RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00719
BRANCH OF SERVICE:  Air FoRCE	SEPARATION DATE:  20051007

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Special Purpose Vehicle & Equipment Maintainer, medically separated for “ankylosing spondylitis” with a disability rating of 10%.  

CI CONTENTION:  The CI 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 - 20050606	VARD - 20051220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ankylosing Spondylitis 	5240	10%	AS and Lumbar Strain	5237-5240	20%	20051205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Ankylosing Spondylitis.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI complained of low back pain as early as 1996 with no specific trauma.  The back pain worsened significantly in 2001, and he was diagnosed with ankylosing spondylitis (inflammatory condition of the spine that may eventually lead to fusing of the vertebrae) in May 2004.  After starting a biopharmaceutical designed to treat autoimmune diseases, his symptoms greatly decreased with complete resolution of morning stiffness.  

During the 10 January 2005 rheumatology evaluation, 9 months prior to separation, the CI complained of one hour of morning stiffness, but his back took several hours to improve throughout the day.  Physical examination showed a slow, rigid gate.  Range of motion (ROM) testing showed approximately 20% reduction in lumbar (not thoracolumbar) flexion.  At the 31 January 2005 internal medicine examination, 8 months prior to separation, the CI noted only minimal morning stiffness and was able to perform all of his mechanic duties.  Physical examination revealed straightening of the lumbosacral spine particularly noticeable with flexion though he was still able to touch his toes.  

The 8 March 2005 MEB NARSUM examination, 7 months prior to separation, noted complete resolution of morning stiffness.  The CI estimated he could perform 90% of his primary duties and felt it took him 10% longer than his peers.  He denied any joint swelling.  Physical examination showed straightening of the lumbosacral spine without mention of spasms.  The examiner noted the CI was “still able to touch his toes.” 

At the 5 December 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, showed a normal gait.  Thoracolumbar ROM was recorded as flexion to 60 degrees (normal 90) and combined ROM of 160 degrees (normal 240) with pain throughout the ROM.  The CI appeared at his formal PEB and testified his physical limitations had almost completely resolved; he contended he was fit and should have been returned to duty.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5240 (ankylosing spondylitis).  The VA rated the back condition 20%, dual coded 5237-5240, (lumbar strain – ankylosing spondylitis), based on the C&P examination, citing forward flexion not greater than 60 degrees.  

The panel considered the probative value of the various examinations proximate to separation in the rating processes.  The panel noted while the C&P examination was more detailed than many of the others, it was after separation, the results varied greatly from the other examinations before separation and members concluded this single examination was not indicative of the true degree of disability at separation.  The panel majority agreed a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) as demonstrated on the rheumatology examinations or the CI being able to touch his toes at the MEB NARSUM examination.  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 with incapacitating episodes, which would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification to 20% but elected not to submit a minority opinion.  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 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 
SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00719.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

	

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings