RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-03917
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050226

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a active duty O3, Tactical Intelligence Officer, 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 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 -20050112	VARD - 20050705	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia Syndrome	5025	10%	Fibromyalgia	5025	40%	20050506	
Right Knee Pain	Not Unfitting	Right Knee Iliotibial Band Syndrome	5299-5260	10%	20050506	
Headache	Not Unfitting	Migraine Headaches	8100	NSC	20050506	
Upper Airway Resistance Syndrome	Not Unfitting	Upper Respiratory Resistance Syndrome	6599-6513	NSC	20050506	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Fibromyalgia (FM) Syndrome. According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced a flu-like illness in August 2001 followed by progressively worsening symptoms of depression, fatigue, myalgias, and arthralgias.  In January 2004, he was

diagnosed with FM by an internist with some improvement made with Paxil and trazodone (antidepressants for FM symptoms/sleep).

At the 10 September 2004 MEB NARSUM rheumatology examination, 6 months prior to separation, the CI reported doing poorly with more than 2 hours of morning stiffness, nonrestorative sleep, severe fatigue, and severe pain on the right side of the head, neck, and trapezius muscle region as well as the right knee. He stated the symptoms impaired his ability to walk more than 2 miles, participate in sports, or get a good night’s sleep, and were associated with depression. He denied any other symptoms related to inflammatory and connective tissue disorders such as hair loss, eye problems, rashes, finger/hand abnormalities, and chest or genitourinary symptoms. He had some improvement with Paxil and trazadone. Physical examination showed no oral ulcers or eye inflammation, no evidence of joint inflammation, and normal heart and lungs. There were 18/18 tender points, but screening blood work for rheumatologic or metabolic disorders was negative. At the 18 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), physical examination showed symmetric trigger points above the waist. Right knee range of motion (ROM) was full with no effusion or instability. Listed medications included Paxil and trazadone.

The 19 November 2004 MEB addendum examination, 3 months before separation, noted improved symptoms with the CI better able to perform activities of daily living and morning stiffness reduced to 20 minutes. However, he continued to report nonrestorative sleep, moderate to severe fatigue and mild muscle pain involving the neck and right trapezius muscle region. The rheumatologist documented “minimal tender points,” and characterized the FM as “mild and intermediate and present for approximately one third of the time.” Due to the probability that the CI would continue to have FM symptom flares, especially with stressful situations, an MEB was recommended.

At the 6 May 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continued fatigue and insomnia, but that he could function with his medication. He still had FM flare-ups every couple months, but dietary modifications, yoga and acupuncture helped alleviated his pain. Physical examination showed a normal gait and the ability to heel and toe walk. Examination of the head, eyes, ears, nose, throat, heart, lungs and abdomen was normal and all joint ROM measurements were intact. There was positive right knee patellar tenderness and grinding as well as pain with meniscal testing. The examiner noted 11/18 tender points based on rheumatologic criteria, but neurological findings were normal and behavior appropriate with no further evaluation by a mental health professional deemed necessary.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the FM syndrome 10%, coded 5025 (fibromyalgia), citing the requirement for continuous medication. The VA rated the FM condition 40%, also coded 5025, based on the C&P examination, citing 11/18 tender points and continued severe fatigue and insomnia. Panel members agreed that a 20% rating was supported for FM 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.” The MEB rheumatology addendum and VA examination most proximate to separation showed no evidence of FM symptoms that were refractory to treatment for a higher rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the FM syndrome, coded 5025.

Contended PEB Conditions: Right Knee Pain, Headache, and Upper Airway Resistance Syndrome. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The right knee condition was given an L2 profile. A “2” profile designation indicates a condition which requires some physical limitations but is not in all cases disqualifying for continued military service. The knee condition was not specifically implicated in

the commander’s statement and did not fail retention standards. Additionally, the only documented right knee symptom was pain, and separate ratings cannot be assigned for this and widespread FM pain (which subsumes right knee pain) IAW VASRD §4.14 (avoidance of pyramiding). The panel concluded the right knee condition could not be recommended for additional disability rating. The headache condition and upper airway resistance syndrome were not profiled or implicated in the commander’s statement and did not fail retention standards. There was no performance-based evidence from the record that either 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 syndrome, the panel recommends a disability rating of 20%, coded 5025 IAW VASRD §4.71a. In the matter of the contended right knee pain, headaches, and upper airway resistance syndrome, the panel recommends no change from the PEB determinations as not unfitting. 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 Syndrome	5025	20%	

	PD-2017-03917

AR20190011655, XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

	PD-2017-03917