RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-04354 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050415

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

CI CONTENTION: “There has been no change to my condition and doctors are still unable to identify a cause for the high temperatures that accompany every flair up.” 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 - 20041203	VARD - 20050602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Syndrome	9423	10%	Chronic Pain Syndrome	9499-9423	10%	20050312	
Chronic Right Hip Pain	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Chronic Pain Syndrome. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s history of chronic pain began in 1998 with a right hip injury while running. The CI was diagnosed with right hip trochanteric bursitis and this condition became chronic with intermittent exacerbations. In July 2003, after returning from an Iraq deployment, the CI also reported back pain and then pain expanding to include the whole spine from the neck down. The

27 October 2003 limited duty (LIMDU) board listed chronic hip and back pain and sacroiliitis with physical limitations to do physical training at the CI’s own pace, no forced marches, physical fitness tests, obstacle courses, martial arts, or sports; and the CI was declared non-deployable. Cervical MRI was essentially normal. Thoracic and lumbar MRIs showed minimal degenerative changes and there were findings suggestive of syringomyelia (a fluid-filled cyst in spinal cord) from T10 through the conus at L1-2, which was thought to be congenital and an incidental finding. Right hip MRI in February 2004 was normal.

The 25 October 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of neck and back pain and more recently symptoms including migraine headaches, nausea, vomiting, fatigue, and flu-like symptoms. There were also multiple arthralgias, numbness of the hands and feet and cold extremities reported. The hip, neck, and back pain were chronic, but the remainder of the symptoms were exacerbated by physical exertion and could be avoided by light activity and rest. The symptoms would last 2 to 4 days depending on the level of exertion. Physical examination showed normal examination of the heart, lungs and abdomen. There was tenderness in multiple muscular areas along the spine and legs including the occiput, medial supraspinatus region, the sacroiliac joints, medial elbows, and medial knees. Neurologic examination was normal. Neck range of motion (ROM) was normal flexion and extension and reduced lateral bending and rotation bilaterally, combined ROM of 210 (normal 340). Low back ROM was normal.

The 27 October 2004 non-medical assessment (NMA), 6 months prior to separation, indicated the CI was a valuable asset to the command and performed well in her administrative position, but due to the physical effects of her medical condition she was unable to perform the duties of her military specialty. The CI reportedly expressed the desire to remain in the Marines, but only if she could perform her job without restrictions.

At the 12 March 2005 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported chronic pain of her entire body, from the spine through her extremities, easy fatigability, headaches, sleep disturbances, stiffness, and sometimes abnormal sensation. The symptoms were daily, but with exacerbations whenever she mentally or physically exerted herself. The symptoms occurred more than two–thirds of the time and were usually due to emotional or environmental stress as well. She reported flare-ups approximately 4 days per month and pain of her cervical and thoracolumbar spine, right hip, knee and ankle. She reported daily headaches that sometimes became severe, and problems with her hands and feet feeling cold without change in color. Physical examination showed normal color in the extremities. The CI had a normal gait. Hip, ankle, shoulder, elbow, wrist and thumb/finger ROM were normal bilaterally, without painful motion. Knee ROM was normal with painful motion bilaterally. Cervical and thoracolumbar spine ROM was normal, without painful motion. There was no muscle spasm, tenderness or, radiating pain on movement of any spine segment. There was no additional loss of ROM with repetition of any joint or spine segment. Neurological examination and the CI’s mental status were normal. X-rays of the cervical and thoracolumbar spine and right and left knees and left ankle were all normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the pain syndrome 10%, coded 9423 (undifferentiated somatoform disorder). The VA rated the pain syndrome 10%, analogously coded 9499-9423, based on the C&P examination, citing chronic pain syndrome. The CI was diagnosed by a rheumatologist with chronic pain syndrome with findings of trochanteric bursitis. The CI’s chronic pain syndrome had symptoms, clinical findings, and a course similar to FM syndrome and she received treatment comparable to FM treatment. The panel deliberated whether the CI’s chronic pain syndrome was more appropriately rated under the VASRD General Rating Formula for Mental Disorders or under VASRD 4.71a (musculoskeletal system), analogous to FM (5025). The panel considered the rheumatologist discussion of the increased susceptibility to chronic pain syndromes in persons

with a history childhood abuse. However, the CI’s recommended limitations were physical and there was no indication in record that the CI was impaired socially or occupationally due to mental health symptoms as supported by the NMA.

The panel therefore recommends a 20% rating, coded 5099-5025 based on evidence of a chronic pain syndrome analogous to FM with 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.” If alternatively rating the chronic pain syndrome as a mental health condition coded 9423, the panel agreed no higher than a 10% rating was supported for symptoms controlled with medication or occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.” There was no evidence of “intermittent periods of inability to perform occupational tasks” required for the next higher 30% rating. Therefore no higher than 20% rating was supported under any applicable VASRD code. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic pain syndrome, coded 5099-5025.

Contended PEB Condition: Chronic Right Hip Pain. Panel members concluded that a preponderance of evidence indicates the chronic right hip pain was not justified as separately unfitting or separately ratable (IAW VASRD §4.14, avoidance of pyramiding), given the hip pain was part of the 5025 rating criteria for the panel’s rating recommendation for the chronic pain syndrome above. After due deliberation, the panel agrees it cannot recommend the chronic right hip pain for additional disability rating.

BOARD FINDINGS: In the matter of the chronic pain syndrome, the panel recommends a disability rating of 20%, coded 5099-5025 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	
Chronic Pain Syndrome	5099-5025	20%	

DEPARTMENT OF THE NAVY
SECRETARY OF TI!E NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO,
1850
CORB:003 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 27 Aug 19
(b)	

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.

2.	On 5 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the office of the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.