RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXX                                                               BRANCH OF SERVICE:  air force
CASE NUMBER:  PD1100377 	                        SEPARATION DATE:  20080721
BOARD DATE:  20120119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty member, SRA/E-4 (3E851, EOD Journeyman), medically separated for spondylopathy (an arthritis-like condition).  In 2005, the CI presented with complaints of multiple joints pains, primarily involving his right wrist, left shoulder, bilateral knees and feet.  The CI was eventually diagnosed with a spondylopathy and treatment was begun with the medications Humira (injection requiring refrigeration) and sulfasalazine.  His joint pains resolved with initiation of the medication and he was subsequently allowed to deploy overseas with his unit.  The CI had to be evacuated from theater early; however, when a prolonged loss of electrical power resulted in loss of his medication due to lack of refrigeration.  Because of the difficulties encountered with maintaining his medication supply overseas, the CI was placed in a non-deployable status and, therefore underwent a Medical Evaluation Board (MEB).  Spondylopathy was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AFI 48-123.  No other conditions appeared on the MEB’s submission.  Other conditions included in the Disability Evaluation System (DES) packet will be discussed below.  The PEB adjudicated the spondylopathy condition as unfitting, rated 20%, with application of the Veterans Administration Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated with a 20% disability rating.

CI CONTENTION:  The CI states:  “I had a good, albeit short, military career.  I was an Explosive Ordnance Disposal (EOD) Technician, with an active TS clearance, and two deployments to Iraq under my belt.  Halfway through my second enlistment is when I was informed that because of my joint disease, I was no longer deployable, and was getting medically separated.  This news hurt me both emotionally and financially.  I loved serving, I loved EOD, and I loved the US Air Force.  I had no idea how the disability ratings worked, I have been healthy all my life and never saw a need to understand them.  When I heard I was rated at 20% that meant nothing to me.  As time went by, I realized how much I missed being a part of the military community.  My current job has me travelling to different military installations and removing ordnance from old ranges.  I cannot use the base gym, cannot buy gasoline on base, and cannot buy gum at the commissary without being accompanied by a military member.  It’s sad.  I can understand why the US Air Force sees me as non-deployable, after all, I have to give myself an injection twice a month that requires refrigeration (not an easy task considering my job was mission critical and our most common theaters of operation were deserts).  I only submit myself for review in hopes of raising my disability rating to a level that grants me base privileges.  I feel I have earned them.  Thank you for your consideration.”  

RATING COMPARISON:

Service IPEB – Dated 20080606	VA (2 Mo. After Separation) – All Effective Date 20080722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spondylopathy	5099-5002	20%	Seronegative Spondylopathy	5099-5002	20%	20080915	
Combined:  20%	Combined:  20%	

ANALYSIS SUMMARY:  

Spondylopathy.  The CI was diagnosed with spondylopathy involving multiple joints to include his right wrist, left shoulder, bilateral knees and feet.  Although he did not have prominent back pain symptoms at the time of his diagnosis, he did have a remote history of some back pain concerns.  The CI did not have any associated systemic involvement such as rashes, gastrointestinal symptoms, inflammatory eye symptoms or oral lesions.  Plain radiographs of his left shoulder and right wrist taken in 2005 were normal, as were plain radiographs of his sacroiliac joints taken in 2006.  Laboratory studies were negative for rheumatoid factor, but positive for HLA-B27.

The MEB exam, seven months pre-separation (and two months after break in medication use/flare), documented “good ROM (range-of-motion)” in his hips, knees, ankles, shoulders and neck.  There was no spinal tenderness to palpation.  The CI denied any uveitis (eye) symptoms or oral sores; and the examiner noted no evidence of serositis (inflammation of organ linings).  The MEB examiner commented that the CI had previously experienced a return of his symptoms after running out of medication during his deployment; however, the symptoms had resolved within one day of resuming his Humira.  Exam indicated “mild swelling and tenderness of the left elbow,” mild synovial thickening of both wrists, and mild tenderness of the finger joints on both hands.  There was no limited or painful motion documented.  There was no abnormal joint imaging.  

At the Department of Veterans’ Affairs (DVA) Compensation and Pension (C&P) exam, two months post-separation, the CI reported that he had not had any symptoms since starting Humira in the spring of 2007.  The VA examiner documented ROM of the cervical and thoracolumbar spines without pain; and normal ROM of the fingers, wrists, elbows, shoulders, hips, knees and ankles, without pain.  The CI’s gait was also noted as normal.

The PEB and the VA chose the same coding for the condition and arrived at the same rating. They both rated at 20% for “one to two exacerbations a year in a well established diagnosis.”  Although the VA exam documented that the CI had not had any symptoms within the past year, both the service and the VA rated based upon the episode of symptom exacerbation in    January 2008 following the unavoidable loss of medication during his deployment.  The MEB exam was very close to the CI’s flare and the VA examination was considered to have the highest probative.  There were no residuals of limitation of motion or ankylosis of any of the involved joints to obtain a compensable rating under the individual joint codes by the time of separation.  There were no associated constitutional manifestations and no incapacitating episodes to justify a higher rating under the 5002 coding.  Alternate coding under 5003 for evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations would not code higher than the 20% under 5002 which is predominate.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the spondylopathy condition. 

Remaining Conditions.  No other conditions were noted in the narrative summary (NARSUM) or found elsewhere in the DES file. The Board, therefore, has no reasonable basis for recommending any additional unfitting conditions for separation rating.

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 spondylopathy condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  The Board unanimously agrees that there were no other conditions eligible for Board consideration which could be recommended as additionally unfitting for rating at separation. 

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: 

UNFITTING CONDITION	VASRD CODE	RATING	
Spondylopathy	5099-5002	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20110503, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans' Affairs Treatment Record

                             		

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews MD  20762

Dear XXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2011-00377

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation with severance pay.

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.