RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2013-02009
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20050831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve, E4, LAV Crewman, medically separated for “resting tachycardia,” “generalized anxiety disorder,” “pain disorder with both physiological and psychological component,” “chronic bilateral inguinal and thigh pain” and “myofascial pain syndrome,” rated for overall effect, with a disability rating of 0%. 

CI CONTENTION:  The CI made no specific contention in their application.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  
   
SERVICE IPEB – Dated 20050528	VARD - 20070920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Resting Tachycardia	Overall effect 0%	Heart murmur	7099-7005	NSC	20070503	
Generalized Anxiety Disorder (GAD)		PTSD	9411	50%	20070503	
Pain Disorder…						
Chronic Bilateral Inguinal and Thigh Pain		No VA Entry	
Myofascial Pain Syndrome		No VA Entry	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Combined PEB Conditions.  The PEB combined the resting tachycardia, GAD, pain disorder, chronic bilateral inguinal and thigh pain, and myofascial pain syndrome conditions under a single disability rating for “overall effect” as permitted by DoDI 1332.38 (E3.P3.4.4).  The combination of multiple conditions as a single disability reflected the PEB’s determination that no condition was separately unfitting, but the functional impairment resulting from the conditions when considered together (“overall effect”) was unfitting.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s single overall effect rating was justified in lieu of separate unfit determinations and ratings.  If the Board judges that two or more separate ratings are warranted in such cases; it must satisfy the requirement that each “unbundled” condition was unfitting in and of itself as shown by a preponderance of evidence.  The Board’s recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the resting tachycardia, GAD, pain disorder, chronic bilateral inguinal and thigh pain, and myofascial pain syndrome conditions are presented separately; with separate fitness determinations and rating recommendations if indicated.  

Resting Tachycardia.  The PEB included “resting tachycardia” (increased heart rate at rest) as a condition contributing to the overall unfitting finding.  The Board noted that the tachycardia was a finding rather than a condition.  It also noted that a 24-hour Holter monitor (an ambulatory EKG), accomplished 7 months prior to separation, showed that the heart rate was in the normal range for the majority of the study and was only slightly elevated on the 3 readings over a heart rate of 100.  The evidence does not show that a separately unfitting tachycardia was present at separation.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  

Generalized Anxiety Disorder.  At a mental health evaluation on 5 January 2004, 19 months prior to separation, the CI reported “a life-long struggle with anxiety.”  A questionnaire was suggestive of a possible GAD and a somatoform disorder NOS [not otherwise specified], a condition in which physical symptoms are present from a mental health condition.  In follow-up on 15 January 2004, he was diagnosed with GAD and a pain disorder.  He continued in counseling and was begun on medications.  A week later, he was again seen in mental health and his medications changed.  It was noted that one of his sisters also had GAD.  The Board noted that no duty limitations were levied at any of the above appointments.  The next mental health evaluation in evidence was an addendum to the narrative summary (NARSUM) dated 18 May 2005, 3 months prior to separation.  He again recounted “a life-long struggle with anxiety” and endorsed many somatic (physical symptoms) complaints.  The examiner noted that the CI had responded well to treatment and did not currently have any functional impairment from his diagnoses nor was future impairment expected.  The evidence does not show that a separately unfitting mental health condition was present at separation.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  

Pain Disorder with both Physiological and Psychological Component.  The history and discussion are the same as that for the GAD discussed above.  The evidence does not show that a separately unfitting pain disorder was present at separation.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  

Chronic Bilateral Inguinal and Thigh Pain.  The CI was first evaluated for groin (inguinal) pain while deployed in February 2003.  He was found to have swollen lymph nodes which did not resolve with treatment and he was evacuated from theater on 2 July 2007 for further evaluation.  He underwent an extensive evaluation including a lymph node biopsy, but no etiology was found.  He did report improvement with medications.  The NARSUM was accomplished by infectious disease on 2 March 2005.  It noted that there was not an infectious etiology and thought that myofascial pain syndrome was the diagnosis, but recommended evaluations by neurology, rheumatology, and psychiatry (above).  A neurological addendum to the NARSUM, dated 13 April 2005, noted that the neurological evaluation had been negative.  A rheumatological addendum, dated 11 May 2005, noted that his pain was consistent with possible chronic tendonitis versus myofascial pain syndrome.  No definitive diagnosis was made.  The Board noted that the CI was evaluated and treated for chronic pain, but that a definitive etiology from an unfitting condition was not determined.  Infectious disease thought that this could be myofascial pain syndrome.  Mental health noted that the CI had GAD and a pain disorder, but opined that these did not have a major occupational impairment.  No neurological disorder was found by the neurologist.  The rheumatologist noted that there was several possible diagnoses for the inguinal and thigh pain condition, but no firm diagnosis was made.  The Board also noted that pain is a symptom rather than a diagnosis.  The evidence does not show that a separately unfitting inguinal and thigh pain condition was present at separation.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  

Myofascial Pain Syndrome.  The findings for the myofascial pain syndrome follow the discussion above.  The Board noted that the rheumatology evaluation for this condition was the most appropriate, by specialty, as well as the most proximate to separation.  A firm diagnosis for the condition was not made.  The evidence does not show that a separately unfitting myofascial pain syndrome was present at separation.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  

BOARD FINDINGS:  In the matter of the resting tachycardia, GAD, pain disorder, chronic bilateral inguinal and thigh pain, and myofascial pain syndrome conditions condition, the Board unanimously recommends no change in the PEB adjudication.   There were no other conditions within the Board’s scope of review for consideration. The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131122 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

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 9 May 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USMC