RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxxx	CASE:  PD-2017-00124
BRANCH OF SERVICE:  Coast Guard 	SEPARATION DATE:  20070322

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Boatswain Mate, medically separated for “thoracolumbar myofascial pain syndrome” with a disability rating of 10%.   

CI CONTENTION:  “…The military rated me at 10% and VA rated me at 40%.”  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 - 20070116	VARD - 20071011	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Thoracolumbar Myofascial Pain Syndrome	5021	10%	Thoracolumbar Myofascial Pain Syndrome	5299-5237	10%	20070530	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Thoracolumbar Myofascial Pain Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s thoracolumbar myofascial condition was reported in November 2005 when he detailed a 6-month history of low back pain, with no specific trauma or injury, but that increased with twisting.  He was found to have tenderness at T5-T7 and the L1-L2 region, but full range of motion (ROM) without weakness or decreased sensation.  He was diagnosed with lower back pain, and treatment included anti-inflammatory and muscle relaxing medications.  Lumber and thoracic X-rays were unremarkable.  The CI’s pain continued and he was prescribed Percocet (narcotic), given a consult to physical therapy, and placed on light duty, but with no relief.  He was then referred to sports medicine in November 2005, and determined to have a musculoskeletal pattern of impaired joint mobility, motor function, muscle performance and ROM associated with localized inflammation.  

In February 2006, he was noted to have tenderness and a positive straight leg raise on the left, but normal strength.  A lumbar spine MRI showed a mild bulging annulus minimally effacing the ventral thecal sac.  In March 2006, measured forward flexion was to 70 degrees with pain (normal 90), extension to 25 degrees (normal 30).  Bilateral side bends and right lateral rotation were within normal limits, and left lateral rotational was 25 degrees (normal 30).  The CI had a slight antalgic gait on the left.  A thoracic spine MRI the same month showed minimal left foraminal osteophytes at the T3-T4 without significant foraminal narrowing.  He was referred to pain management and prescribed a neuromuscular stimulator.  At an orthopedic evaluation in May 2006, the CI reported upper and mid back pain.  The physical examination (PE) demonstrated normal gait, no tenderness or spasms, and “functional” thoracolumbar motion.  

During the 11 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the PE showed flexion to 70 degrees, with pain, and normal side bending and rotation.  Straight leg raising was 40 degrees on the right and 35 degrees on the left.  The 14 December 2006 MEB NARSUM examination noted CI complaints of not being able to perform duties due to the stress put on his spine from rough ship handling at high speeds.  Sitting and standing increased the discomfort.  The PE showed an antalgic gait, flexion to 70 degrees, and normal side bending and rotation.  

During the 24 May 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported random, daily mid to low back pain that was sharp and moderate.  The PE showed a normal gait with no spasm, atrophy, guarding, tenderness, or weakness.  Flexion was to 90 degrees with pain beginning at 70 degrees, and combined ROM was 225 degrees (normal 240).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the thoracolumbar myofascial pain syndrome 10%, analogously coded 5099-5021 (myositis), citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  The VA also rated the thoracolumbar myofascial pain syndrome 10%, but analogously coded 5299-5237 (lumbosacral strain), based on the C&P examination, also citing the 10% rating criteria.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion as reported on the NARSUM and VA C&P examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the thoracolumbar myofascial condition.  

BOARD FINDINGS:  In the matter of the thoracolumbar myofascial pain syndrome and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161211, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

Dear xxxxxxxxxxxxxxxxxxxxxx,
 
Commandant
United States Coast Guard

I am the Designated Decision Authority for the Coast Guard on applications submitted to the Depa1tment of Defense Physical Disability Board of Review (PDBR). Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR's recommendation in your case (Case Number PD-2017-00124) and decline to modify your findings.

Enclosed for your information are a copy of the PDBR's recommendation and a copy of the record of proceedings.

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR and the Department of Veterans Affairs.

If you have any further questions, please contact the Coast Guard Personnel Service Center at (202)795-6645.

2 Enclosures

Copy: 
CG Personnel  Service  Center (EPM-1) 
DoD Physical Disability Board of Review Department  of  Veterans Affairs