RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05571
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Supply Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “fibromyalgia” with a disability rating of 20%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20080725	VARD - 20030722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	20%	Fibromyalgia	5025	10%	STR	
COMBINED RATING:  20%	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 began in January 2001 after falling while running.  Musculoskeletal pain and tender points developed and a rheumatologist diagnosed fibromyalgia syndrome in February 2002.  The CI was separated and placed on TDRL on 3 December 2002.  

The 15 November 2002 MEB NARSUM examination, one month prior to TDRL placement, noted diffuse myalgia and arthralgia most prominent in her arms, fingers and feet.  She reported 2-3 hours of morning stiffness as well as disturbed sleep.  A hot shower or bath helped relax her muscles.  She could perform all activities of daily living without difficulty but did have to take frequent rest periods.  She was able to care for her family, including her husband and 1-year old son.  The CI was also attending college, taking on-line classes towards an Associate’s degree.   Labs and X-rays of the joints were essentially unremarkable.  Physical examination showed normal gait, 16 out of 18 tender points, full range of motion of most joints including the back.  However, she was unable to place palms of her hands on the ground due to lower back pain.  There was paraspinal muscle tightness in the cervical region and spasm in the lumbar region.  The examiner determined the fibromyalgia syndrome was stable and associated with paraspinal muscle tightness/spasm, restless sleep, and possibly exacerbated by mild hypermobility.  Tylenol and Flexeril were recommended to treat pain, muscle spasms and insomnia.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from TDRL with a permanent disability disposition of separation with severance pay at 20%.  The PEB cited episodic exacerbations present more than 1/3 of the time and often precipitated by environment, emotional stress or over-exertion.   The VA rated the fibromyalgia condition 10%, coded 5025 (fibromyalgia), based on the STR, citing widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms that require continuous medication for control.  

The NARSUM examination noted a report of myalgia and arthralgia mostly in her arms, finger and feet, without swollen joint or rashes, and somewhat relieved with a hot shower or bath.  Muscle relaxants, rest and pain medications were also beneficial.  The CI reported she was able to perform activities of daily living, care for her family, and attend college.  Non-steroidal and muscle relaxant medications were prescribed.  There was no evidence symptoms were constant and refractory to therapy to meet criteria for a higher 40% 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 at the time of TDRL removal.

BOARD FINDINGS:  In the matter of the fibromyalgia condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication at the time of TDRL removal.  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.  

ARXXXXXXXXXXX, XXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX:

	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.