RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXX	CASE: PD-2017-04557
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070117

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Police, medically separated for “undifferentiated spondyloarthropathy…in the hands” with a disability rating of 20%.

CI CONTENTION:  Review all conditions.  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 - 20061213	VARD – 20070428	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Undifferentiated Spondyloarthropathy…Four Different Joints in the Hands	
5099-5002	
20%	Synovitis, Right Thumb	5020-5228	0%	

20070317	
			Synovitis, Right Index Finger	5020-5229	0%		
			Synovitis, Left 5th Finger	5020-5230	0%		
Lumbar Spondylosis	
Not Unfitting	Lumbar Spondylosis...	5239	10%		
Bursitis, Right Shoulder		Right Shoulder Bursitis & Rotator Cuff Tendonitis	5201-5019	10%		
Tendonitis, Right Shoulder						
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Spondyloarthropathy (Arthritis) in the Hands. According to the service treatment record and MEB narrative summary (NARSUM), the CI began experiencing pain, swelling, and stiffness in the left (non-dominant) thumb joint in October 2004 with no precipitating injury or trauma identified. Subsequently, swelling and pain spread to involve multiple joints of the left and right hands. The CI denied any illness before the onset of her joint symptoms, and laboratory studies for rheumatologic and inflammatory conditions were non-diagnostic.

At the 6 September 2006 MEB rheumatology addendum examination, 4 months prior to separation, the CI reported morning stiffness in the involved hand joints as well as occasional stiffness in the left sacroiliac joint. No other joints were involved, and she remained very active and was not on a medical profile. At the time, she had had developed swelling and pain in the right thumb metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints and the left fifth MCP joint, but denied any systemic symptoms associated with rheumatologic disorders. Physical examination showed normal examination of the hair, nails, skin, eyes, and mouth. There was synovitis (inflammation of the lining of the joints) and tenderness of the right thumb MCP and PIP joints, right second PIP joint and left fifth MCP joints and the CI was unable to fully flex the right index finger. There were no nodules of the fingers (associated with rheumatoid arthritis), but there was soft tissue swelling. The wrists, elbows, shoulders, hips, knees, ankles, feet and toes had full ROM and were without swelling or tenderness. Hand X-rays showed soft tissue swelling, no bony erosions, and sacroiliac joint X-rays were normal. The rheumatology diagnosis was “undifferentiated seronegative spondyloarthropathy manifested by inflammatory arthritis of the hands.” Oral anti-inflammatory medications for arthritis had not been effective and steroid injections of the involved joints were recommended. The CI’s prognosis was uncertain since the inflammatory arthritis symptoms had been present for less than one year.

The 27 October 2006 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of hand, back, shoulder, and neck pain. She awoke in the morning with her left index finger locked in a flexed position, and it gradually loosened over the next 2 hours until she could extend it. She took indomethacin (oral anti-inflammatory medication) which helped managed the pain in the hands, back, and shoulder. No physical examination was performed, but the examiner noted that right and left finger joints were mildly swollen at all times, and that the indomethacin was helping reduce the severity and length of flare-ups to a couple of days.

At the 17 March 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported worsening episodic pain in both hands with swelling of all fingers and locking of the index fingers. Flares occurred monthly and lasted approximately 2 weeks. Physical examination showed a gap between the thumb pad and the fingers of less than one inch on attempted opposition of thumb to fingers. The fingers could reach the proximal transverse crease of the hand on flexion, and there was no decreased strength or dexterity. There was limited flexion of the right thumb MCP and IP joints, right second finger proximal IP, and right and left fifth MCP joints, with painful motion and synovitis of all the listed joints. Bilateral hand X-rays were unremarkable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral hand condition 20%, coded 5099-5002 (analogous to rheumatoid arthritis). The VA rated the right thumb, coded 5020-5228 (synovitis-limitation of thumb motion), right index finger, coded 5020-5229 (synovitis-limitation of index finger), and left fifth finger, coded 5020-5230 (synovitis-limitation of little finger) 0% each, based on the C&P examination, citing (for the thumb) a non-compensable evaluation unless there is limitation of motion of the thumb with a gap of one to two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers; and (for the little finger); and a non- compensable evaluation for any limitation of motion of the ring or little fingers. Panel members agreed that there was no limitation of motion of the right thumb (5228), right index finger (5229) or left little finger that supported higher than a 0% rating. There was no evidence of symptoms productive of definite impairment of health (such as anemia or weight loss) or incapacitating exacerbations occurring 3 or more times per year to support a higher rating than 20% under 5002. The panel adjudged that there was no evidence to support a rating higher than that adjudicated by the PEB. 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 undifferentiated spondyloarthropathy.

Contended PEB Conditions: Lumbar Spondylosis, Right Shoulder Bursitis, and Right Shoulder Tendonitis. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The contended conditions were not profiled or implicated in the commander’s statement and did not fail retention standards. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the undifferentiated spondyloarthropathy and IAW   VASRD
§4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended lumbar spondylosis, right shoulder bursitis, and right shoulder tendonitis conditions, the panel recommends no change from the PEB determinations as not unfitting. 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:

AR20190012736,

Dear XXXXXXXXXXXXXXXXXXXX:

	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.