RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01614
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20041019

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aerospace Control and Warning Systems Journeyman, medically separated for “fibromyalgia associated with headaches and back pain” with a disability rating of 20%.   

CI CONTENTION:  “I now have 100% disability rating for PTSD and 40% for fibromyalgia.  I have had great difficulty maintaining part-time employment since my discharge due to my anxiety, depression, chronic pain, flash backs, difficulty w/people, etc.”  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 - 20040804	VARD - 20050412	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	20%	Fibromyalgia	5025	20%	20050308	
PTSD	Cat II	PTSD	9411	NSC	20050308	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  	

Fibromyalgia.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s fibromyalgia symptoms first manifested in January 2002 with headaches and back pain, but worsened in July 2003 which led to a diagnosis of fibromyalgia.  The 15 April 2004 commander’s statement noted the CI was able to work full shifts although the fibromyalgia limited her ability to perform certain duties.  Occasionally she missed work due to appointments but the Commander recommended she stay in the Air Force, perhaps in another career field without deployment stress and heavy lifting.  

The 26 June 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of fatigue, insomnia, headaches, neck pain, back pain and pain in most of her joints (neck, shoulders, wrists, hands, hips, knees, lower legs/shins and ankles.)  Medications provided “fair results.”  Other interventions (exercise and nutrition) gave minimal results.  Pain remained daily and she was unable to perform heavy labor.  The diagnosis was confirmed by the rheumatologist with whom her last appointment was 20 April 2004.  Physical examination showed trigger point tenderness in the cervical, scapular and lumbar regions with full range of motion of hands, wrists, elbows and shoulders.  The lower extremities were free of synovial activity.  A diagnosis of fibromyalgia was rendered noting minimal response to treatment consistent with the illness and with the expectation of long-term pain.  

At the 8 March 2005 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported slow cognition, forgetfulness for names, sporadic monthly headaches not related to her menstrual cycle, constant low back pain worse with standing or lying down.  She had fatigue, aching from her neck to her mid-back and sometimes in her low back, and muscle aches in her hips and knees and elbows.  Although she slept 7-8 hours per night, she remained tired all day.  She denied flare-ups and had no physician prescribed periods of incapacitation in the last 12 months.  She required bed rest twice in the past year due to severe back pain.  The CI continued taking anti-inflammatory medication.  She was a full-time student at a local junior college and was planning to get a Master’s degree.  Physical examination showed tenderness over the base of the occiput and the trapezius muscles bilaterally; and the cervical paravertebral, thoracic paravertebral and the lumbar paravertebral muscles.  There was tenderness over the medial epicondyles and medial aspect of the patella bilaterally.  Thoracolumbar flexion and extension was normal but right lateral flexion was limited to 15 degrees with some increased discomfort.  Sensation and muscle strength were intact in the upper and lower extremities.  X-ray of the lumbar spine showed minor left convex lateral curvature but was essentially normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the fibromyalgia 20%, coded 5025 (fibromyalgia) citing association with headaches and back pain.  The VA also rated the fibromyalgia condition 20%, coded 5025, based on the C&P examination 8 months after separation, citing widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesia, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms that [were] episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that [were] present more than one-third of the time.”

The panel deliberated whether the CI’s symptoms were best characterized as episodic with frequent exacerbations (20%) or constant and refractory to therapy (40%).  The Commander recommended retention in a less physically demanding AFSC.  Both the NARSUM and the C&P examinations documented the presence of the requisite trigger points, essential criteria for a diagnosis of fibromyalgia.  The panel noted that the CI reported “fair results” with several pain medications that included narcotic medication.  Although she still reported daily pain, she was able to work full-time while still in the Air Force and able to attend school full-time after separation.  She denied flare-ups and was planning a pregnancy.  Members agreed that despite some pain, the CI was able to work with broad pain treatment and medical follow-up.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the fibromyalgia condition.  

Contended PEB Condition:  PTSD.   The panel’s main charge is to assess the fairness of the PEB’s determination that the PTSD was Category II, a condition that can be unfitting but not currently compensable or ratable.  While deployed the CI complained of mental health (MH) symptoms related to the non-witnessed death of a friend during deployment.  Psychotherapy from August-September 2003 focused on intrusive recollections of childhood abuse with no report of post-traumatic experiences related to her deployment at that time.  After return from deployment, she reported a 9-10 year history of depression and of superficial cutting from 6-8 and 18-19.  She reported intrusive recollections and a hyper startle response when hearing loud sounds in public places but no flashbacks.  Psychological testing confirmed depressive personality traits and anxiety.  She was diagnosed with PTSD in March 2004 and medication reduced her MH symptoms.  Between February and June 2004, her test scores for MH symptoms improved from moderate to normal.    

The panel considered the PEB’s adjudication of the PTSD.  The NARSUM PTSD addendum rendered a diagnosis of PTSD, which was aggravated by service.  The CI was noted to have definite impairment from the PTSD which was determined to have a childhood onset.  Although the CI reported MH symptoms in childhood, there was no evidence of a specific DSM-IV diagnosis prior to joining the Service.  She denied treatment for any condition until after she enlisted and then received counseling for adjustment difficulties with depressive and anxious symptoms from October - December 2001.  The NARSUM examiner noted diagnoses of PTSD and MDD were made during deployment due to stress of deployment and death of the close friend.  Individual therapy focused on depression and intrusive recollections of childhood abuse.  Other than a hyper startle response when hearing loud noises in public, the CI did not report related post-traumatic deployment experiences.  Although the PTSD was profiled and judged to fail retention standards, the NARSUM indicated a reduction of symptoms, supported by psychological test results of normal for symptoms of anxiety and depression.  The NARSUM examiner concluded that symptoms were functionally transient and slight.  The commander’s statement noted the CI worked full time with duties limited only by fibromyalgia.  Panel members agreed there was no performance-based evidence from the record that the PTSD significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the PTSD and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the fibromyalgia condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161015, 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-2016-01614.

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,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings