RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2018-00513 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050415

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

CI CONTENTION: “The member was rated at 20% but reduced to 10% for “non-compliance to therapy” which was not accurate. 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 - 20050121	VARD - 20050517	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	10%	Fibromyalgia	5025	20%	20041101	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Fibromyalgia. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was initially evaluated for multiple myalgias in January 2003. In June 2003, a neurologist diagnosed fibromyalgia, which was confirmed by rheumatology in July 2003. During the 4 June 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months prior to separation, the CI reported fibromyalgia with muscle and joint pains, numbness and tingling in the arms and legs, weekly gastroenteritis/reflux symptoms, chest pains, costochondritis, and multiple emergency room visits. Physical examination was non-contributory. The MEB NARSUM examination, 12 days later, noted complaints of fibromyalgia without adequate relief. Physical findings showed the CI was well appearing with a normal gait and benign abdomen. There were 14 of 18 positive tender points, with no extremity cyanosis, clubbing or edema, and all joints had full range of motion (ROM) without effusion.

The 1 July 2004 MEB rheumatology addendum, 9 months before separation, noted complaints of increasing arthralgias and myalgias since return to full duty in December 2003. She rated overall health as 6.5/10, pain level as 9/10, fatigue as 10/10, and reported non-restorative sleep with

diffuse muscle aches and pain as well as diffuse hand and foot joint arthralgias. Additional symptoms included constipation and intermittent diarrhea consistent with irritable bowel syndrome (IBS), and occasional migraines. The provider noted a normal gait, strength, and abdomen, with full ROM in all joints and no evidence of peripheral joint synovitis. There were 18/18 tender points and trace to 1+ tenderness in the bilateral finger and foot-to-toe joints. The specialist recommended reinstitution of aggressive fibromyalgia management, which had improved the CI’s symptoms until she returned to duty and experienced a flare.

At the 1 November 2004 VA Compensation and Pension (C&P) examination, 6 months before separation, the CI reported fibromyalgia with continued pain in her hands, feet, hips and back; and headaches (every 4 days). Physical examination showed normal gait, weight bearing and stance. There was joint tenderness, but no synovitis or swelling, and hand/foot ROM was normal with hand grip strength at 80% of normal bilaterally. Hip ROM measurements showed painful, bilateral abduction to 35 degrees (normal 45); and neck/back ROM was normal with some pain.

The panel directed attention to its rating recommendation based on the above evidence. The informal PEB rated the fibromyalgia 20%, coded 5025 (fibromyalgia), with a non-compliance deduction to a 10% disability rating. The CI appealed and the Formal PEB (FPEB) rated the fibromyalgia 10%, coded 5025, citing “there was no evidence to document exacerbations more than one-third of the time. Therefore the impairment is most consistent with a rating of 10% under VA code 5025.” The VA rated the fibromyalgia 20%, coded 5025, based on the C&P examination, 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 are present more than one- third of the time.

The narrative from the FPEB indicated a focus on episodes with limitations that led to sick call visits resulting in quarters, which appeared to better align with incapacitating/prostrating symptoms. This did not, however, align with the broader VASRD 5025 interpretation of episodic fibromyalgia exacerbations in any/all of the symptoms listed above (such as fatigue, sleep disturbance, HA and IBS noted in the STR). Symptoms had been well-controlled on aggressive therapy, and then interrupted by return to full duty, and so panel members agreed that the CI’s symptoms did not reach the 40% criteria. With return to full duty, the STR documented symptoms present more than one-third of the time, warranting a 20% 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 fibromyalgia, coded 5025.

BOARD FINDINGS: In the matter of the 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%	

DEPARTMENT 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
12 Oct 20

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

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 1 Apr 20

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.

2.	On 7 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the office of the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.

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PDBR