RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01233
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Unit Supply Sergeant, medically separated for “fibromyalgia” with a disability rating of 20%.

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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:

SERVICE PEB - 20050406	VARD - 20060404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	20%	Fibromyalgia	5025	10%	STR	
[Right] Retropatellar Pain Syndrome	Not Unfitting	Right Knee Pain	5257	NSC	STR	
Migraine Headaches	Not Unfitting	Migraines	8100	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Fibromyalgia.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s fibromyalgia condition was diagnosed in 2004 after she complained of fatigue, numbness, swelling in the hands, myalgia, difficulty sleeping, and migraine headaches.  The 09 February 2005 rheumatology examination, 4 months prior to separation, noted complaints of “tension” across the back of her neck, low back pain, and leg aches.  She also stated that she had difficulty sleeping and had morning fatigue and stiffness.  She noted occasional hand swelling and numbness.  Physical examination was essentially normal except for numerous central and peripheral tender points in both the upper and lower extremities.  The MEB NARSUM examination, also performed on 09 February 2005, noted complaints of generalized musculoskeletal pain, fatigue, non-restorative sleep, prolonged morning stiffness, and paresthesia.  The CI reported the pain was constant and characterized it as aching.  The pain got worse as the day progressed.  She had difficulty sleeping and morning stiffness causing difficulty dressing.  The CI was being treated with Nortriptyline and Tylenol and was not using narcotics.  The examiner noted prior treatment with NSAIDs, Flexeril, Paxil, and physical therapy.  Physical examination showed multiple tender points, but was otherwise normal.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the fibromyalgia condition 20%, coded 5025 (fibromyalgia).  The VA rated the fibromyalgia condition 10%, also coded 5025.  The panel noted that the CI met the criteria for diagnosis of fibromyalgia IAW VASRD §4.71a in that her condition was evaluated by a rheumatologist and she had widespread musculoskeletal pain and trigger points including both upper and lower axial components as well as peripheral components.  Her condition also included fatigue, sleep disturbance, stiffness, and paresthesia.  The panel noted reports of daily, constant, aching, pain rating on average 8/10 and increasing to 10/10 in the early evening; despite multiple treatment modalities (medications, physical therapy, and exercise).  Panel members agreed that the evidence supports a rating for symptoms nearly constant 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.  

Contended PEB Conditions:  [Right] Retropatellar Pain Syndrome and Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Although the knee condition was profiled, it was not implicated in the commander’s statement nor judged to fail retention standards.  The migraine headache condition was not profiled, implicated in the commander’s statement, nor judged to fail retention standards.  The performance-based evidence from the record did not support that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the fibromyalgia condition, the panel recommends a disability rating of 40%, coded 5025 IAW VASRD §4.71a.  There are 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, the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Fibromyalgia	5025	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180004939, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:  

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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

Sincerely,					      
Enclosure