RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04035
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, UH-60 Helicopter Repairer, medically separated for “fibromyalgia, with low back and shoulder pain and sleep disturbance with 14/18 ACR tender points, using no medication” with a disability rating of 0%.    

CI CONTENTION:  The applicant makes no specific contention in their application.  The applicant’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 confined to 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 - 20021015	VARD - 20021211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	0%	Fibromyalgia	5025	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Fibromyalgia Condition.  The STR contained an undated rheumatology encounter which diagnosed the CI with fibromyalgia noting greater than 11 of 18 tender points above and below the waist and associated with non-restorative sleep.  His symptoms included generalized muscle aches and fatigue, pain in many joints (as well as the entire spine) and negatively impacted his activities of daily living (ADLs) and military duties.  He was initially treated with physical therapy (PT) and medications (anti-inflammatory, antidepressants, and sleep aids).  His radiographic work-up of the back, chest, and knees were normal.  The last two military related clinical encounters were dated 12 months and 4 months prior to separation and both noted that the CI was not taking any prescribed or over-the-counter medications.  Additionally, the internal medicine evaluation at 4 months pre-separation noted a normal neurologic and musculoskeletal examination.  He was permanently profiled in February 2002 and was referred to a Medical Evaluation Board (MEB).  

At the narrative summary (NARSUM) examination (06 February 2002 and 11 months pre-separation), the CI endorsed neck, shoulder, and low back pain (LBP) aggravated by exercise and stress.  His physical examination (PE) revealed diffuse tenderness about the entire spine and shoulder areas without any focal findings.  He was neurologically intact and his gait was normal.  Joint and spine range of motion (ROM) was not documented.  His overall pain symptom was assessed as “slight” and “frequent.”  The final diagnosis remained fibromyalgia.  The DD Form 2808, Report of Medical Examination, dated 26 February 2002 (10 months prior to separation), listed “none” under current medications.

The Board directed attention to its rating recommendation based on the above evidence.  The minimum compensatory VASRD criterion for fibromyalgia is based upon the continuous use of medication for the control of symptoms.  Board members first acknowledged and reviewed the above cited four examinations within 1 year of separation and concluded that no medication was prescribed for the primary condition and therefore, the minimum 10% impairment rating was not supported.  Another critical criterion for a higher rating (excluding medication use) for this condition is the “frequency of symptoms.”  The specific levels of symptom frequency are described as either “episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time,” or having “constant” symptomatology.  Board Members did consider the higher level of impairment knowing that the CI’s symptoms as documented on the NARSUM were aggravated by exercise and stress, but ultimately concluded that the occurrence of such symptoms were not present more than one-third of the time.  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’s adjudication for the fibromyalgia condition. 

BOARD FINDINGS:  In the matter of the fibromyalgia 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 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 28 2016

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 AR20160009459 (PD201404035)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
I accept the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA