RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01963
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050529

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aircraft Powerplant Repairer, medically separated for “fibromyalgia” with a disability rating of 20%.  

CI CONTENTION:  The CI continues to experience problems with her hips and left shoulder due to the fibromyalgia.  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 PEB, but determined 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.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(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, operating 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 the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20050401	VARD - 20090818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	20%	Fibromyalgia	5025	0%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Fibromyalgia.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s fibromyalgia condition began in July 2003 after experiencing hip pain, followed by neck, back and shoulder pain in the following months.  

The 14 October 2004 rheumatology evaluation noted complaints of constant pain without being able to obtain relief with multiple treatments.  She also reported very poor sleep because of joint pain and having prolonged morning stiffness at times (3-4 days per week) lasting 1 hour or more.  Physical examination showed the CI appeared healthy and in no acute distress.  There were 17 of 18 tender points for fibromyalgia.  The rheumatologist indicated the CI met the full criteria for fibromyalgia with 17/18 tender points, widespread pain headaches, irritable bowel complaints and otherwise normal lab tests.  

Rheumatology follow-up on 8 November 2004 indicated that the CI was able to sleep through the night with medication, but that the daytime pain symptoms were unchanged.  The provider added medication for daytime symptoms and a primary care note dated 9 December 2004 indicated the CI reported 8/10 pain level and some improvement in symptoms.  

At the 21 December 2004 MEB examination (recorded on DD Forms 2807 and 2808), 5 months prior to separation, the CI reported painful joints and muscles diagnosed as fibromyalgia, with tension headaches, mild gastric reflux, and sleeplessness.  Physical examination showed tenderness at fibromyalgia trigger points.  

The 21 December 2004 MEB NARSUM examination, 5 months prior to separation, noted a chief complaint of “everything hurts all the time and it can’t stop” and constant pain.  Physical Therapy with a home exercise program and ultrasound therapy did not provide significant improvement.  The CI was taking daily medications of Ultram (narcotic-like pain reliever), Tylenol and night-time Flexeril (muscle relaxant).  Under “present condition” the examiner indicated that the CI complained of constant pain in her hips, entire back, shoulders, ankles, knees, and neck; fatigue all day; difficulty falling asleep at night and difficulty with staying asleep; waking up at least three times per night; some depression; and alternating diarrhea and constipation.  Physical examination showed no evidence of synovitis.  There were 17 of 18 tender points of fibromyalgia present.  

Rheumatology follow-up on 15 March 2005 indicated that the CI had severe 7/10 pain of the entire body and was having trouble performing her job because of pain.  The CI indicated that Flexeril helped her stay asleep.  The CI had been intolerant to Elavil (an anti-depressant) and the specialist added a different antidepressant medication (Trazodone), changed her non-narcotic pain medication, and recommended cognitive behavioral therapy.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the fibromyalgia condition 20%, coded 5025 (fibromyalgia), citing 17 of 18 tender points diagnosed, “present more than one-third of the time.”  The VA rated the fibromyalgia condition 0% coded 5025, effective in 2008, citing not having results of a current examination to show the CI’s current condition.  The panel deliberated on if the CI‘s disability was more nearly approximated by the next higher 40% criteria, or by the 20% criteria as awarded by the PEB under code 5025 as excerpted below:  

5025 	Fibromyalgia (fibrositis, primary fibromyalgia syndrome)
	With widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms:  
		That are constant, or nearly so, and refractory to therapy	40
		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	20

The record documented a rheumatologist-diagnosed condition of fibromyalgia with symptoms that were constant, or nearly so.  Almost every STR note in the year prior to separation indicated starting pain as 7/10, or higher.  Some notes indicated decreased sleep symptoms, though there were no notes that indicated resolution of symptoms, or sustained periods of symptom relief.  The NARSUM indicated there was no improvement with physical therapy or medical treatment.  The CI’s pain symptoms were constant and not relieved by therapy.  Panel consensus was that the CI’s symptoms were constant, or nearly so, and refractory to therapy.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 40% for the fibromyalgia condition, coded 5025.  

BOARD FINDINGS:  In the matter of the fibromyalgia condition, the panel unanimously recommends a disability rating of 40%, coded 5025 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Fibromyalgia	5025	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010556, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 40% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure