RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-05472 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050831

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Field Radio Operator, medically separated for “fibromyalgia” with a disability rating of 10%.

CI CONTENTION: Review requested of the fibromyalgia condition. 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 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 - 20050712	VARD - 20050927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	10%	Fibromyalgia	5025	40%	20050720	
Fibrositis	Cat II					
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 first presented as hip pain in April 2004. She subsequently developed low back, bilateral knee, and ankle and foot pain as well as paresthesia in her feet. She was treated with various medications and therapies with minimal improvement as the pain spread to the wrist and neck. She had 10 of 12 trigger points. Symptoms persisted and worsened and negatively impacted her ability to perform her duties. She had multiple flares due to prolonged activity and exposure to environmental elements required at her job. The medication made her drowsy which limited her night work. She was placed on limited duty and transferred to administrative duties. Rheumatology firmed up the diagnosis of fibromyalgia with sleep disturbance around April 2005. She was seen in the emergency room for extremity pain in May 2005 after spending several hours in the sun. The May 2005 non-medical assessment (NMA) noted the CI could not perform load-bearing duties and was limited to clerical duties. She was always on time to her place of duty and ready to work on any task assigned to her.

The 8 June 2005 MEB NARSUM addendum, 3 months prior to separation, noted complaints of musculoskeletal pain, which worsened throughout the day, but was better with rest. She

awakened feeling as tired as when she went to bed, with skin sensitivity worse in the morning and better throughout the day. She also had signs and symptoms of irritable bowel syndrome. Medications helped mitigate the pain but did not completely relieve it. The 6 June 2006 musculoskeletal system examination was normal except for diffuse tenderness with extremes of motion of neck, shoulders, back, hips, knees and ankles, and tenderness at most tendon insertion points around the major joints named. A diagnosis of fibrositis was rendered.

At the 20 July 2005 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported she was advised to avoid any strenuous exertion and to do only administrative duties. She had only missed about 5 days of work during the past year. Physical examination showed pain on percussion of the upper and lower posterior chest, neck, knees, ankles and back. Grip strength was somewhat reduced in both hands, but she had full range of motion of all major joints and X-rays were unremarkable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the fibromyalgia 10%, coded 5025 (fibromyalgia), citing “member has confirmed diagnosis of fibromyalgia by rheumatology, no psychological pathology.” The PEB also listed fibrositis as a related Category II condition which contributed to the primary unfitting condition. The panel agreed that this condition was part of the unfitting fibromyalgia and a separate rating could not be achieved without pyramiding (VASRD §4.14). Therefore, any disability from this condition was properly subsumed in the primary unfitting condition. The VA rated the fibromyalgia 40%, coded 5025, based on the C&P examination, 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 are constant, or nearly so, and refractory to therapy.

Although the VA stated that the Service and VA ratings differed due to the use of different rating criteria, the panel agreed there was no compelling evidence showing the CI’s symptoms were constant and refractory to therapy (40% rating). The CI was able to function in a limited duty status for 2 years. Despite not being unable to perform physical duties, she was able to do administrative work with little time lost. The NMA noted the CI was always on time and performed tasks as assigned. Rest and medication were beneficial to the CI’s chronic condition and some of her symptoms improved during the day. The panel agreed there was no evidence of episodic symptoms present more than one-third of the time to support a 20% rating. After due deliberation, considering all 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:

2	PD-2017-05472

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

IN REPLY REFER TO:
1850
CORB: 003
10 Sep20

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

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.