RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03042
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20010916 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Medical Specialist) medically separated for “ankylosing spondylitis … bilateral sacroiliitis,” rated at 20%.   

CI CONTENTION:  “Please consider all conditions.”  The complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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 20010720	VA* - (~1 Mo. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ankylosing Spondylitis ... 	5009	20%	Ankylosing Spondylitis Lumbar Spine	5009	20%	20010821	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1 	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20011005 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Ankylosing Spondylitis, Lumbar Spine.  The service treatment record (STR) corroborates the history in the narrative summary (NARSUM) of an onset of back pain, and later left sacroiliac pain, in May 2000 (17 months pre-separation).  The etiology of these symptoms was diagnosed as ankylosing spondylitis by a rheumatologist in April 2001 (positive HLA-B27 [serologic marker]).  The CI was treated with an immunosuppressant (Azulfidine) and daily anti-inflammatory medication.  Other than left sacroiliitis suggested by imaging, the CI did not manifest any other rheumatologic involvement (synovitis, arthritis, rash, ocular, or other organ system involvement) while on active duty.  There is no STR evidence for more severe range-of-motion (ROM) limitation than as noted below, positive neurologic findings, significant deterioration of health, functional limitations not specified below, or periods of incapacitation.
The NARSUM was conducted 29 June 2001 (10 weeks pre-separation) and documented persistent low back (acuity not elaborated) and left sacroiliac pain associated with morning stiffness; and, specified functional limitations of general soldiering requirements (including running) and “difficulty with prolonged sitting or standing.”  The examiner noted that the CI was able to perform required administrative duties and exercised twice daily which helped the stiffness.  The NARSUM physical examination recorded negative joint and skin findings, and normal neurologic testing with 5/5 strength.  There was no spine or sacroiliac tenderness and the ROM description was “normal extension and side to side motion ... Schober (a scale used by rheumatologists to assess spine flexion) limited to 14 centimeters [normal 15].”  The commander’s performance statement corroborated the CI’s daily exercise routine and documented “constant pain throughout the day but experiences increased pain with lifting heavy objects, carrying weight, most physical training, running, jumping, standing and sitting for long periods of time ... slight limp ... known to try and hide the amount of pain he is truly in.”

A VA Compensation and Pension (C&P) examination was conducted 21 August 2001 (3 weeks pre-separation) and documented “pain on a daily basis” without further elaboration or specified functional limitations other than “has impaired his ability to continue with the required military duties.”  The VA physical examination recorded a normal spinal curvature (no comment regarding gait), and no spasm or spinal tenderness, but bilateral sacroiliac tenderness.  The VA examiner documented normal ROM measurements in all planes (flexion 90 degrees and combined 240 degrees).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA both conferred a 20% rating under code 5009 (arthritis, other types [would include ankylosing spondylitis]) which defaults to criteria of 5002 (rheumatoid arthritis).  The 20% criteria is “one or two exacerbations a year in a well-established diagnosis.”  The next higher 40% criteria includes “symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year.”  All members agreed that the evidence does not support the 40% criteria.  The CI’s health was well preserved at separation and there was no indication of any significant incapacitation.  VASRD §4.71a, with regards to rating under 5002, stipulates, “The ratings for the active process will not be combined with the residual ratings for limitation of motion or ankylosis.  Assign the higher evaluation.”  The §4.71a spine rating criteria in effect differed from the current spine formula; and, only two available codes were applicable: 5292 (limitation of motion) requiring “severe” limitation to achieve a higher rating; and, 5295 (lumbosacral strain) requiring “severe ... listing of the whole spine” and “marked limitation of forward bending,” among other unsupported criteria, to achieve a higher rating.  Thus, all members agreed that alternate rating under spine criteria was not favorable.  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 ankylosing spondylitis/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 ankylosing spondylitis/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.  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 20140620, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160005008 (PD201403042)

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