RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02673
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20020617

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Space Systems Operations Craftsman, medically separated for “fibromyalgia associated with bilateral knee pains,” with a disability rating of 20%.  

CI CONTENTION:  The CI contends he should receive a higher rating for his condition.  His 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 upon a 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 - 20020319	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia Associated with Bilateral Knee Pains	5025	20%	No VA evaluation in evidence at the time of the application.	
RATING:  20%	RATING:  ---%	

ANALYSIS SUMMARY:  

Fibromyalgia Associated with Bilateral Knee Pains Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed multiple joint pains (poly-arthralgias) in late 2000 which did not respond to medications or rest.  A physical examination on 2 February 2001, noted a full range of motion of the extremities without swelling.  In primary care on 16 February 2001, he again had unexplained poly-arthralgias and was treated with a steroid burst at the recommendation of a civilian rheumatologist.  His symptoms improved on the prednisone.  He was again seen on 15 June 2001, and noted to be on a low dose of prednisone (2.5 to 5.0 mg).  The prednisone was subsequently discontinued as it was not beneficial.  He reported improvement with the use of a hot tub.  On examination, he reported pain with flexion of the knees, but did not have redness, swelling, or crepitus (an audible or palpable grating sensation).  These records from the civilian rheumatologist are not in evidence.  The CI was evaluated by a military rheumatologist on 25 July 2001, and noted to have a normal bone scan and laboratory studies.  A presumptive diagnosis of fibromyalgia (FM) syndrome was made and the CI was referred for MEB.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 1 October 2001, 9 months prior to separation, the CI reported ongoing joint pain attributed to FMS with sleep disturbances from his pain.  On examination, he was noted to have tenderness on palpation and motion of the left shoulder and of the fingers, wrists, and elbows with at the extreme ranges of motion.  He also had bilateral knee pain, right greater than left and flexion greater than extension.  In flight medicine on 18 October 2001, the CI reported using a cane for his knee pain.  He had a slow walk “as if in pain.”  His knees were very tender to palpation and with motion, but there was neither effusion nor redness.  Medications (a non-steroidal anti-inflammatory drug) were helpful in controlling his pain.  The CI had a follow-up appointment in rheumatology on 28 November 2001.  He reported he had pain all over in the muscles and joints.  He had some morning stiffness.  His physical examination and laboratory studies were unremarkable other than 14/18 trigger points being positive.  He was thought to have probable FMS.  A trial of a nerve stabilizer medication was recommended, but it caused excessive drowsiness and was discontinued.  The MEB NARSUM examination was performed on 5 December 2001, 6 months prior to separation.  The CI was noted to have been counseled on regular exercise and it was recorded that he participated in water aerobics 3-5 times a week; however, this was later disputed by the CI.  It was noted that he frequently used a cane or crutches for walking.  He endorsed joint pain and morning stiffness of the knees and shoulders primarily, but also of the fingers, elbows, and wrists on occasion.  He also endorsed Raynaud’s phenomenon of the fingertips.  He denied fever, chill, oral ulcers, photo-sensitivity, back pain, or prior arthritis.  He reported recent weight gain since he could not exercise.  On examination, the 68 inch CI weighed 194 pounds.  He was in no distress, but moved slowly getting onto the examination table.  There was tenderness to palpation and with motion of the left shoulder and right > left knee flexion (greater than extension).  The fingers, wrists, and elbows were intermittently tender to firm palpation and extremes of motion.  The Board noted this mirrored the MEB examination done 2 months earlier and is not thought to be a new examination.  The commander noted on 11 December 2001, the CI had difficulty with even routine tasks.  His commander also noted that his duty performance was poor (per performance reports, this began over 1 year prior to the onset of his symptoms) rendered him a poor candidate for continuation on active duty.  It was also noted that the CI did not appear to be “motivated in the pursuit of treatment to overcome his illness.”  

The Formal PEB adjudicated the FM condition associated with bilateral knee pain at 20% coded 5025 (fibromyalgia).  The CI submitted a rebuttal dated 1 April 2002.  In it, he corroborated the PEB observation that he had missed less than 5 days of work over the past year and never needed to leave early or show up late.  He also stated that he was not able to exercise for 20 minutes 3-4 times a week on either a bike or elliptical trainer.  He reported this was the exception rather than the rule.  He stated that he could walk no more than 100 feet without rest and he needed to be in rooms at or above 78 degrees due to his Raynaud’s Syndrome.  The rebuttal was considered by the SAF Personnel Council.  It noted a physical therapy summary from December 2001 which indicated “’outstanding improvement in his strength and range of motion’ since beginning a program involving the stationary bike and elliptical trainer.”  The PEB adjudication was upheld.  There was not a VA Compensation and Pension (C&P) evaluation in evidence and, per the CI as written in his application, none was accomplished prior to his application.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the FM condition 20%, coded 5025 (fibromyalgia), noting the minimal loss of time from work and the activity level as recorded above.  It also noted that the CI remained active in the activities of daily living and controlled his symptoms with medications taken as needed.  It was also noted that the CI did not suffer from many of the conditions associated with FMS other than mild sleep disturbance and possible Raynauds Syndrome.  It was also noted that he had been able to lose weight and had been under the maximum for the prior 3 months.  The criteria for a higher, 40% rating are “nearly constant (symptoms) or nearly so and refractory to therapy.”  The CI was recorded has having benefit from treatment and to have a good exercise tolerance.  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 fibromyalgia associated with bilateral knee pain condition.  

BOARD FINDINGS:  In the matter of the fibromyalgia associated with bilateral knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20140521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-02673.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings