RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02496
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, medically separated for “low back pain” with a disability rating of 20%.  

CI CONTENTION:  No specific contention was made.  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 Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (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 - 20080731	VARD - 20090226	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ankylosing Spondylitis	5240	20%	Ankylosing Spondylitis and Degenerative Joint Disease of Lumbar Spine	5242-5240	20%	20081124	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Ankylosing Spondylitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in February 2004 with gradual onset of intermittent pain and was treated with medication.  He was evaluated by a rheumatologist in February 2008 and the evaluation was remarkable for positive HBLA 27 (proteins commonly found on white blood cells), and diagnosed with ankylosing spondylitis.  No surgical indications were found and he was fully compliant with medical care and treatment recommendations.  

The 12 July 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of low back pain.  He described the pain as a dull, achy and intermittent.  He rated the pain 3/8 in intensity and worse with running, bending, wearing IBA, and lifting more than 40 pounds.  The pain improved with rest and taking sulfasalazine and glucosamine.  He denied any radicular symptoms and loss of bowel or bladder function.  Physical examination showed positive tenderness to midline of the L5-S1 and negative straight leg raise (SLR) testing bilaterally.  Painful range of motion (ROM), measured with a goniometer, recorded active flexion to 60 degrees (normal 90) and combined ROM of 155 degrees (normal 240) after repetitive motion.  There were no ROM restrictions due to fatigue, weakness, lack of endurance, or incoordination.  

At the 24 November 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continued pain in the low back.  The pain, rated at 2/10, was constant and associated with stiffness, .  The pain was brought on by physical activities and running but improved with rest and medication.  He denied any paresthesia or loss of bladder and bowel control.  He denied having any periods of incapacitation.  Physical examination of the thoracolumbar spine showed evidence of limited and painful motion in all directions.  There was evidence of accentuation of the lumbar lordosis and para spinal muscle spasms at L2-3, L3-4, and L4-5.  There was no evidence of tenderness or weakness.  SLR testing was negative in the sitting and supine positions bilaterally.  Painful ROM, measured with a goniometer, recorded active flexion to 55 degrees with combined ROM of 185 degrees after repetitive motion.  ROM was not limited by fatigue, weakness, lack of endurance, or incoordination.  There was no evidence of intervertebral disc syndrome (IVDS).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5240 (ankylosing spondylitis), citing forward flexion functionally limited to 60 degrees.  The VA also rated the low back condition 20%, dual coded 5242-5240 (degenerative arthritis of the spine -ankylosing spondylitis), based on the C&P examination, citing limitation of forward flexion.  The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the MEB NARSUM and VA examinations.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  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 low back condition.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, 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 20170314, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008799, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      

Enclosure