RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03654
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Human Resources Specialist. medically separated for “myofascial pain syndrome” with a disability rating of 20%.  

CI CONTENTION:  The applicant requests the board consider all conditions.  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 - 20011207	VARD - 20030829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Myofascial Pain Syndrome	5099-5021	20%	Early Polyarthritis Right Hand of Undetermined Etiology	5099-5002	10%	20030225	
			Early Polyarthritis Left Hand of Undetermined Etiology	5099-5002	10%		
Adjustment Disorder, Chronic, with Depressive Symptoms	Not Unfitting 
	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Myofascial Pain Syndrome.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s myofascial pain syndrome as manifested by intermittent pain and swelling in both hands began in 1999.  An electromyogram performed on 22 March 2001 was negative for bilateral upper extremity neuropathy.  At the MEB NARSUM examination, the CI reported daily pain and swelling of both hands which hindered her ability to perform her duties as a personnel administrative clerk.  She reported that anti-inflammatory and narcotic medications did not relieved her pain.  The CI also reported low back and feet pain.  Physical examination demonstrated no evidence of hand or wrist edema and fully range of motion at the wrist and fingers.  The examiner noted that the CI had multiple features seen with fibromyalgia, but did not meet the American College of Rheumatology 1990 criteria.  At the VA Compensation and Pension (C&P) examination on 25 February 2003, performed 12 months after separation, the CI reported intermittent bilateral had pain which worsened with “excessive activities.”  Physical examination showed full wrist and hand range of motion with painful motion of the right metacarpophalangeal (MCP) joints.  There was right decrease right hand grip strength of 3/5 and edema and tenderness to palpation of the right MCP joints. The left hand was without evidence of edema, tenderness, and weakness.  The CI was right-hand dominant.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under an analogous 5021 code (Myositis), citing tender points without focal neurologic deficits.  The VA assigned a 10% rating for each hand using an analogous 5002 code (arthritis rheumatoid [atrophic]) based on the VA C&P examination 12months after separation, citing pain with essentially normal range of motion.  The evidence did not support a 30% rating analogous to productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year (5002).  The Board considered separately rating each hand under however it would not have resulted in a higher than 20% combined rating.  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 myofascial pain condition.  

Contended PEB Conditions.  .  The Board’s main charge is to assess the fairness of the PEB’s determination that adjustment disorder with depressive symptoms was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Adjustment disorder and personality disorder are conditions that do not constitute a physical disability.  The Board therefore has no reasonable basis for recommending this condition as additionally unfitting for separation rating.

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.  In the matter of the contended adjustment disorder with depressive symptoms condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140729, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017198 (PD201403654)

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