RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01564
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20040721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Machinist’s Mate, medically separated for “chronic sacroiliitis, right worse than left” with a disability rating of 10%.  

CI CONTENTION:  A different diagnosis of the same joints supports a higher rating.  The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 MEB, but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel 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, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20040520	VARD - 20050526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Sacroiliitis, Right Worse than Left	5299-5237	10%	Chronic Sacroiliitis	5236	10%	20050418	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Sacroiliitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s sacroiliac (SI) condition began in August 2002 after a fall.  A December 2002 MRI showed SI subluxation.  She was started on physical therapy and then placed on a 6-month period of limited duty (LIMDU), and while on LIMDU she became pregnant, causing an extension of her LIMDU.  After she delivered her baby, pain did not improve with therapy, medication, or SI joint injections.  There was no surgical indication.  

The 19 March 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued low back pain without radicular symptoms.  Physical examination showed a positive FABER (Flexion, ABduction and External Rotation – test for SI joint inflammation) bilaterally, tenderness over the bilateral SI joints, and no tenderness over the back muscles.  

At the 18 April 2005 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported constant pain that felt like a bruise across her low back and buttocks, right more than left.  Bending forward, prolonged sitting, and driving increased her pain.  Walking up stairs also increased the pain.  Standing was the most comfortable position.  Physical examination demonstrated tenderness over L5-S1 and bilateral SI joints.  Forward flexion of the thoracolumbar spine was to 90 degrees (normal) and combined range of motion was 240 degrees (normal) with painful motion noted on extension and rotation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic sacroiliitis condition 10%, coded 5299-5237 (analogous to lumbosacral strain), citing painful motion.  The VA also rated the sacroiliitis condition 10%, coded 5236 (sacroiliac injury and weakness), based on the C&P examination, citing tenderness over L5/S1 and bilateral SI joints and painful motion.  

The panel first noted that in accordance with VASRD §4.66, sacroiliitis, sacroiliac subluxation, and all other disabilities involving the SI joints should be considered as one anatomical segment with the lumbosacral spine and rated according to the General Rating Formula for Diseases and Injuries of the Spine.  The panel agreed that, while there was no limitation of ROM to justify a rating under that formula, there was tenderness of the thoracolumbar spine and SI joints to support a 10% rating but no more.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes, which would provide for a higher rating under that formula (for IVDS).  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic sacroiliitis condition.  

BOARD FINDINGS:  In the matter of the chronic sacroiliitis condition and IAW VASRD §4.71a and §4.66, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160923, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

							XXXXXXXXXXXXXXXXXX
	     				                        Assistant General Counsel
						           (Manpower and Reserve Affairs)