RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX	CASE:  PD-2013-02487
BRANCH OF SERVICE: Army	BOARD DATE:  20141010
SEPARATION DATE:  20040805

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31R/Multichannel Transmissions Systems Operator) medically separated for a back problem.  The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “slight, constant low back pain (LBP) due to ankylosing spondylitis,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “low back pain due to ankylosing spondylitis w/o neurologic abnormality” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION: The CI writes: “Ankylosing spondylitis—this causes me constant pain and discomfort in my hips and lower back which has cause major health issues with myself.  I believe this should be reviewed for a higher percentage.  Major depressive disorder—my depression is seeming to be affecting me more and more each day, I am on medicine and see a psych doctor to talk with is helping but constantly in fear that I will succumb to this. Sinusitis—Been to the emergency room because this gets so bad with the sneezing and pressure.  Pes Planus—this has progressively gotten worse with time and have spent a lot of money on insoles for shoes to help relieve the pain.  Left Knee—Because of the injury to my left knee in the Army and my “something” and meniscus had to be repaired or reconstruction, or replaced with the add of screws in Jan of 2008.  Right Knee—because of injuries sustained while in the Army I constantly have swelling and discomfort in this knee”. [sic]

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 LBP due to ankylosing spondylitis condition is addressed below; and, no additional conditions (the contended major depression, sinusitis, pes planus, left and right knees) are not within the DoDI 6040.44 defined purview of the Board as none of the contended conditions were on either the MEB or PEB documents.  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 Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20040604	VA – Failed to Report	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain due to Ankylosing Spondylitis w/o Neurologic Abnormality	5240	10%	Ankylosing Spondylitis	5240	0%	N/A	
Other x 0 (Not in Scope)	Other x 3	
Rating:  10%	Rating:  50%	
Derived from VA Rating Decision (VARD) dated 20041109 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Low Back Pain due to Ankylosing Spondylitis.  The CI had a long history of LBP starting from an injury and evaluation on 6 April 1998 after lifting sand bags.  He was re-evaluated for LBP on 2 July 2001, which documented numerous other evaluations in the past, including back class treatment.  At that time, the pain was persistent since January 2001 with no history of trauma.  The examination showed tenderness of the lower lumbosacral tenderness.  There were normal gait and full range of motion (ROM) at that exam.  An X-ray of the spine found bilateral sacroiliac sclerosis, and lumbar spine pseudarthrosis.  A computerized axial tomography study (CT scan) of the sacroiliac joints found multiple small cysts and sclerosis of the inferior 1/3 of both sacroiliac joints.  He was evaluated by rheumatology on 24 September 2004.  The CI was diagnosed at that visit with seronegative spondyloarthropathy (of which ankylosing spondylitis is one).

The narrative summary (NARSUM) performed on 22 March 2004, 4 months prior to separation, noted the 3.5 years of pain after lifting a heavy object.  He was tested and diagnosed with ankylosing spondylitis and been treated by rheumatology since.  The pain was of the lower midline of the spine radiating into both hip areas.  Pain was increased by bending, lifting, stairs and any vigorous exercise; the pain worsened the next day after any extra walking.  The pain was constant all day, some days worse than other days, and did not interfere with sleep.  He used Percocet (narcotic) medication once or twice a week when pain was so bad he could not stand it, he used Mobic (non-steroidal anti-inflammatory) medication daily and Ambien for sleep.  Physical examination revealed he walked slowly.  There were muscle spasms of the lower lumbar musculature bilaterally, accentuated when bending at the waist.  Flexion was 50 degrees, extension 20 degrees, right lateral flexion 30 degrees, left lateral flexion 15 degrees, right rotation was 15 degrees, and left rotation was 20 degrees.  There was no VA Compensation and Pension exam of the spine due to no-show.

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic code 5240 (ankylosing spondylitis) used by the PEB for a 10% rating, and the VA for a 0% rating.  This condition is rated under the VASRD General Rating Formula for Diseases and Injuries of the Spine.  The Board found evidence of ROM limitations greater than 30 degrees but not greater than 60 degrees (measured at 50 degrees) for a rating under this code of 20%.  There were no possible alternate or additional coding options for a rating in the CI’s favor above 20%.  After due deliberation, considering all of the evidence, and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the ankylosing spondylitis 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. In the matter of the ankylosing spondylitis condition, the Board unanimously recommends a disability rating of 20%, coded 5240 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Ankylosing Spondylitis Condition	5240	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131107, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20150005541 (PD201302487)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA