RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-03818
BRANCH OF SERVICE: Army	SEPARATION DATE:  20020823

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Dental Specialist, medically separated for “post-traumatic fibromyalgia syndrome,” with a disability rating of 20%. 

CI CONTENTION:  The CI requested consideration of all conditions. The CI’s 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 – Dated 20020226	VARD - 20020916	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Fibromyalgia Syndrome	5025	20%	Fibromyalgia With Associated Symptoms of Anxiety, Depressed Mood, and Widespread Pain	5025	20%	20020802	
Depressive Disorder, NOS	Not Unfitting					
Probably Sjogrens Syndrome	Not Unfitting	Sjogrens Syndrome	6018	0%	20020802	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Posttraumatic Fibromyalgia Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s posttraumatic fibromyalgia syndrome condition began in November 2000 after a motor vehicle accident.  At the time of her initial rheumatology evaluation dated 26 October 2001, the CI reported diffuse musculoskeletal pain, sleep disturbance, fatigue, abdominal pain and arm numbness.  A diagnosis of posttraumatic fibromyalgia was rendered.  She received multiple treatment modalities including medications, physical therapy, and trigger point injections which did not resolve her fibromyalgia symptoms.  At a Rheumatology evaluation in May 2002 the CI reported generalized pain, depression, and difficulty sleeping.  The examiner noted that the CI had to discontinue pain medication secondary to GI bleeding.  The MEB NARSUM examination in June 2002 (2 months prior to separation) noted reports of diffuse musculoskeletal pain, fatigue, sleep disturbances, numbness of the left upper extremity, abdominal pain, anxiety and depression.  Physical examination showed decreased range of motion in the lumbar spine and 18/18 of the cardinal tender points were positive.  The examiner documented constant marked pain which the CI rated 3-10/10.  The examiner also noted that despite medical treatment the CI continued to experience pain and that all medical and surgical options for fibromyalgia were exhausted.  

At the 2 August 2002 VA Compensation and Pension (C&P) examination, performed 1 month before separation, the CI reported fatigue and aching all over, specifically in the back and both shoulders. Fatigue was one of the CI’s greatest concerns and reported taking multiple medications to attempt to control the pain. Physical examination showed 18/18 tender points. There was tenderness to palpation from the cervical spine down to the lumbar spine.  Sacroiliac joints were tender to palpation and the CI had trigger points in the upper back, indicative of myofascial pain with muscle spasms. Range of motion was described as normal in the upper and lower extremities. There was no erythema, warmth, or edema of any joint.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5025 code (fibromyalgia), citing symptoms not fully controlled with medications.  The VA also assigned a 20% rating using the 5025 code.  The Board noted that the CI complained of daily diffuse musculoskeletal pain and sleep disturbance that did not respond to multiple treatment modalities.  The NARSUM examiner noted that all medical treatment option for fibromyalgia were exhausted and that the CI’s pain was constant and marked.  The Board members agreed that the evidence supports a 40% rating for fibromyalgia that is constant and refractory to therapy.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 40% for the fibromyalgia condition.  

Contended PEB Conditions: Sjogrens syndrome and depressive disorder (d/o) not otherwise specified (NOS). The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the posttraumatic fibromyalgia condition, the Board unanimously recommends a disability rating of 40%, coded 5025 IAW VASRD §4.71a.  In the matter of the contended Sjogrens syndrome and depressive disorder NOS conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Posttraumatic Fibromyalgia Syndrome	5025	40%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140514, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB																		

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for, AR20160018210 (PD201403818)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 40% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 40% effective the date of the original medical separation for disability with [severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

			       
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA