RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03851 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080813

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “sacroiliitis” with a disability rating of 10%.

CI CONTENTION: Review was requested of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). Additionally the back condition has been worse.  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 - 20080520	VARD - 20081010	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sacroiliitis	*5289-5236	10%	Lumbar and Left Sacroiliac Strain…	5236	20%	20080917	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	
* Code 5289 was likely a typo of 5299 as 5289 “spine, ankylosis of, lumbar” was no longer a valid code following VASRD changes in September 2003.

ANALYSIS SUMMARY:

Chronic Thoracolumbar Pain. According to the service treatment record and MEB narrative summary (NARSUM), prior to service in 1998 the CI underwent back surgery after a motor vehicle accident. In 2000, the CI subsequently passed an induction examination into the Reserve and a second physical in 2002 upon being called to active duty. He reinjured his back while deployed to Iraq in August 2003 while pulling a filled fueling hose as part of his daily military duties. Despite physical therapy (PT), activity modification, profiling, and pain management (including TENS;

epidural steroid injections; radio frequency ablation; botulinum toxin, narcotic, muscle relaxant, and neuroactive medications), the back pain did not subside. There was no surgical indication.  A lumbar spine and sacroiliac (SI) joints CT scan performed in July 2005 was unremarkable. A lumbar spine MRI completed in March 2008 was normal.

During the 26 February 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported ongoing back pain with occasional left leg numbness treated by the pain clinic. Physical examination recorded “mildly decreased” lumbar spine range of motion (ROM). Painful motion was not addressed. At the 14 April 2008 MEB NARSUM, 4 months prior to separation, the CI reported low back pain with medication providing incomplete relief. Physical examination documented a normal gait and spinal curvature, left SI joint tenderness, and paraspinal muscle spasm was absent. Goniometric-measured, repetitive, thoracolumbar spine ROM was performed during the 25 April 2008 MEB PT examination and showed flexion of 70 degrees (normal 90) and combined ROM of 185 degrees (normal 240). Painful motion was elicited.

A pain center examination on 6 June 2008, 2 months before separation, the CI was one month status-post botulinum toxin and taking narcotic pain medication twice a day, with additional narcotic medication as needed. He had had one visit to the emergency department for increased back pain. Physical examination noted “slightly limited” lumbar spine ROM with tenderness along the left lower lumbar paraspinal muscles. The pain specialist increased the CI’s baseline narcotic medication to three times per day.

At the 17 September 2008 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported marked back stiffness on raising in the mornings, numbness in the right toes and foot when sitting over 20 minutes, and severe left back and thigh pain if he tries to cross his left ankle over the right knee crossing his legs while seated. Physical examination revealed a normal gait and posture, lumbar spinal and left SI joint tenderness. Muscle spasm was absent and there was no ankylosis. Thoracolumbar flexion was 40 degrees and combined ROM was 170 degrees with painful motion. There was additional pain with no additional ROM loss following repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the lumbar and SI condition 10%, analogously coded 5239 (spondylolisthesis or segmental instability), citing localized tenderness and limitation of flexion. The VA rated the thoracolumbar condition 20%, coded 5236 (SI injury and weakness) based on the C&P examination, citing limitation of flexion.

The panel deliberated on the probative value of the examinations in evidence. The VA examination was closest to separation, most detailed, and followed a course of pre-separation worsening as noted by an emergency department visit and increased pain management interventions; and was therefore adjudged as having the highest probative value for rating at separation. 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 VA examination. There was no evidence of intervertebral disc syndrome 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 recommends a disability rating of 20% for the sacroiliitis condition, coded 5236.

BOARD FINDINGS: In the matter of the sacroiliitis condition, the panel recommends a disability rating of 20%, coded 5236 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Sacroiliitis	5236	20%	

PD-2017-03851 

AR20190011607, XXXXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

PD-2017-03851