Author: JOHN J. D'ORAZIO
Last saved by: julie.raveau
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xx	CASE:  PD1201975
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20130508
SEPARATION DATE:  20040115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCPL/E-3, 2111/Small Arms Repairer/Technician) medically separated for ankylosing spondylitis (AS), associated with bilateral sacroiilitis and hip pain.  The CI was first seen in August of 2002 for on-going back and hip pain.  He was evaluated and treated by orthopedics and rheumatology with the condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was eventually referred for a Medical Evaluation Board (MEB).  The ankylosing spondylitis, associated with bilateral sacroiilitis and hip pain condition, was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The PEB adjudicated “ankylosing spondylitis, associated with bilateral sacroiilitis and hip pain” as unfitting, rated 20% in accordance with the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated with a 20% disability rating.

CI CONTENTION:  “Service related illness is severe enough to disrupt personal & professional quality of life.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting ankylosing spondylitis, associated with bilateral sacroiilitis and hip pain condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.

RATING COMPARISON:  

Service IPEB – Dated 20031102 | VA - (4 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Ankylosing Spondylitis, Associated w/Bilateral Sacroiilitis and Hip Pain | 5099-5002 | 20% | Ankylosing Spondylitis | 5236-5240 | 20% | 20040513
Combined:  20% | Combined:  20%
Derived from VA Rating Decision (VARD) dated 20040811 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:

Ankylosing Spondylitis, Associated w/Bilateral Sacroiilitis and Hip Condition.  The narrative summary dictated 22 September 2003, notes the CI was diagnosed with AS about a year earlier by a rheumatologist after approximately a one-year history of progressive low back stiffness.  Lumbar spine X-rays and magnetic resonance imaging showed bilateral sacroiliitis.  At the MEB exam, the CI reported morning stiffness that lasted more than an hour, difficulty with prolonged running, jumping, standing, and also sitting, which increased his stiffness.  The MEB physical exam, performed approximately 4 months prior to separation, noted bilateral sacroiliac tenderness, greater on the left than right.  Back movement was good.  There were no neurologic abnormalities and straight leg raise was negative bilaterally.  At the VA Compensation and Pension exam on 13 May 2004, approximately 4 months after separation, the CI reported constant low back and hip pain rated 5-6 out of 10 to 9 out of 10 with flare-ups that occurred twice per week and lasted about half a day.  The CI denied any systemic symptoms such as rash or weight loss.  The CI reported he had not lost any work time due to his back pain while in the military or since separation.  The VA exam showed a normal gait, stance, posture, upper extremity and lower extremity range-of-motion (ROM), strength, and reflexes.  There were no neurologic abnormalities.  The CI was able to able to do deep squats and heel and toe walk without difficulty.  Lumbar spine ROM was extension 10 degrees (normal 30 degrees), forward flexion 45 degrees (normal 90 degrees), right and left lateral bending 20 degrees (normal 30 degrees); and rotation 40 degrees (normal 30 degrees).  There was no localized tenderness to palpation, radiating pain, or hip pain.  Hip ROM was flexion 105 degrees (normal 125 degrees), abduction 60 degrees (normal 45 degrees).  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the AS condition as 5099-5002 (analogous to rheumatoid arthritis) at 20%.  The VA rated it as 5236-5240 (analogous to sacroiliac injury with AS) also at 20%.  The Board deliberated the rating of the CI’s AS condition with 5002 or 5240.  The CI had limited lumbar flexion of 45 degrees; there was no hip pain; hip ROM was slightly decreased but non-compensable.  The Board noted that the record supported the AS was controlled with medication and was without incapacitating exacerbations, evidenced by the fact that the CI continued to perform the duties of his regular MOS and did not miss work while in the military or post-separation.  Both the MEB and VA exams documented the absence of associated symptoms of an active process, such as weight loss, or anemia.  The CI’s AS residual was decreased lumbar ROM with flexion of 45 degrees.  The Board opined that in the absence of systemic symptoms of an active process, the AS condition was best rated based on the residual limitation of lumbar spine motion in accordance with the VARSD general rating formula for diseases and injuries of the spine, coded 5240.  The Board found this provided a disability rating of 20% for lumbar flexion of 45 degrees.  Thus the Board could not find a path to a higher permanent disability rating than that provided by the PEB.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the AS condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the AS condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:  

UNFITTING CONDITION | VASRD CODE | RATING
Ankylosing Spondylitis Condition | 5099-5002 | 20%
COMBINED | 20%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120801, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	xx
	President
	Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW 
                                        BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
          (b) CORB ltr dtd 20 Aug 13

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandum, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- former USN 
- former USMC
- former USMC
- former USMC
- former USMC
- former USN 
- former USMC
- former USN 

						  xx
	     					  Assistant General Counsel
						     (Manpower & Reserve Affairs)

PD1201975