RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03314
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Field Artillery Surveyor, medically separated for “chronic myofascial pain, due to bilateral temporomandibular joint (TMJ) disk displacement,” with a disability rating of 10%.

CI CONTENTION:  The CI contends that his condition continues to worsen and negatively impacts his daily activities.  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 based on 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 - 20050412	VARD - 20050526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Myofascial Pain, due to Bilateral TMJ Disk Displacement	5099-5003	10%	TMJ Dysfunction	9905	10%	20050301	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Myofascial Pain, due to Bilateral TMJ Disk Displacement.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s “chronic myofascial pain, due to bilateral TM [temporomandibular] joint disk displacement” condition began in 1998 while on a previous period of active duty.  He began to have right TMJ pain and was treated conservatively and his condition eventually stabilized.  The CI was separated from the Army in March 1999 and his condition was stable at that time.  The CI re-enlisted with a baseline of clicking and popping of the TMJ and pain only with hard to chew foods.  Magnetic resonance imaging in January 2003 showed abnormal TMJ discs (cartilage) bilaterally with anterior dislocation (subluxation) with the mouth closed and reduction with the mouth open.  There were chronic degenerative changes bilaterally.  There were no joint effusions.  After dental work in September 2003, the CI’s jaw pain and stiffness increased.  The CI underwent bilateral TMJ arthroscopy and irregularities (fibrillations) of the TMJ discs were noted bilaterally, without perforations.  Following surgery, despite multiple evaluations and treatment interventions, the CI’s jaw pain with eating persisted and he was unable to wear a helmet or a protective mask.  The MEB forwarded “bilateral anterior disk displacement with reduction” and “myofascial pain disorder” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 1 February 2005, 3 months prior to separation, the CI reported severe TMJ, with headaches and jaw locking at times.   Physical examination showed decreased mouth opening and noted no crepitus.  The MEB NARSUM examination on 27 February 2005, 2 months prior to separation, noted complaints of bilateral TMJ pain with eating heavier foods.  Physical examination showed tenderness of both TMJ.  There was no swelling or crepitus.  The maximal incisal opening was 52 millimeters (MM) with pain at 45 mm, with a click and deviation to the right (normal approximately greater than 40 mm).  Lateral excursion was 12mm bilaterally (normal approximately greater than 8 mm) with pain on the right. 

At the 1 March 2005 VA Compensation and Pension (C&P) Dental evaluation, performed 2 months before separation, the CI reported TMJ dysfunction with pain when chewing and sleeping.  The CI also reported related headaches.   He was using a hard and soft splint for the TMJ condition.  The physical examination showed maximal incisal opening of 35 mm, right lateral excursion of 12.5 mm and left lateral excursion of 10.6 mm.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic myofascial pain condition 10%, coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA also rated the TMJ condition 10% coded 9905 (limited motion of temporomandibular articulation), based on the VA C&P examination 2 months before separation.  There was limitation of motion of the intercisal opening between 31 and 40 mm noted at the VA C&P examination to support a 10% rating coded as 9905 IAW VASRD §4.150 (dental and oral conditions).  The Board also considered if a higher rating was available with any other §4.150 code.  There was no malunion, nonunion, or loss of the mandible, or osteomyelitis/osteonecrosis to warrant consideration under the respective codes (9904, 9903, 9902, 9901, and 9900).  The PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating, and, therefore, no change to the PEB’s coding choice is recommended.  The PEB adjudicated the two conditions forwarded by the MEB - “bilateral anterior disk displacement with reduction” and “myofascial pain disorder” - as a single unfitting condition.  Both conditions refer to the same same disability and IAW VASRD §4.14 (avoidance of pyramiding) two disability ratings cannot be provided for the same symptoms under a different diagnosis.  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 chronic myofascial pain condition.  

BOARD FINDINGS:  In the matter of the “chronic myofascial pain, due to bilateral TM joint disk displacement” condition and IAW VASRD §4.150, 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 20140704, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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

17 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017174 (PD201403314)

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 and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA