RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00984
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20081229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Electric Power Production Craftsman) medically separated for a back condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was issued an L4 profile and referred for an Medical Evaluation Board (MEB).  Ankylosing spondylitis was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated ankylosing spondylitis as unfitting, rated 10% citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Unfairly denied retirement due to in lieu of orders. Was injured prior to receipt of in lieu of orders and because I was not able to deploy at that time, I was forcefully separated. I have an outstanding military record and feel that the denial of my retirement unfair and unjust. I gave the DOD 15 years of service and was kicked to the curb on a technicality.”  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 condition outside the Board’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.  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:  

IPEB – Dated 20081029	VA* - (~3 Mos. Pre -Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ankylosing Spondylitis	5240	10%	Degenerative Arthritis of Thoracolumbar Spine	5242	10%	20080925	
Other x 0 (Not In Scope)	Other x 7	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20090129 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Ankylosing Spondylitis.  The CI presented for evaluation of back pain in March 2008.  X-rays in March 2008 of the lower thoracic spine suggested possible inflammatory arthritis, and there were mildly abnormal changes in the right sacro-iliac joint.  However, magnetic resonance imaging (MRI) of the spine was normal.  A rheumatologist subsequently rendered a diagnosis of ankylosing spondylitis.  The MEB narrative summary (NARSUM) on 12 September 2008 (4 months prior to separation) reported intermittent flares of mid and low back pain.  Physical exam showed stiffness when arising out of the chair.  No back muscle spasm was present.

At the VA Compensation and Pension (C&P) exam on 25 September 2008 (3 months before separation), the CI reported localized pain that occurred 3 times per month, and was produced by activity and relieved by rest.  He could still function when pain was present, and he had experienced no incapacitation.  He could not perform gardening activities or push a lawn mower.  Examination showed a normal gait and spinal contour.  Sacroiliac X-rays were normal and lumbar spine X-rays showed degenerative arthritis.

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	PT ~8 Mos. Pre-Sep	PT ~7 Mos. Pre-Sep	PT ~4 Mos. Pre-Sep	VA C&P ~3 Mos. Pre-Sep	
Flexion (90 Normal)	30	90	90	75	
Combined (240)	100	160	160	200	
Comment	+Painful motion, spasm	+Painful motion, spasm; gait, contour not mentioned.	+Painful motion, spasm; gait, contour not mentioned.	+Tenderness, painful motion.	
§4.71a Rating	40%	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5240 code (Ankylosing spondylitis) while the VA assigned the same rating using the equally applicable 5242 code (Degenerative arthritis of the spine).  Although one examination supported a 40% rating for forward flexion not greater than 30 degrees, all other exams were more proximal to separation and thus assigned higher probative value relevant to rating at the time of separation.  Board members agreed that these exams supported a 10% rating for combined ROM greater than 120 degrees but not greater than 235 degrees.  The VA exam also warranted a 10% rating for forward flexion greater than 60 degrees but not greater than 85 degrees.  Although muscle spasm was present on two exams, there was no requisite link to abnormal gait or spinal contour to justify the next higher 20% rating.  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 ankylosing spondylitis 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 ankylosing spondylitis 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 20140222, 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 XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00984.

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.

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.

Sincerely,

Attachment:
Record of Proceedings