RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00735
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040703

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Topographic Analyst, medically separated for “ankylosing spondylitis (AS),” 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 upon a 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 - 20040405	VARD - 20050201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
AS	5099-5002	20%	Degenerative Disc Disease, Lumbosacral Spine, with Sciatic Joint Dysfunction	5242	10%	20040913	
Knee Pain	Not Unfitting	No VA Placement	
Ankle Pain		No VA Placement	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Ankylosing Spondylitis (AS).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first noted back pain in March 1995 after a fall.  In January 1996 he tested positive for the HLA-B27 antigen, which is strongly associated with AS.  At the physical medicine clinic visit on 7 November 2003, he was diagnosed with AS based on X-ray, laboratory, and physical examination findings.  AS is a progressive disease and treatment did not result in improvement sufficient to allow unrestricted duty.  It was not amendable to surgical intervention.  The MEB forwarded AS 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 ~4 Mos. Pre-Sep	MEB ~4 Mos. Pre-Sep	VA ~2 Mos. Post-Sep	
Flexion (90 Normal)	80	“Full active ROM” 	90 	
Combined (240)	165	--	215	
Comments	Painful motion	Tenderness	Painful motion, mild scoliosis, and tenderness	
§4.71a Rating	10%	10%	10%	

The physical therapy MEB ROM study on 20 February 2004, 4 months prior to separation, showed decreased ROM in all planes, as indicated in the above chart, with pain experienced at the end range.  During the MEB examination on 10 March 2004, 4 months prior to separation, the CI reported chronic low back pain (LBP) with occasional numbness or tingling in his legs and feet.  The physical examination showed “≈ full active ROM” with mild tenderness bilaterally at the L5-S1 level.  Examination tests for radicular symptoms were negative and his neurologic and lower extremity evaluations were normal.  The MEB NARSUM on 8 April 2004, 3 months prior to separation, noted complaints of chronic LBP.  No separate physical examination was performed.  At the VA Compensation and Pension (C&P) evaluation, performed on 13 September 2004 2 months after separation, the CI reported an 8-year history of intermittent LBP that occurred about 3 times per week and lasted up to 6 hours.  His pain was elicited by physical activity or “too much rest.”  The examiner recorded that the CI had no incapacitation.  The physical examination showed decreased ROM that was slightly limited by pain as indicated in the chart above.  The CI’s ROM was not limited by fatigue, weakness, lack of endurance or incoordination.  His SI joints were tender, but there was no ankylosis. There was no muscle spasm or intervertebral disc syndrome.  Examination tests for radicular symptoms were negative.  His gait, posture, motor strength, sensation, and reflexes were all normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5099-5002 (analogous to rheumatoid arthritis), citing “X-ray findings disclosing fusion of the sacroiliac joints and lumbar spine changes.”  The VA rated the back condition 10% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 2 months after separation.  The Board noted the code for AS is 5240, but uses the same rating criteria as 5242.  The limitation of motion supported a 10% rating.  No route to support a rating higher than the 20% rating adjudicated by the PEB was found.  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 back condition.  

Contended PEB Conditions:  Knee and Ankle Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of these conditions 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 either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended knee and ankle conditions, the Board unanimously recommends no change from the PEB determinations 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 20150608, 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, AR20170000071 (PD201500735)

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