RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02507
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Still Photographic Apprentice, medically separated for “fibromyalgia syndrome,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 - 20050310	VARD - 20051024	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia Syndrome	5025	10%	Fibromyalgia	5025	NSC	STR	
History of Depression Controlled on Medication	Cat II	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Fibromyalgia Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s fibromyalgia condition began as intermittent right shoulder numbness and tingling in 2003.  The CI underwent physical therapy and pain medications without pain relief.  

At a 19 May 2004 examination, the CI reported “problems off and on with her shoulders since July of 2003.”  The CI complained of some pain to the superior medial aspect of her right scapula, with occasional radiation to the right side of her neck but more commonly to her right shoulder and actually down her right arm.  The CI stated that she did have intermittent numbness and tingling to her right arm and occasionally to her right hand.  The CI stated that her symptoms were exacerbated with heavy lifting.  The CI was right hand dominant.  

On 28 October 2004, annotated on a rheumatology progress note, the CI reported right shoulder and neck side pain with intermittent exacerbations, radiations to right side upper arm and also right side neck.  The CI also reported weakness and numbness in the right upper extremity.  Physical examination findings showed positive tender points of fibromyalgia in her mid-portion of the upper border of the trapezius muscles, 2nd intercostal areas, supraspinatus areas close to midline, lateral epicondyles, and upper quadrant of the gluteal areas bilaterally.  A diagnosis of fibromyalgia was rendered.

At a 17 December 2004 neurology appointment, the CI was found to have triggering spots located on the top of the “superior trapezius muscle on the right side near the neck and other one on paraspinal area around T4-5 level.  There was no more tenderness on previous injection site on superior medial scapular border and T7 level.” 

The MEB NARSUM examination on 5 January 2005, 4 months prior to separation, noted complaints of fibromyalgia with significant trigger points.  The examiner noted the CI had chronic myalgia and myositis in the right shoulder area with intermittent numbness and tingling into her right arm.  Physical examination showed painful trigger points to various locations most pronounced to the neck, upper back and shoulder regions.  The CI was taking Zoloft and Tramadol to help alleviate the symptoms.  

At a 31 January 2005 appointment with Neurology, the examiner found “two more triggering spots, located on right superior medial scapular border and other one on paraspinal muscles around T6 or T7 level.”  

At a medical appointment on 11 February 2005, the examiner noted the CI had a “flaring” of her fibromyalgia symptomology.  The CI reported self-increasing her dosage of Zoloft to alleviate the increased muscle aches.  The examiner increased the dosage of Zoloft along with added the use of Tramadol as needed.  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 syndrome condition 10%, coded 5025 (fibromyalgia).  The VA did not service connect the fibromyalgia condition coded 5025, based on STR, citing the lack of evidence of current disability.  It was noted that the CI had at least monthly appointments with a primary care physician with complaints of exacerbation or flares of the symptoms.  The panel also noted that the CI had various treatment modalities that did not substantially alleviate the symptoms.  Additionally, the CI’s medication dosage was increased, Zoloft, and an additional medication, Tramadol, was prescribed and used as needed.  These medications calmed the symptoms, however, they did not eradicate the symptoms.  The CI reported that her symptoms were exacerbated with heavy lifting.  The panel majority determined that the CI’s condition met criteria for a 20% medical disability rating coded 5025 for episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time.  The evidence did not support a 40% medical disability rating for constant symptoms 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 20% for the fibromyalgia condition, coded 5025.  

Contended PEB Conditions:  Depression.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the fibromyalgia syndrome condition, the panel majority recommends a disability rating of 20%, coded 5025 IAW VASRD §4.71a.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  In the matter of the contended depression condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Fibromyalgia Syndrome	5025	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151029, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02507.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  The Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR