RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-04210
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080924

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6 , Cannon Crewmember, medically separated for “ankylosing spondylitis” 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 FPEB - 20080804	VARD - 20090612	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ankylosing Spondylitis	5099-5002	20%	Ankylosing Spondylitis	5240	0%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Ankylosing Spondylitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s ankylosing spondylitis began in March 2007 when he awoke one morning with swollen knees (especially on the left) and ankles; no specific injuries or trauma was reported.  An MRI one month later indicated “extensive periarticular soft tissue edema.  No meniscal or ligamentous abnormality or loose body…and mild edema of the medial femoral condyle and lateral tibial plateau, implying contusion.”  In April 2007, the right knee worsened, however X-ray findings were normal.  A series of physical therapy treatments, medications and profiles followed with no significant relief.  In May 2007, he was diagnosed with patellar chondromalacia and synovitis, but referred for a rheumatology evaluation because of an elevated erythrocyte sedimentation rate of 90 and elevated C-reactive protein.  However, rheumatoid factor was negative, and in October 2007, the rheumatologist indicated his condition was “consistent with ankylosing spondylitis affecting both axial and appendicular joints.”  He began treatment with Humira injections which improved symptoms significantly.  

At the 26 March 2007 orthopedic examination, 18 months prior to separation, the CI reported that he “awoke this morning with decreased ability to move the left knee.”  Physical examination showed full range of motion (ROM) in the neck, spine and hip, all without pain, but the left knee had limited ROM with pain, and he was unable to bear much weight on the that side.  At another
orthopedic visit 7 months later, he continued to have significant knee and ankle pain and stiffness despite losing weight. The provider noted painful but “preserved” bilateral ankle ROM.

At the 22 April 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months before separation, the CI complained of “rheumatoid arthritis from lower back on down” with knee and ankle pain and swelling.  Physical examination showed bilateral knee pain and pain with ambulation. During the MEB NARSUM examination a week later, he reported resolved hip and lower back pain and that his ankles and knees were pain-free on most days.  However, during exacerbations, the pain reached 7/10 in severity and lasted 2-3 days.  He did not feel he had any specific muscular weakness or decreased ROM in the affected joints.  The examiner recorded full ROM in his knees and ankles at his most recent evaluation.  There was no indication of incapacitating exacerbations occurring 3 or more times a year.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the ankylosing spondylitis 20%, analogously coded 5099-5002 (arthritis, rheumatoid, atrophic), citing that “because this particular case of ankylosing spondylitis primarily involves the major joints of the lower extremities rather than the spine (5240) rating is analogous to rheumatoid arthritis of the knees and ankles with one incapacitating exacerbation in the past year.”  The VA rated the condition 0%, coded 5240 (ankylosing spondylitis), based on the STR, citing the CI did not appear for a scheduled examination.  Panel members agreed that rating the condition under code 5240 would not capture the disability since evidence of impairment from spinal involvement was limited.  A higher 40% rating under code 5002 is for symptoms combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year.  While the NARSUM examination noted exacerbations, the CI was pain-free most of the time, with good response from anti-inflammatory medication.  He stated he suffered diminished physical conditioning, but felt he did not have any specific muscular weakness or decreased ROM.  The examiner reported full ROM for both knees and ankles and he was asymptomatic in the hips and lower back.  At the time of separation, the CI was not taking any medication.  The record showed one placement of quarters for 48 hours due to upper respiratory infection, but none related to pain.  Thus, panel members agreed, the higher rating was not justified.  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 ankylosing spondylitis.  

BOARD FINDINGS:  In the matter of the ankylosing spondylitis 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:
	PD-2017-04210
AR20190012129, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXX

	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.

	PD-2017-04210