RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXX	CASE: PD‐2017‐05994
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061002

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Food Service Specialist, medically separated for “fibromyalgia” with a disability rating of 10%.

CI CONTENTION: No specific contention was made. 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 ‐ 20060714	VARD ‐ 20070501	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	10%	Fibromyalgia	5025	40%	20070106	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Fibromyalgia (FM). According to the service treatment record and MEB narrative summary (NARSUM), the CI’s FM first manifested in October 2004 as neck pain that traveled to her right fingertips. At a rheumatology examination on 11 April 2006, the CI reported dizziness, morning stiffness, joint pain, hand numbness, muscle spasms, headaches, fatigue, and shoulder and right arm pain that radiated to the upper back and neck. She denied a rash, oral ulcers, hair loss or Raynaud’s phenomenon. Symptoms worsened with increased stress, physical exertion and repetitive movements. Physical examination showed positive tender points (TPs) of the anterior chest, trapezius, right epicondyle, right hip, and lumbar area. There was good range of motion (ROM) of the shoulders, wrists, hips, knees, ankles, and feet. There was no synovitis of the hands or feet. Fibromyalgia was considered the most likely diagnosis. The CI was prescribed as‐needed anti‐inflammatory, muscle relaxant and anti‐depressant medications (used for FM treatment).

At a rheumatology follow‐up examination on 2 May 2006, the CI reported worsening pain, but better sleep on low dose anti‐depressant medication. A civilian rheumatologist agreed with the assessment of a myofascial pain syndrome and the CI had been started on felodipine for Raynaud’s phenomenon. The CI reported pain in the hands, wrists, head, arms, and back, with morning stiffness lasting 20 minutes and sleep dysfunction, headaches and fatigue. The

musculoskeletal examination of the upper and lower extremities was normal, including the hands and feet, but there were 13/18 FM TPs. The CI was diagnosed with FM and the dosages of her medications were adjusted.

The 8 June 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of right shoulder muscle pain and bilateral upper trapezius muscle pain that radiated down her arm to her neck, worsened by writing, typing, push‐ups or overhead activities. The pain improved with muscle relaxants. She also reported low back pain, bilateral hip and knee pain, occasional headaches, and leg and ankle pain with running. She was prescribed anti‐inflammatory, muscle relaxants and medication for Raynaud’s. Physical examination showed no synovitis and normal ROM in the extremities and spine. There were TPs noted in the right upper shoulder and neck. There was right trapezius muscle spasm and tenderness. There was also tenderness over the anterior tibia, lateral knees and greater trochanters.

At the 6 January 2007 VA Compensation and Pension (C&P) general medical examination, 3 months after separation, the CI reported spine, shoulder, arm, hand, and hip pain without precipitating factors. She also reported weakness, fatigue, lack of endurance, and depression‘; her neck, hands and toes stayed cold, and with cold exposure her fingers became pale and white. Her medications helped with sleep, but she always had pain. Medications for FM included gabapentin, two antidepressants and a muscle relaxant. Physical examination showed normal posture and gait and no temperature changes of the skin. There was full ROM of the neck without discomfort, but the examiner noted TPs of the occiput, lower cervical, trapezius, supraspinatus, gluteal area, hips, and knees. In late January 2007 the CI was noted to be pregnant and no medications were recommended, but the CI took Tylenol, as needed, throughout her pregnancy. At an outpatient VA primary care visit on 1 May 2007, 7 months after separation, the CI complained of pain in the shoulders, neck, arms, back and ankles. She was still taking only Tylenol, as needed, and massages helped the pain.

At the 14 December 2007 VA C&P spine examination, 14 months after separation, the CI reported Raynaud’s, depression, intermittent sharp pain of the neck and back with chronic stiffness; and pain of the hips, knees and elbows. She denied periods of bed rest, but was prescribed anti‐ inflammatory, anti‐depressant and Raynaud’s medication. Physical examination showed normal posture and gait, but there was spinal tenderness without muscle spasm. Hand color and temperature were normal as were sensation and strength of the bilateral upper extremities. There was tenderness of the knees, ankles and feet. The VA examiner noted there was moderate impairment due to FM.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the FM 10%, coded 5025 (FM), citing “continuous medication for control.” The VA rated the FM 40%, coded 5025, based on the C&P examination, citing evidence of 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 were constant, or nearly so, and refractory to therapy.

Panel members agreed the FM symptoms were precipitated by environmental or emotional stress or by overexertion, and were present more than one‐third of the time to support a 20% rating. There was no evidence that the FM was refractory to therapy because the CI benefited from massage, rest, postural changes, and muscle relaxants, and medication helped with sleep. The panel also noted that the CI only took Tylenol as needed. Panel members also noted the areas of tenderness varied on serial examinations, which was indicative of waxing and waning of symptoms common in FM. 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, coded 5025.

BOARD FINDINGS: In the matter of the FM, 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%	

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

AR20200004031,

Dear XXXXXXXXXXXXX:

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.

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