RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX		CASE: PD-2020-00130 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060720

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

CI CONTENTION: Pain in extremities, knees, and back. 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 - 20090604	VARD - 20070705	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fibromyalgia	5025	10%	Fibromyalgia	5025	40%	20061101	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Fibromyalgia (FM). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI began experiencing intermittent neck, elbow, hand, thigh, foot, and upper back pain in 2005. At a rheumatology consult on 27 September 2005, she was diagnosed with FM. The provider noted that symptoms would be “worse with less sleep and with more activity,” and recommended Ultram (opiate narcotic analgesic) and a sleep aid. There was no evidence of inflammatory arthritis or chronic soft tissue disease.

During the 8 November 2005 MEB NARSUM examination, 9 months prior to separation, the CI complained of body aches, difficulty sleeping due to pain, easy fatigability, and sluggishness. Physical examination showed no acute distress, a normal gait, and intact motor strength, sensory functions, and deep tendon reflexes. There were multifocal areas of tenderness about the base of the neck, shoulders, elbows, knees and thighs, and pain was noted without associated limitation of motion. The examiner stated that the while CI’s pain levels fluctuated day-to-day, she was never pain-free and had more bad days than good days.

At a primary care visit on 14 March 2006, the CI reported severe pain after her prescriptions for Flexeril (muscle relaxant) and Zoloft (anti-depressant) had been discontinued due to cardiac symptoms. She was then prescribed Ultram and Ambien (sleep aid), and 2 weeks later she was noted to be a “little better.” During follow-up visits in April, May and June 2006, the CI reported pain levels ranging from 5-10/10, and that the Ultram worked “well,” but caused mild drowsiness; she also felt “mentally happy” with Wellbutrin (anti-depressant), which was “working well.”

At the 1 November 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported daily pain and stiffness “all over,” but that Tylenol, Ultram and Percocet “helps.” Physical examination revealed her to be in no acute distress with a steady and smooth gait. Widespread trigger [tender] points were negative with the exception of the posterior cervical region bilaterally (trapezius).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the FM 10%, coded 5025 (FM), citing pharmacy records showing intermittent use of pain medication, and that the CI was not in acute distress during physical examination. The VA rated the FM 40%, coded 5025, based on the C&P examination, citing widespread musculoskeletal pain and tender points which were refractory to therapy. The panel directed attention to its rating recommendation based on the evidence at separation. A 20% rating requires “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 episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but are present more than one-third of the time.” The 31 May 2005 commander’s statement noted deterioration in the CI’s ability to run or perform heavy lifting, and that her condition caused her to miss duty. However, she was able to walk, bike or swim at her own pace and distance, and there was documentation in the STR and C&P examination that prescribed pain medication improved her FM symptoms. Thus, panel members agreed that a 20% rating, but no higher, was justified for symptoms present more than one-third of the time. 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

AR20200009918, 

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.