RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01884
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20050728

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

CI CONTENTION:  The VA rated the condition higher.  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 - 20050420	VARD - 20050818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia Syndrome	5025	20%	Fibromyalgia	5025	40%	20050607	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Fibromyalgia Syndrome.  According to service treatment record and MEB narrative summary (NARSUM), the CI’s fibromyalgia condition began March 2004 with pain in neck, back, shoulders, arms and knees.  She also had intestinal problems, sporadic headaches, fatigue and nonrestorative sleep symptoms with 16/18 tender points.  In September 2004, rheumatology rendered a diagnosis of fibromyalgia.  She was prescribed medication to assist with sleep, pain and mood as well as regular physical exercise and stretching program.  

The 7 February 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of symptom exacerbations requiring acute care on three occasions in the past year despite medication and therapy compliance.  She was feeling much worse overall.  She had a difficult time getting out of bed in the morning and felt completely exhausted at all times without energy to do normal tasks.  Her last physical fitness test was November 2004 where she was not able to do the push up or sit up events, and missed passing the walk event by less than 1 minute.  She was otherwise able to do all soldier duties.  She was working in a desk job that did not routinely require physical duties.  Medications included Allegra (allergy), Celebrex (anti-arthralgias), Ambien (sleep), and Sertraline (depression/anxiety.)  She continued to have chronic pain and fatigue despite good medical therapy.  Physical examination showed 16/18 tender points but was otherwise normal.    

The 15 February 2005 commander’s statement noted repeated return to the clinic for treatment of her pain, fatigue and headaches.  Each time she was given Toradol and often placed on quarters ranging from 24-48 hours.  Her condition worsened and she was sometimes unable to perform simple physical tasks due to pain.  She often came to work looking drained of energy and with trouble completing assigned tasks for the day.  She was extremely active in participating in the unit’s field, physical and common task training.  

At the 7 June 2005 VA Compensation and Pension (C&P) evaluation, 2 month before separation, the CI reported she could perform unlimited walking.  She was taking Allegra, Ambien and Zoloft (anti-depression/anxiety.)  In general she could sustain heavy physical activity without immediate distress.  Physical examination showed a normal evaluation.  She self-reported many fibromyalgia tender spots, but X-ray and lab studies were normal.  She could undertake the usual activities of normal daily living and appeared to be in excellent health.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the fibromyalgia 20%, coded 5025 (fibromyalgia), citing numerous medications for pain, depression and sleep.  The VA rated the fibromyalgia 40%, coded 5025 (fibromyalgia), based on the C&P examination 2 months before separation, citing widespread musculoskeletal pain and tender points that are constant, or nearly so and refractory to therapy.  

The NARSUM examination noted the CI had symptom exacerbations three times in the past year despite therapy and medication compliance.  However, she was able to perform soldier duties and worked a desk job.  The commander noted that despite her difficulties she actively participated in the unit’s training.  The C&P examination, 2 months prior to separation, noted the CI could perform unlimited walking and could sustain heavy physical activity without immediate distress.  She was no longer taking Celebrex and appeared in excellent health.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the fibromyalgia.  

BOARD FINDINGS:  In the matter of the fibromyalgia and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel 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 20170119, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005853, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure