RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00666
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040529

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Chemical Operations Specialist, medically separated for “chronic low back pain with degenerative disc disease [DDD] and a rheumatological component of ankylosing spondylitis,” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  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 - 20040218	VARD - 20040609	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with DDD and a Rheumatological Component of Ankylosing Spondylitis	5240	20%	Lumbar Spine Degenerative Disc Disease with a Rheumatological Component of Ankylosing Spondylitis	5240	20%	20040310	
Hypertension	Not Unfitting	Hypertension	7101	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain with DDD and a Rheumatological Component of Ankylosing Spondylitis.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition began in May 1991 after twisting his back.  Since that time, the CI had recurring back problems and in July 2003 he experienced an acute episode of back pain.  Since his initial injury, the CI denied any specific injury or trauma.  Diagnostic imaging (X-ray) studies on 23 July 2003 showed mild DDD at L5-S1 and L4-5.  No other abnormalities were noted.  Diagnostic imaging studies 23 September 2003 revealed bulging intervertebral discs at L4-5 without narrowing of the neuroforaminal (space through which the spinal nerve root passes).  There were sclerosis and cystic changes of the sacroiliac (SI) joints, left greater than right, which the examiner noted was consistent with a history of human leukocyte antigen (HLA) B27 arthritis.  X-ray studies of the thoracic spine 7 November 2003 revealed slight right convex scoliosis and exaggerated kyphosis.  There was DDD at T8-T9 and T9-T10.  There were no other abnormalities seen.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “chronic low back pain secondary to degenerative disease” for PEB adjudication.  

The range of motion (ROM) examinations 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 ~6 Mos. Pre-Sep	PT/MEB ~5 Mos. Pre-Sep	VA ~2 & 4 Mos. Pre-Sep	
Flexion (90 Normal)	60(58/60/62)	65(55/65/60)	55(45/54/45)	
Combined (240)	170	170	185	
Comments	Limited ROM 	Limited ROM/no tenderness to palpation	Limited ROM with pain
 non tender/ normal gait	
§4.71a Rating	20%	10%	20%	

During the MEB examination dated 23 December 2003, 6 months prior to separation, the CI reported low back pain occurring 75-100% of his waking hours.  The pain disturbed his sleep and was relieved by medication (Celebrex, HCTZ, and Diazepam).  The pain limited his physical activities preventing him from running, jumping, marching, bending, or lifting.  The pain prevented him from wearing his load-bearing equipment, or body armor.  He was restricted by medical profile from any aerobic fitness events and permitted to walk or cycle at his own pace and distance.  Physical examination showed normal reflexes with no tenderness to palpation.  Physical therapy (PT) thoracolumbar ROMs after repetition were limited in flexion and combined ROM as recorded in the chart.  

At the 10 March 2004 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported low back pain increased with any significant lifting which prevented him from performing his military duties.  The pain was aggravated by prolonged sitting.  The pain prevented him from running or conducting long bicycle rides.  Physical examination showed normal posture, gait, strength, and reflexes.  There were no muscle spasms and there was no tenderness to palpation.  Straight leg raise testing was negative for radiating symptoms.  The thoracolumbar ROM (performed 4 months before separation, using a goniometer) after repetition showed limited flexion and combined ROM with minimal pain, as recorded in the chart.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain with DDD and a rheumatological component of ankylosing spondylitis condition 20%, coded 5240 (ankylosing spondylitis), citing arthritic and sclerotic changes of the sacroiliac joints bilaterally.  The VA also rated the same condition 20%, coded 5240 (ankylosing spondylitis), based on the VA C&P examinations 2 months (thoracolumbar ROM examination) and 4 months before separation, citing limitation of motion with pain.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), which was reported on the PT and VA C&P examinations.  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula for that condition.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve 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 chronic low back pain with DDD and a rheumatological component of ankylosing spondylitis condition.  

Contended PEB Conditions:  Hypertension.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic low back pain with DDD and a rheumatological component of ankylosing spondylitis condition and IAW VASRD §4.71a, the Board unanimously or majority recommends no change in the PEB adjudication.  In the matter of the contended hypertension condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20150602, w/attachments
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, AR20170002439 (PD201500666)

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