SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05813.

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05813
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080326

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Survival, Evasion, Resistance, and Escape Operations Craftsman, medically separated for “low back pain due to ankylosing spondylitis” with a disability rating of 10%.   

CI CONTENTION:  Review requested of the back condition, which continues to worsen and negatively impact daily activities, and 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 - 20090211	VARD - 20080825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain…	5240	10%	Degenerative Arthritis of the Sacroiliac Joint	5242	10%	20080708	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced hip pain which migrated to the lower spine and then the entire back in June 2003, after heavy running during airborne training.  Conservative treatment was not helpful, and symptoms waxed and waned over the next 4 years until he was diagnosed with ankylosing spondylitis by a rheumatologist in September 2007.  Despite starting weekly Enbrel (tumor necrosis factor blocker) injections, he continued to have acute flares of pain.  
The 4 October 2007 MEB NARSUM examination, 6 months prior to separation, noted CI complaints of recurring back pain.  Physical examination showed significant tenderness over the bilateral hips and sacroiliac joints, as well as throughout the back.  Range of motion (ROM) was restricted, with pain on flexion and extension throughout the axial skeleton.  During the 18 January 2008 physical therapy (PT) examination, 2 months before separation, the CI had no specific complaints.  Measured ROM after three repetitions, revealed flexion of 85 degrees (normal 90) and combined ROM was 195 degrees (normal 240), with painful motion.  

At the 8 July 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported recurring hip, and upper/lower back pain reaching up to 10/10 in intensity.  Physical examination showed no tenderness or radiating pain with movement.  Flexion was 90 degrees and combined ROM was 235 degrees, with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5240 (ankylosing spondylitis).  The VA also rated the low back condition 10%, but coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing limitation of combined ROM.  Members agreed that a 10% rating, but no higher, was justified for thoracolumbar spine limitation of flexion (greater than 60 degrees but not greater than 85 degrees) as reported on the PT examination and for combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees) as reported on both the PT and VA examinations.  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 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 pain due to 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: