RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01045
BRANCH OF SERVICE:  MARINE CORPS 	                        SEPARATION DATE:  20090830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Aviation Communications System Technician, medically separated for “myofascial pain syndrome,” with a disability rating of 20%.  

CI CONTENTION:  “Films taken prior injury were observed-show no evidence of spinal issues/injury being present. After injury direct observations were made and films show visible impact of this injury. Review during the time of members raiting [sic] established a consistent and improper use of 20%.”  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 PEB – 20090610	VARD - 20091216  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Myofascial Pain Syndrome	5237	20%	Degenerative Disc Disease of the Lumbar Spine, Scheuermann’s Disease and Thoracic Kyphosis	5242	0%	20090709	
Degenerative Disc Disease of Lumbar Spine	Cat II					
Degenerative Disc Disease of Thoracic Spine	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Myofascial Pain Syndrome.  Absent history of direct trauma, the CI developed low back pain (LBP) after running in 2007 which progressed to subjective weakness in both legs.  Diagnostic imaging revealed moderate degenerative disc disease (DDD) of the lumbar spine.  Electro-diagnostic studies were negative for radiculopathy.  Serial evaluations by neurosurgery concluded with a diagnosis of thoracic and lumbar back pain additionally categorized as myofascial pain and recommended non-surgical treatment.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a Medical Evaluation Board (MEB).  The MEB NARSUM examination on 13 March 2009 (6 months prior to separation) noted complaints of continued back pain, mid-back numbness, and an occasional “falling asleep” sensation in the right leg.  His physical examination (PE) showed slight (4/5) weakness in the lower extremities as well as a slight antalgic gait.  Physical therapy measured range of motion (ROM) noted forward flexion of the thoracolumbar spine of 60 degrees and a combined measure of 195 degrees.  

At the VA Compensation and Pension (C&P) examination on 9 July 2009, performed 2 months before separation, the CI reported non-radiating thoracic back pain as well as radiating lumbar pain extending “…down to his legs, up into his arms”.  A detailed PE of the entire spine to include thoracolumbar ROM was normal.  “The [CI] can do all the activities and functions of daily living.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the overall pain condition at 20% coded 5237 (lumbosacral strain), citing no specific reasoning.  The VA rated the lumbar DDD with thoracic kyphosis condition at 0% coded 5242 (degenerative arthritis), citing normal physical exam findings.  The Board agreed that a 20% rating, but no higher, was justified for the presence of spinal tenderness, slight weakness, decreased ROM, and resultant altered gait reported on the NARSUM exam.  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 spinal (myofascial) pain condition.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  

The PEB listed the DDD of the thoracic and lumbar spine conditions as related diagnoses (Category 2) contributing to the disability in this case.  The Board noted that the thoracic and lumbar degenerative spinal disc disease were the underlying and primary diagnoses causing the myofascial pain syndrome and were not separate conditions which could be separately rated according to §4.14 (avoidance of pyramiding).

BOARD FINDINGS:  In the matter of the myofascial pain syndrome 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.  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 20140226, 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