RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00394
BRANCH OF SERVICE:  Army	
DATE PLACED ON TDRL:  20010802	DATE REMOVED FROM TDRL:  20060809

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Unit Supply Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “ankylosing spondylitis” with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  The CI’s 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 Physical Evaluation Board (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 based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (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 PEB - 20010510/20060710	VARD - 20011217	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Ankylosing Spondylitis	5099-5022	40%	--	Ankylosing Spondylitis	5299-5293	40%	--	
	5240	--	0%					
COMBINED RATING:  40% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Ankylosing Spondylitis.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in December 1998 with no history of injury or trauma.  He was diagnosed with ankylosing spondylitis in August 2000.  Radiographic evaluation (X-rays, CT scan) in November 2000 was suggestive of a mild inflammatory arthritis consistent with ankylosing spondylitis.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “ankylosing spondylitis” for PEB adjudication.

The MEB NARSUM examination on 29 March 2001 (3 months prior to TDRL placement) the CI complained of mid thoracic and low back pain that occurred with standing, bending, lifting, push-ups, sit-ups, and inability to pick up his child.  Physical examination showed the ability to touch the toes with some discomfort.  Range of motion (ROM) was measured at flexion to 70 degrees (normal 90) with painful motion.  There was no significant muscle spasm or tenderness.  Strength and neurologic testing were normal with no evidence of radiculopathy.

At the VA Compensation and Pension (C&P) evaluation on 29 October 2001 (2 months after TDRL placement; 6 years prior to TDRL removal), the CI reported constant low to mid back pain, neck with spinal stiffness and tenderness, and no loss of work time.  The physical examination showed a marked kyphotic posture (slouch), painful stiff spine, with a guarded gait.  ROM flexion was 70 degrees.  Radiographic evaluation showed reduced height of the C4 vertebra with abnormal curvature and thoracolumbar spine “minimal scoliosis.”

At a TDRL reexamination visit in December 2005 (7 months prior to TDRL removal), the CI reported constant pain in the neck, upper, mid, and lower spine, with stiffness in the morning and after prolonged sitting or inactivity.  The physical examination showed full ROM; painful motion was not addressed.  At the physical therapy examination on 27 June 2006 (a month prior to TDRL removal), the examiner documented “significant thoracic kyphosis,” normal gait, and no evidence of increased pain during ROM.  ROM flexion was normal with the combined ROM of 225 degrees (normal 240).

The Board first considered the evidence for rating at the time of TDRL placement.  The PEB rated the back condition 40% at TDRL placement, coded 5099-5002 (arthritis rheumatoid (atrophic) as an active process), citing “general progression of symptoms which are now of such a nature that is able to work only about 4 hours daily, no lifting, just sleep on couch with support”; rating for definite impairment with a “reasonably well maintained” ROM.  The VA also rated the low back condition 40%, analogously coded 5293 (intervertebral disc syndrome) based on the VA C&P examination 2 months after TDRL placement, citing recurring attacks of severe intervertebral disc syndrome with only intermittent relief.

In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation, which was the 2002 VASRD standards for the spine at TDRL placement.  The Board agreed that there was no muscle spasm on extreme forward bending or loss of spine motion to support a rating higher than the PEB’s 40% rating under codes 5286, 5289, or 5295.  There was no vertebral fracture (5285), sacroiliac injury/weakness (5294) or evidence of pronounced intervertebral disc syndrome with persistent neuropathy for consideration under these respective codes.  However, the Board agreed with the PEB’s 40% rating based on analogous code 5002 criterion, comprised of symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations.  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 low back condition on TDRL placement.

The Board next considered the evidence for rating at the time of TDRL removal.  The PEB rated the back condition 0% at TDRL removal, coded 5240 (ankylosing spondylitis), citing thoracolumbar ROM greater than 240 degrees and IAW VASRD 2003.  The VASRD in effect at the time of TDRL removal was the 2006 VASRD which contains the same standards for the spine as the 2003 VASRD applied by the PEB.  The Board agreed there was no documentation of muscle spasm, guarding, or localized tenderness resulting in an abnormal gait in support of a 20% rating.  Forward flexion was normal but the total combined ROM was 225 degrees at the June 2006 PT examination (a month prior to TDRL removal) that supports a 10% rating.  There were no periods of physician prescribed bed rest noted in the record to rate this condition under intervertebral disc syndrome, and pain (whether or not it radiates) is considered under the general spine formula.  There was no associated peripheral nerve deficit noted for a separate rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a 10% disability rating at TDRL removal coded 5240, IAW VASRD §4.71a.

BOARD FINDINGS:  In the matter of the ankylosing spondylitis condition and IAW VASRD §4.71a, the Board unanimously recommends no rating change at the time of TDRL placement, and a 10% rating coded 5240 at TDRL removal.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Ankylosing Spondylitis	5099-5002	40%	--	
	5040	--	10%	
COMBINED	40%	10%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 4 June 2015, 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

03 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160019829 (PD201500394)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA