RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00225
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20070127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Infantryman) medically separated for a lumbar spine condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Ankylosing spondylitis was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated ankylosing spondylitis with positive HLA-B27 (confirmatory lab test) as unfitting, rated 20% citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  His spine condition has caused his health problems.  He was not evaluated for sleep apnea, fibromyalgia, and osteoarthritis conditions.  His complete submission is at Exhibit A.

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review (such as the additional conditions cited in the contention) and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20061122	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ankylosing Spondylitis ...	5240	20%	Ankylosed Spondylitis	5240	20%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070606 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Lumbar Spine Condition.  The service treatment record (STR) corroborated the MEB narrative summary (NARSUM) history of an onset of back pain in 1996 (11 years prior to separation) after stepping in a hole.   X-rays were normal, but the pain persisted; and, there are scattered entries throughout the STR reflecting ongoing and worsening complaints with conservative treatment.  There were no significant radicular symptoms.  Magnetic resonance imaging late in the course noted degenerative disc changes at L4 to S1 without herniation or neural compromise (no surgical indications) with bony degenerative changes (facet hypertrophy and sacroiliac ankylosis) suggesting the ultimately diagnosed condition of ankylosing spondylitis (a rheumatologic disease that attacks the spine).  There are early STR entries noting gait disturbance, but those closer to separation document a normal gait (with none to the contrary).  There are numerous STR entries confirming normal neurological findings (5/5 strength) with none to the contrary.  There are various entries documenting grossly normal range-of-motion (ROM), but a few indicating non-specifically decreased flexion and extension; with none indicating severe ROM limitation.  There is no STR evidence for abnormal spinal contour or periods of incapacitation.

The MEB NARSUM was conducted 27 September 2006 (4 months prior to separation) and documented persistent diffuse back pain radiating into the buttocks with intermittent foot paresthesias, but no subjective weakness or other radicular symptoms, and specified only profile limitations (20 pound lifting restriction).  The physical examination recorded a normal gait, lumbar spasm and tenderness, and normal neurological findings (5/5 bilateral strength).  Formal ROM measurements from physical therapy (PT) on the same date as the MEB NARSUM were attached; recording flexion to 40 degrees (normal 90) and combined ROM of 165 degrees (normal 240).  An internal medicine addendum to the MEB NARSUM provided the formal diagnosis of ankylosing spondylitis and elaborated the prognosis as a chronic progressive disease.  It did not provide additional evidence specifically probative to rating.  Repeat ROM measurements by PT were performed on 20 October 2006 (after the NARSUM, 3 months prior to separation) and recorded flexion to 70 degrees and combined ROM of 140 degrees.  

As noted above, there was no temporally probative VA or other post-separation evidence in this case; although, the next available Compensation and Pension examination (7 March 2009, 2+ years after separation) recorded improved ROM measurements (flexion 90 degrees).

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA 20% ratings (based on the same service evidence) under code 5240 (Ankylosing spondylitis) were consistent with criteria of the VASRD §4.71a general spine formula for the ROM and ratable findings in evidence.  There is no ROM evidence in support of a higher rating, no evidence of additionally ratable peripheral nerve impairment, and no documentation of incapacitating episodes which would provide for a higher rating under that formula.  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 of the lumbar spine 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 lumbar spine 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140102, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160000429 (PD201400225)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA