RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01298
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050901

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “myofascial pain syndrome,” with a disability rating of 0%.

CI CONTENTION:  The CI requests review of all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20050510	VARD - 20051019	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Myofascial Pain Syndrome	5099-5021	0%	Myofascial Pain Syndrome	5099-5025	0%	20050505	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Myofascial Pain Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s myofascial pain syndrome condition began prior to enlistment.  The CI reported he had myofascial pain, especially of the neck, shoulders, and upper back region “all his life.”  The CI was enlisted from November 1999 to November 2002.  He was involved in a motor vehicle accident in early 2002 while on active duty which aggravated his myofascial pain.  He was then honorably discharged but re-enlisted in October 2003.  Following advanced individual training the CI’s myofascial pain was exacerbated and he was placed on profile.  The CI reported pain of the neck, upper back, arms, lower back and legs at various examinations in the STR.  A 4 May 2004 rheumatology evaluation, 16 months before separation, was requested by physical therapy for an opinion regarding fibromyalgia and noted complaints of back and leg pain.  The physical examination noted full ROM of the cervical spine, shoulders, elbows, wrists, hips, knees, and ankles without synovitis.  There was no pain with any spinal motion.  There were tender points of the sternoclavicular regions, epicondylar regions, left sacroiliac region, right ischial bursal region and the bilateral calves.  The rheumatology diagnosis was myofascial pain syndrome.  The CI was also evaluated by orthopedics and neurology specialists.  Cervical and lumbar spine X-rays were normal.  Cervical magnetic resonance imaging noted mild degenerative disc disease without nerve impingement or spinal canal stenosis.  Electrodiagnostic studies were negative for neuropathy or radiculopathy.  

The 17 August 2004 orthopedic evaluation, 13 months before separation, noted normal examination of the neck, back, upper and lower extremities and the impression was mechanical low back pain and neck pain.  Physical therapy was recommended.  At the 18 October 2004 neurological evaluation, 11 months before separation, the neurological examination was completely normal.  The neurology assessment was that the CI’s neck pain was due to occipital neuralgia and possibly a component due to temporomandibular joint pain.  The CI was treated with steroids and anti-inflammatory medication for the occipital neuralgia.  

The 10 January 2005 MEB neurology addendum, 8 months before separation, noted the CI had been treated by neurology for neck pain with occasional pins and needles sensation in both arms and for chronic headaches.  The neurologist noted that when the CI was treated with a course of steroids followed by a course of anti-inflammatory medication for the occipital neuralgia he had near complete resolution of the headaches and significant improvement in his myofascial pain as well.  The improvement in the headaches was sustained but the upper and low back pain had returned to baseline.  

The 8 March 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of myofascial pain syndrome.  A rheumatology consult had resulted in a diagnosis of myofascial pain syndrome and neurology and ENT evaluations had found no alternative or additional cause of the CI’s symptoms.  The MEB NARSUM noted that as of March 2004 the CI reported headaches, stiff neck, shoulder pain, low back and leg discomfort.  He reported difficulty running, and performing sit-ups and push-ups.  The MEB NARSUM examiner indicated the CI presented to the examination with “minor complaints of shoulder, neck pain, and upper extremity pain.  These are localized to the trapezius muscle and neck muscles.”  Physical examination showed a normal gait.  The examination otherwise cited the rheumatology examination summarized above, except noted there was pain with spine ROM.  

There was no VA Compensation and Pension examination in evidence proximate to separation.  The 19 October 2005 VA Rating Decision cited evidence including a “VA examination…dated May 5, 2005,” 4 months before separation.  The rating decision notes that the rating is based on a pre-discharge examination.    The VARD cited the relevant VA examination findings excerpted below.  

You had complaints of mostly back and neck pain.  You do not currently take medication for this condition.  VA examination was essentially normal.  You did have neck pain with movement.  Diagnosis was myofascial pain syndrome without objective evidence of disease.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the myofascial pain syndrome condition 0%, analogously coded 5099-5021 (myositis), an analogous code for myofasciitis, manifested by headaches, stiff neck and upper back and shoulder pain, citing full range of motion, intact strength, reflexes  and sensation, and no pain to palpation.  The VA also rated the myofascial pain syndrome condition 0%, analogously coded 5099-5025 (fibromyalgia), based on the VA examination 4 months before separation, citing absence of evidence.  The VA also rated DDD (cervical degenerative disc disease) 0%, coded 5242 (spinal arthritis).  
There was evidence of painful motion of the neck at the pre-discharge VA examination as cited by the VARD.  There was no other impairment of the neck or upper extremities noted on multiple specialty examinations in record, the MEB NARSUM examination, or the VA examination.  The panel agreed that a 10% rating was supported coded 5099-5021 analogous to myositis with painful motion of the neck (a group of minor joints).  The panel also considered if a higher rating than 10% was supported coded analogously to fibromyalgia.  However, the panel found that the limited objective evidence of painful motion of the lumbar spine at the MEB NARSUM examination and painful motion of the neck at the VA examination while on no medication did not support the 20% rating under 5025, specified as “widespread musculoskeletal pain and tender points,” with widespread defined as “pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities."  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the myofascial pain syndrome condition, coded 5099-5021.  

BOARD FINDINGS:  In the matter of the myofascial pain syndrome condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5021 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Myofascial Pain Syndrome	5099-5021	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150611, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011797, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure