RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00518
BRANCH OF SERVICE:  NAVY	 SEPARATION DATE:  20071204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-5, Electronics Technician, medically separated for “myofascial pain syndrome,” with a disability rating of 10%.

CI CONTENTION:  The CI elaborated no specific contention in his application.  The applicant’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 PEB - 20070808	VARD - 20080402	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Myofascial Pain Syndrome	5099-5021	10%	Migraine Headaches	8100	0%	20071010	
			Rt Shoulder Impingement Syndrome	5201-5024	10%	20071010	
			Lt Shoulder Impingement Syndrome	5201-5024	10%	20071010	
			Cervical Sprain	5237	10%	20071010	
Anxiety Disorder	Category III	Anxiety	9413	NSC	20071003	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:   

Myofascial Pain Syndrome.  In January 2006, this CI reported a 1-year history of left shoulder pain.  The shoulder pain had begun gradually, without trauma.  Magnetic resonance imaging (MRI) of the left shoulder was normal.  She was treated with medication, physical therapy (PT), transcutaneous electrical nerve stimulation (TENS), chiropractic manipulation, and limited duty (LIMDU).  In spite of all treatment efforts, her pain persisted.

On 3 May 2007, the CI was seen by Rheumatology.  She reported diffuse joint/muscle pain, especially in the neck and shoulder area.  On physical examination (PE), she was in no acute distress.  There was normal movement of all extremities.  Some tender points were present, but it was determined that the CI did not meet clinical criteria for Fibromyalgia.  The examiner’s diagnosis was “myofascial pain syndrome.”

The Medical Evaluation Board (MEB) narrative summary (NARSUM) was dated 21 May 2007.  The CI reported difficulty with lifting, climbing ladders, and prolonged stationary positions.  At the MEB physical examination (PE), she was in no apparent distress.  Cervical range-of-motion (ROM) was full.  Trigger points were present at multiple areas of the musculoskeletal system.  The NARSUM diagnosis was also “myofascial pain syndrome.”

The CI was medically separated from service on 4 December 2007.  Eight weeks before separation, on 10 October 2007, she presented for a VA Compensation and Pension (C&P) exam. She reported stiffness, weakness, swelling, giving way, lack of endurance, fatigability, tingling, numbness, and pain.  The pain was described as aching, sticking, cramping, squeezing, sharp, dull, and stabbing.  The pain was 10/10 in severity.  She functioned at pain with medication (Motrin), and there was no incapacitation.  On PE, her general appearance was normal.  Posture and gait were normal.  Neurological exam was normal.  The neck examination was normal.  The CI reported pain with shoulder motion.  The appearance of both shoulders was normal.  Gross examination of the muscles was normal. X-rays of both shoulders were normal.  When shoulder ROM was tested, she had 100 degrees of abduction bilaterally, and 120 degrees (or greater) of forward flexion bilaterally.

The Board directed attention to its rating recommendation, based on the evidence.  The Navy PEB used VASRD diagnostic code (DC) 5099-5021 (analogous to myositis), and assigned a disability rating of 10%.  The Board considered using other codes which could be applied to the CI’s condition.  The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence which would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the myofascial pain syndrome.  

BOARD FINDINGS:  In the matter of the unfitting Myofascial pain syndrome, 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.  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.    

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131223, with attachments
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 11 Mar 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 USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC