RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:                                                         XXXXXXXXXXXXX.
        BRANCH OF SERVICE:  air force
CASE  NUMBER:    PD1100377                                SEPARATION   DATE:
20080721
BOARD DATE:  20120119


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered individual (CI) was an active duty member, SRA/E-
4  (3E851,  EOD  Journeyman),  medically  separated  for  spondylopathy  (an
arthritis-like condition).  In 2005, the CI  presented  with  complaints  of
multiple joints pains, primarily involving his right wrist,  left  shoulder,
bilateral  knees  and  feet.   The  CI  was  eventually  diagnosed  with   a
spondylopathy  and  treatment  was  begun  with   the   medications   Humira
(injection requiring refrigeration)  and  sulfasalazine.   His  joint  pains
resolved with initiation of the medication and he was  subsequently  allowed
to deploy overseas with his unit.  The CI had to be evacuated  from  theater
early; however, when a prolonged loss of electrical power resulted  in  loss
of  his  medication  due  to  lack  of  refrigeration.    Because   of   the
difficulties encountered with maintaining his  medication  supply  overseas,
the CI was placed in a non-deployable  status  and,  therefore  underwent  a
Medical  Evaluation  Board  (MEB).   Spondylopathy  was  forwarded  to   the
Physical Evaluation Board (PEB) as medically unacceptable  IAW  AFI  48-123.
No other conditions appeared on  the  MEB’s  submission.   Other  conditions
included in the Disability Evaluation System (DES) packet will be  discussed
below.  The PEB adjudicated the spondylopathy condition as unfitting,  rated
20%, with application of the Veterans  Administration  Schedule  for  Rating
Disabilities (VASRD).  The CI made no appeals, and was  medically  separated
with a 20% disability rating.


CI CONTENTION:  The CI states:   “I  had  a  good,  albeit  short,  military
career.  I was an Explosive Ordnance  Disposal  (EOD)  Technician,  with  an
active TS clearance, and two deployments to Iraq  under  my  belt.   Halfway
through my second enlistment is when I  was  informed  that  because  of  my
joint disease, I  was  no  longer  deployable,  and  was  getting  medically
separated.  This news hurt me both emotionally  and  financially.   I  loved
serving, I loved EOD, and I loved the US Air Force.  I had no idea  how  the
disability ratings worked, I have been healthy all my life and never  saw  a
need to understand them.  When I  heard  I  was  rated  at  20%  that  meant
nothing to me.  As time went by, I realized how much I missed being  a  part
of the military community.  My current job has me  travelling  to  different
military installations and removing ordnance from old ranges.  I cannot  use
the base gym, cannot buy gasoline  on  base,  and  cannot  buy  gum  at  the
commissary without being accompanied by a military  member.   It’s  sad.   I
can understand why the US Air Force sees me as non-deployable, after all,  I
have to give myself an injection twice a month that  requires  refrigeration
(not an easy task considering my job  was  mission  critical  and  our  most
common theaters of operation  were  deserts).   I  only  submit  myself  for
review in hopes of raising my disability rating to a level  that  grants  me
base  privileges.   I  feel  I  have  earned  them.   Thank  you  for   your
consideration.”


RATING COMPARISON:

|Service IPEB – Dated 20080606 |VA (2 Mo. After Separation) – All        |
|                              |Effective Date 20080722                  |
|Condition                     |Code                                     |


ANALYSIS SUMMARY:

Spondylopathy.  The CI was diagnosed with spondylopathy  involving  multiple
joints to include his right wrist, left shoulder, bilateral knees and  feet.
 Although he did not have prominent back pain symptoms at the  time  of  his
diagnosis, he did have a remote history of some back pain concerns.  The  CI
did  not  have  any  associated  systemic  involvement   such   as   rashes,
gastrointestinal  symptoms,  inflammatory  eye  symptoms  or  oral  lesions.
Plain radiographs of his left shoulder and right wrist taken  in  2005  were
normal, as were plain radiographs of his sacroiliac joints  taken  in  2006.
Laboratory studies were negative for rheumatoid  factor,  but  positive  for
HLA-B27.

The MEB exam, seven months pre-separation (and two  months  after  break  in
medication use/flare), documented “good ROM (range-of-motion)” in his  hips,
knees, ankles, shoulders and  neck.   There  was  no  spinal  tenderness  to
palpation.  The CI denied any uveitis (eye) symptoms or oral sores; and  the
examiner noted no evidence of serositis  (inflammation  of  organ  linings).
The MEB examiner commented that the CI had previously experienced  a  return
of his symptoms after running  out  of  medication  during  his  deployment;
however, the symptoms had resolved within one day of  resuming  his  Humira.
Exam indicated “mild swelling  and  tenderness  of  the  left  elbow,”  mild
synovial thickening of both  wrists,  and  mild  tenderness  of  the  finger
joints on both hands.  There was no limited or  painful  motion  documented.
There was no abnormal joint imaging.

At the Department of Veterans’ Affairs (DVA) Compensation and Pension  (C&P)
exam, two months post-separation, the CI reported that he had  not  had  any
symptoms since starting Humira in the  spring  of  2007.   The  VA  examiner
documented ROM of the cervical and thoracolumbar spines  without  pain;  and
normal ROM of the  fingers,  wrists,  elbows,  shoulders,  hips,  knees  and
ankles, without pain.  The CI’s gait was also noted as normal.

The PEB and the VA chose the same coding for the condition  and  arrived  at
the same rating. They both rated at 20% for  “one  to  two  exacerbations  a
year in a well established diagnosis.”   Although  the  VA  exam  documented
that the CI had not had any symptoms within the past year, both the  service
and the  VA  rated  based  upon  the  episode  of  symptom  exacerbation  in
January 2008  following  the  unavoidable  loss  of  medication  during  his
deployment.  The MEB exam was very close  to  the  CI’s  flare  and  the  VA
examination was considered to have the highest  probative.   There  were  no
residuals of limitation of motion  or  ankylosis  of  any  of  the  involved
joints to obtain a compensable rating under the individual  joint  codes  by
the  time  of  separation.   There   were   no   associated   constitutional
manifestations and no incapacitating episodes to  justify  a  higher  rating
under the  5002  coding.   Alternate  coding  under  5003  for  evidence  of
involvement of two or more major joints or two or more minor  joint  groups,
with occasional incapacitating exacerbations would not code higher than  the
20% under 5002 which is predominate.  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 spondylopathy condition.

Remaining Conditions.  No other  conditions  were  noted  in  the  narrative
summary (NARSUM) or found elsewhere in the DES file. The  Board,  therefore,
has  no  reasonable  basis  for  recommending   any   additional   unfitting
conditions for separation rating.


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  spondylopathy  condition  and  IAW  VASRD
§4.71a, the Board unanimously recommends no change in the PEB  adjudication.
 The Board unanimously agrees that there were no other  conditions  eligible
for  Board  consideration  which  could  be  recommended   as   additionally
unfitting for rating at separation.


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  |
|Spondylopathy                                     |5099-5002   |20%     |
|COMBINED    |20%     |


The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20110503, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans' Affairs Treatment Record


                                        President
                                                                    Physical
Disability Board of Review
SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews MD  20762

Dear XXXXXXXXXXX:

      Reference your application submitted under the provisions of DoDI
6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2011-00377

      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 with severance pay.

      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.


                                        Sincerely,





                                       XXXXX
                                       Director
                                       Air Force Review Boards
                                       Agency