RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01116
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Abrams Tank Turret Mechanic, medically separated for “chronic pain syndrome [and chronic low back pain]” with a disability rating of 20%.

CI CONTENTION:  The CI requested review of 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 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 - 20040319	VARD - 20040719	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Syndrome [and Chronic Low Back Pain]	5099-5025	20%	Chronic Pain Syndrome to Include Bilateral Hips, Ankles, Elbows, Wrists and Right Shoulder	5099-5025	20%	STR	
			Lumbar Spine Diffuse Spondylosis	5242	10%	STR	
Hypercholesterolemia	Not Unfitting	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Pain Syndrome (subsumes Chronic Low Back Pain).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic pain syndrome condition began in July 1998 as lower back pain after parachute jumping.  The CI subsequently developed pain in multiple joints. He was evaluated by neurology and rheumatology and was diagnosed with chronic pain syndrome.  The MEB forwarded “chronic pain syndrome” and “chronic low back pain” for PEB adjudication.  
At the MEB examination (recorded on DD Forms 2807 and 2808) dated 29 December 2003, 5 months prior to separation, the CI reported pain in all joints.  On the physical examination, the examiner noted that the CI had a fractured right foot with occasional pain, hip knee and ankle arthritis and was treated by rheumatology.  The MEB NARSUM examination on 5 January 2004, 5 months prior to separation, noted complaints of arthritis and low back pain.  The CI stated that the low back pain and leg tightness at night interfere with his sleep.  The CI stated that “almost every joint hurts” and that sitting at a computer or on the commode caused him bilateral leg numbness from the hips down that resolves when he stands up.  The examiner annotated that a rheumatologist stated that “the patient does not currently have connective tissue disease, systemic lupus or rheumatoid arthritis; he has a chronic pain syndrome.”  Physical examination showed tenderness to palpation bilaterally in the lumbosacral area.

At the 30 March 2004 VA Compensation and Pension (C&P) evaluation, performed 2 months prior to separation, the CI reported that he started having pains in his lower back in July 1998 with pain starting “almost everywhere in both ankles, both hips, both shoulders, both elbows, the wrists, hands, feet and headaches,” however, the pain began to interfere with the CI’s duties in 2003.  Physical examination showed there were no trigger points or generalized arthritic systemic disease demonstrated on examination.  The examiner documented the CI was not on any follow-up or treatment program for the condition.  The examiner opined, “Review of the current history and the current physical examination does not reveal characteristics which attain a chronic pain syndrome.”  No pathology is identified on physical examination to render a diagnosis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic pain syndrome which included MEB diagnosis 2 (lower back pain) 20%, using an analogous 5099-5025 code (fibromyalgia), citing the analogous usage due to not exhibiting the usual tender points.  The VA also rated the chronic pain syndrome condition 20%, analogously coded 5099-5025 (fibromyalgia), based on the CI’s STR, citing widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesia, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms that are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time.

The Board noted that the CI’s chronic pain syndrome initially manifested as low back pain and subsequently developed into multiple joint pain to include the lower back.  The Board agreed CI’s chronic pain syndrome did not warrant a higher rating of 40% because there was no constant, or nearly so, pain that was refractory to therapy.  The CI was placed on a trial of steroids and Valium 5 mg. at night to help alleviate his pain on 15 September 2003.  At a follow-up appointment on 25 September 2003, the CI stated that on day three he was essentially pain-free, although when he was tapered off the dose, he was back to baseline discomfort.  The Board agreed medical therapy provided relief from the CI’s pain.  Additionally, the Board noted the CI’s VA C&P examination, 2 months prior to separation, did not reveal characteristics which attain a chronic pain syndrome.  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 pain syndrome condition.

Contended PEB Condition:  Hypercholesterolemia.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic pain syndrome condition and IAW VASRD §4.71a, the Board unanimously or majority recommends no change in the PEB adjudication.  In the matter of the contended hypercholesterolemia condition, the Board unanimously recommends no change from the PEB determination as medically acceptable.  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 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002607 (PD201501116)

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