RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02656 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20030312

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cryptologic Technician Seaman, medically separated for “fibromyalgia” with a disability rating of 10%.

CI CONTENTION: “I feel 10% was insufficient for a condition that not only ended my career, but has rendered it hard to maintain a quality of life due to constant pain and fatigue with intermittent depression. While not degenerative, the effects of Fibromyalgia on my physical and mental health have impacted my life in ways I could not even imagine at the time of separation.” 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 - 20021115	VARD - 20040602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	10%	Fibromyalgia	5025	20%	20040227	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Fibromyalgia. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s fibromyalgia began in boot camp in 2001 when she was noted to have dependent edema after a fall. Because of lingering pain, evaluation revealed multiple tender points in the neck, back, arms, wrists, and knees, with skin sensitivity to pressure and constant fatigue. She also had difficulty sleeping as well as difficulty walking or standing for a significant length of time. She had

no other symptoms of connective tissue disease or lupus erythematosus. The 2 November 2001 MEB NARSUM examination noted she had no synovitis and had normal range of motion (ROM) of each of her joints. She had tenderness under the patella and a positive patellar grind test consistent with the patellar femoral syndrome (not in the scope of review). There were diffuse symmetrical tender points in the occiput, trapezius, scapula area, olecranon, chest, greater trochanter, and knees. Neurological examination was normal. She had a positive ANA (antinuclear antibody) at 1:80 in a speckled pattern, but additional tests for connective tissue disease were negative. Thyroid studies revealed a TSH of 4.18 uIU/ml (normal 0.35-4.8) and T4 of 0.87 ng/L (normal 0.71-1.85). She was diagnosed with fibromyalgia and was initially treated with Elavil (for nerve pain and/or depression), but had no response. Graduated exercise was encouraged. She was then placed on a muscle relaxer and pain medication and had some response with slightly better sleep.

A 12 June 2002 MEB NARSUM addendum, 9 months prior to separation, noted the CI indicated she had several days when she could not get out of bed because her muscles and joints were painful and her symptoms seemed to be worse when she was under stressful situations. Sleep was still difficult and she had more fatigue. Occasionally, she also had days when there was less muscle and joint pain. The 22 August 2002 MEB NARSUM examination, 7 months prior to separation, noted complaints of continued pain in her shoulders, trapezius, and neck, which began about midday and became worse and required her to rest at the end of the work day. She also had pain in her legs in the morning that required her to stretch out to relieve some of the symptoms. She noted that her rigorous work schedule caused more stress and she had a recent evaluation by psychiatry. Physical examination showed no evidence of synovitis and normal ROM of each of her joints. She had multiple tender points in the neck, trapezius [muscles], scapula [areas], epicondyle area (of the elbows), lumbar and gluteal areas, and knees and ankles bilaterally. She had grinding under the patella. Neurological evaluation was normal. The examiner noted the CI continued to have symptoms of fibromyalgia which made it difficult for her to continue an active full work day without symptom aggravation. Because of her symptoms, she was unable to complete the physical readiness test. Ultram (an opioid-like medication) along with a slight work schedule modification and physical therapy were prescribed.

At the 27 February 2004 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported everything hurt, and she noted being tired all the time, having no energy, and feeling like she had not slept for 3 weeks. She complained mostly of pain in her shoulders between the scapulae as well as in her ankle and knee joints. Symptoms were precipitated by stress, and she tried to alleviate them by doing Pilates exercises. She had taken medication in the past without relief, but was no longer taking any prescribed medication. However, she was able to work full time, but lost 2 to 3 work days in a month because she could not get out of bed. Physical examination showed tender points located bilaterally at the suboccipital muscle insertions, at the cervical areas, and also at the upper trapezius, second rib, supraspinatus, lateral epicondyle, and the knees at the medial fat pad.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated for fibromyalgia, coded 5025. The PEB rated 10% and the VA rated 20% based on the C&P examination, citing the VASRD criteria. The panel noted a 10% rating using code 5025 requires continuous medication for control, while a 20% rating requires symptoms “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.” Panel members agreed that the CI’s condition was most nearly consistent with a 20% rating, and did not rise to a 40%, which requires symptoms “that are constant, or nearly so, and refractory to therapy,” since the CI was working full time and not taking prescribed medication by the time of the VA examination. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for fibromyalgia, coded 5025.

BOARD FINDINGS: In the matter of fibromyalgia, the panel recommends a disability rating of 20%, coded 5025 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Fibromyalgia	5025	20%	

The following documentary evidence was considered:

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO
6040
CORB:003 14 May 21

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXXXXXXXXXX

Subj:	Physical Disability Board of Review Determination Ref:	(a) 6040.44(Series)
1.	The Physical Disability Board of Review (PBDR) reviewed your case in accordance with reference
(a) and forwarded their recommendation for action.

2.	On 23 April 2021 the Assistant Secretary of the Navy (Manpower and Reserve Affairs) accepted the PDBR’s recommendation of an increase in disability rating to 20% effective the date of your discharge. This decision was then sent to Navy Personnel Command for appropriate action.

3.	The PDBR determination is final and not subject to appeal or review.