both the NARSUM (which was performed before the diagnosis in November 2008) and the January 2009 VA examination (performed after the reported first two episodes of leg infection) supported no higher than a 10% rating (based on §§4.59, 4.40 and 4.45). The panel considered alternative VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating. There was therefore no higher than a 10% rating supported for the right knee proximate to separation.

The panel next considered a rating recommendation for the left knee. There was no evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45) at the MEB NARSUM and January 2009 VA examinations. The panel considered alternative VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating. There was therefore no higher than a 0% rating supported for the left knee. After unbundling the knees, the panel found that its recommendations of 10% for the unfitting right knee and 0% for the unfitting left knee provided no ratings benefit to the CI. Therefore, the panel recommends no change to the PEB’s combined adjudication. 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.

2	PD-2018-00177

DEPARTMENT OF THE NAVY
SECRETARY OF TI!E 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.