RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01670
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20040528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aviation Ordnanceman, medically separated for “focal myofascial pain syndrome” with a disability rating of 10%.   

CI CONTENTION:  The VA gave her a higher rating for myofascial pain syndrome.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040312	VARD - 20050110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Focal Myofascial Pain Syndrome	5299-5003	10%	Post-Traumatic, Rt Shoulder…	5201	30%	20040422	
Chronic Pain, Myofascial Pain	Cat II	Myofascial Pain Syndrome	5025	40%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Focal Myofascial Pain Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right (dominant) shoulder myofascial pain began after heavy lifting in May 2000 with a re-injury after lifting in March 2003.  A rheumatology consult on 13 November 2003, noted the pain was primarily focused around the right shoulder with “no other joint pain or muscle aches elsewhere except for tension headaches.”  At a December 2003 physical medicine visit, she reported constant right shoulder pain and the examiner recorded flexion to 135 degrees (normal 180) and abduction to 90 degrees (normal 180).  
The 17 December 2003 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of constant right shoulder discomfort radiating to the neck and mid back.  The examiner documented painful ROM with forward flexion and abduction measured to 70 degrees.   

At the 22 April 2004 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported the inability to lift more than 2 pounds.  Physical examination revealed painful range of motion (ROM) with forward flexion to 90 degrees and abduction to 60 degrees.  The upper extremities were normal and equivocal to sensation and motor strength.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the focal myofascial pain condition 10%, analogously coded 5299-5003 (degenerative arthritis).  The PEB also listed “chronic pain, myofascial pain syndrome” as a related Category II condition (contributes to the unfitting disability).  The VA rated the right shoulder as two separate conditions based on the C&P examination:  post-traumatic impingement syndrome/right partial frozen shoulder at 30%, coded 5201 (arm; limitation of motion); and myofascial pain syndrome at 40%, coded 5025 (fibromyalgia), citing widespread musculoskeletal pain and tender points.  Although the Navy PEB listed the myofascial pain syndrome as a Category II condition, members agreed that the right shoulder injury was the initiating event and primary cause of impairment (as referenced in the pre-separation rheumatology report).  Therefore, the related diagnosis was not considered a separately ratable condition according to VASRD §4.14 (avoidance of pyramiding). The panel then determined that the VA C&P examination held the greatest probative value, being most proximate to separation, and adjudged that a 20% rating, but no higher, was justified for the limitation of right shoulder abduction “at or below 90 degrees” under code 5201.  A 30% rating was not warranted because abduction ROM was not “beyond the halfway point between side and shoulder level.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the focal myofascial pain syndrome condition, coded 5201.    

BOARD FINDINGS:  In the matter of the focal myofascial pain syndrome, the panel recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Focal Myofascial Pain Syndrome	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161024, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:       (a) DoDI 6040.44
	(b) PDBR ltr dtd 12 Jun 18 ICO XXXXXXXXXXXXXXXXXX	
             (c) PDBR ltr dtd 05 Jul 18 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 11 Jun 18 ICO XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 05 Jul 18 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 05 Jul 18 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 05 Jul 18 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.  

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.   

     f. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.
 
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

                                  XXXXXXXXXXXXXXXXXX
                                  Assistant General Counsel
                                  (Manpower and Reserve Affairs)