RECORD OF PROCEEDING 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXXXXXXXX                                                           BRANCH OF SERVICE:   ARMY 
CASE NUMBER:  PD1100993                                                                   SEPARATION DATE:  20070731 
BOARD DATE:  20121012 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  activated  Army  National  Guard  MAJ/O-4  (88A/Transportation 
Corps Officer), medically separated for fibromyalgia and chronic plantar fasciitis.  The CI was 
activated as a Captain to Ft. Lewis in February 2003, injuring his back during a rucksack road 
march in March 2003.  35 months later the CI was separated based on a Medical Evaluation 
Board  (MEB)/Physical  Evaluation  Board  (PEB)  process  that  included  16  conditions.    The  CI 
complained  of  numerous,  intermittent  orthopedic,  neurologic  and  constitutional  complaints.  
After  extensive  evaluation  and  treatment  by  several  sub-specialists,  the  diagnosis  of 
fibromyalgia  was  made  by  a  Rheumatologist.    During  this  same  period,  the  CI  experienced 
bilateral foot pain that was diagnosed as plantar fasciitis.  The fibromyalgia and chronic plantar 
fasciitis  conditions  could  not  be  adequately  rehabilitated  and  the  CI  did  not  improve  with 
treatment to meet the physical requirements of his Military Occupational Specialty (MOS) or 
satisfy physical fitness standards.  He was issued a permanent P3/U3/L3/S3 profile and referred 
for an MEB.  The MEB identified fibromyalgia, sleep apnea, intractable migraines, low back pain, 
bilateral plantar fasciitis and cognitive disorder conditions as not meeting retention standards 
along  with  10  additional  conditions  (listed  as  meets  retention  standards  in  the  rating 
comparison  chart  below)  and  forwarded  them  for  PEB  adjudication.    The  PEB  initially 
adjudicated the fibromyalgia and chronic plantar fasciitis conditions as unfitting, rated 40% and 
0% respectively, and placed the CI on the Temporary Disability Retirement List (TDRL).  The CI 
appealed the PEB findings.  Although initially upheld, the Army then held a PEB Reconsideration 
Board,  with  additional  information  submitted  by  a  medical  provider  and  the  CI,  that 
subsequently adjudicated the fibromyalgia and chronic plantar fasciitis as unfitting, rated 10% 
and  0%  respectively,  with  application  of  the  Veteran’s  Affairs  Schedule for  Rating Disabilities 
(VASRD).    The  remaining  conditions  were  either  stated  as  subsumed  under  the  fibromyalgia 
rating or determined to be not unfitting.  The CI was medically separated with a 10% disability 
rating.   
 
 
CI CONTENTION:  “The Army rated me 10% for fibromyalgia, but the VA has rated me 60% for 
fibromyalgia and other related issues (cognitive disorder, migraines, sleep apnea, etc.) which 
are  all  presumptive  diagnoses  for  Gulf  War  Veterans.    My  rating  should  have  reflected  the 
VASRD”.  The CI’s remarks and statements in his congressional inquiry are also considered as 
contentions. 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (DoDI) 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military  service;  or,  when  requested  by  the  CI,  those  condition(s)  “identified  but  not 
determined to be unfitting by the PEB.”  The ratings for unfitting conditions will be reviewed in 
all cases.  The conditions sleep apnea, intractable migraines, low back pain, depressive disorder, 
hypertension, left shoulder osteoarthritis, bilateral tinnitus, fatty liver, gastroesophageal reflux 

(GERD),  stable  pulmonary  nodules,  cervical  degenerative  disc  disease,  hypertriglyceridemia, 
rosacea and cognitive disorder are considered as requested for consideration meet the criteria 
prescribed in DoDI 6040.44 for Board purview; and, are addressed below.  Any conditions or 
contention not requested in this application, or otherwise outside the Board’s defined scope of 
review, remain eligible for future consideration by the Army Board for Correction of Military 
Records. 
 
 
RATING COMPARISON: 
 

VA (6 Mos. Post-Separation) – All Effective Date 20070801 

Service Recon PEB – Dated 20070702 

Condition 

Code 

Rating 

No Separate VA Entry (see 9434 below and 5025 above) 

Code 
5025 
8100 

5010-5237 

5024-5284 
5024-5284 

6847 
9434 
7101 

6260 

5201-5024 

Rating 
10%* 
30% 
10% 

10% 
10% 
50% 
50% 
0% 
10% 
10% 

Exam 

20080219 
20080219 
20080219 

20080219 
20080219 
20080212 
20080201 
20080219 
20080219 
20080206 

Not Service Connected 

7399-7346 

6820 

5010-5237 

7899-7806 

No VA Entry 

10% 
0% 
10% 

0% 

20080219 
20080219 
20080219 

 

Fibromyalgia 
w/  Migraines 
Low Back Pain 
w/ 
w/ 
Cognitive Disorder 
Chronic Plantar Fasciitis 
Sleep Apnea (OSA) 
Depressive Disorder 
Hypertension 
Left Shoulder Osteoarthritis 
Bilateral Tinnitus 
Fatty Liver 
Gastroesophageal Reflux 
Stable Pulmonary Nodules 
Cervical DDD 
Hypertriglyceridemia 
Rosacea 

Condition 

Fibromyalgia 
Migraines 
Lumbar Spine, DDD  

Plantar Fasciitis, Left Foot 
Plantar Fasciitis, Right Foot 
Sleep Apnea (OSA) 
Depressive Disorder 
Hypertension 
Left Shoulder Strain 
Tinnitus 
Fatty Liver 
Gastroesophageal Reflux  
Disease 
Pulmonary Nodules 
Cervical Degenerative Disc 

Rosacea 

5025 

10% 

0% 

5399-
5310 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

Combined:  10% 

Combined:  90% 

* VASRD code 5025 increased to 40% effective 20081208 (combined 100%) 
 
 
ANALYSIS  SUMMARY:    The  Board  acknowledges  the  CI's  contention  suggesting  that  ratings 
should have been conferred for other conditions documented at the time of separation, some 
of which were evaluated and determined not to be individually unfitting for continued service.  
The  Board  wishes  to  clarify  that  it  is  subject  to  the  same  laws  for  disability  entitlements  as 
those under which the Disability Evaluation System (DES) operates.  The Disability Evaluation 
System  (DES)  is  responsible  for  maintaining  a  fit  and  vital  fighting  force.    While  the  DES 
considers all of the member's medical conditions, compensation can only be offered for those 
medical  conditions  that  cut  short  a  service  career,  and  then  only  to  the  degree  of  severity 
present at the time of final disposition.  However, the Department of Veterans’ Affairs (DVA), 
operating  under  a  different  set  of  laws  (Title  38,  United  States  Code),  is  empowered  to 
compensate all service-connected conditions and to periodically re-evaluate said conditions for 
the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary 
over time.  The Board is empowered to evaluate the fairness of fitness determinations, and to 
make recommendations for rating of conditions which it concludes would have independently 
prevented  the  performance  of  required  duties  (at  the  time  of  separation).    The  Board’s 
threshold for countering DES fitness determinations is higher than the VASRD §4.3 (reasonable 
doubt)  standard  used  for  its  rating  recommendations,  but  remains  adherent  to  the  DoDI 
6040.44 “fair and equitable” standard. 

 
Fibromyalgia  Condition.    The  narrative  summary  (NARSUM)  prepared  4  months  prior  to 
separation  notes,  “Fibromyalgia:    In  2005,  he  developed  left  shoulder  muscle  pain  and  neck 
muscle  pain  not  explained  by  a  neurologic  disorder.  In  2006,  he  was  referred  to  a 
Rheumatologist,  who  noted  14  out  of  18  tender  points  and  diagnosed  fibromyalgia.”    The 
NARSUM  also  noted  migraine  headaches  occurring  2  times  per  week  and  manifest  as  a 
throbbing pain with increased scalp sensitivity at various locations and once every 6 months 
causing several minutes of visual loss.  These headaches are treated with prophylactic calcium 
channel  blocker  medication,  oral  and  nasal  anti-migraine  “tryptan”  medications  acutely  as 
needed  and  laying  down  in  a  dark  room.    At  the  MEB  exam  prepared  5  months  prior  to 
separation, the CI reported left shoulder hurts all the time, both ankles and knees – swell, hurt 
daily  and  are  worse  in  cold  weather  and  “sometimes  do  not  work.”    Also  reported  were 
numbness/tingling left arm on 2 fingers and paresthesias both sides.  The MEB physical exam 
noted “multiple tender skin/muscle areas on arms, buttocks, hips, lower extremities & occiput 
suggestive of fibromyalgia.”  Of significant note, is the presence of a letter prepared by the CI 
appealing the results of the original PEB finding of fibromyalgia as unfit, rated at 40% with TDRL 
adjudication.  This letter is dated 25 June 2007 and states: 
 

“I appeal my PEB findings for the following reasons: 
     a. The PEB has rated me as being temporarily disabled (TDRL) at 40% for fibromyalgia. 
     b. The 40% rating would indicate that my fibromyalgia is constant and refractory to       
         treatment, this is NOT the case. 
     c.  I do have episodes of increased pain but they are around one third of the time.  NOT  
          constant.  My episodes are linked to stress or overexertion but are, for the most part,  
         controlled. 
     d. I have learned to manage my disease.  I am now able to work out on a regular basis     
         which has helped to control a great degree of the pain. I have learned what activities  
         affect my pain so I have significantly better coping skills. 
     e. I believe a 40% rating is not an accurate reflection of my current state.”   
 

The  CI  also  forwarded  a  letter  on  28  June  2007  to  Senator  Murray  of  Washington,  in 
which he stated: “I can function with fibromyalgia, my symptoms are present maybe 25% 
at most.” 
 
The  VA  Compensation  and  Pension  (C&P)  exam  performed  7  months  after  separation 
documents the diagnosis of fibromyalgia was made in December 2006.  It involves the whole 
body  with  headache,  easy  fatigability,  sleep  disturbance,  stiffness,  depression,  anxiety,  and 
abnormal  sensation  like  burning,  pricking,  tickling  or  tingling.    Hands  turn  blue  and  become 
painful when exposed to cold.  Symptoms occur daily at least two-thirds of the year and are 
precipitated  by  anxiety,  loud  noise,  stress  or  overexertion.    Treatment  consisted  of  physical 
modalities  along  with  daily  pregabalin  (Lyrica),  non-steroidal  anti-inflammatory  medications 
(NSAID)  and  several  narcotic  medications.    Examination  revealed  at  least  12  tender  points 
symmetrically with no generalized muscle weakness or wasting. 
 
The Board directs attention to its rating recommendation based on the above evidence.  Both 
the PEB and the VA utilized VASRD code 5025, fibromyalgia, and rated it at 10%.  The VA rating 
of 10% was arrived at after “removing” and separately rating several of the conditions that the 
PEB combined under the fibromyalgia condition.  Although this combined rating complies with 
the  AR  635–40,  B–5  definition  of  pyramiding,  the  VASRD-only  definition  of  pyramiding  IAW 
§4.14, Avoidance of Pyramiding, is substantially different.  Therefore, each condition of back 
pain, cognitive disorder and migraines will be discussed below as remaining conditions. 
 

The Board’s first charge with the conditions subsumed with the unfitting fibromyalgia condition 
is an assessment of the appropriateness of the PEB’s fitness adjudications, and/or combination 
under  the  5025  fibromyalgia  rating.    Although  the  Board’s  threshold  for  countering  fitness 
determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating 
recommendations, it remains adherent to the DoDI 6040.44 “fair and equitable” standard. 
 
Back Pain Condition:  The PEB indicated back pain recurred in 2006 and there was radiographic 
evidence of mild degenerative changes.  Neurosurgical evaluation performed in October 2004 
for  low  back  pain  documented  the  following,  “Impression:  Mr.  M---  suffers  from  multiple 
myofascial  syndrome  with  multiple  trigger  points.”    The  PEB  considered  the  back  pain  as  a 
manifestation  of  fibromyalgia  and  not  separately  unfitting.    After  due  deliberation  in 
consideration  of  the  preponderance  of  the  evidence,  the  Board  concluded  that  there  was 
insufficient cause to recommend a change in the PEB fitness determination for the back pain 
condition. 
 
Cognitive disorder Condition:  The PEB stated the following, “Cognitive disorder is associated 
with mild though measurable deficits of initial learning of novel information and poor retention 
of complex information; this is commonly associated with fibromyalgia and is included in rating 
for fibromyalgia.” The commander’s statement only references physical disabilities as impacting 
the CI’s ability to perform within his MOS.  The Board considered if the cognitive disorder was 
separately unfitting if removed from “under” the fibromyalgia condition.  After due deliberation 
in  consideration  of the preponderance  of  the  evidence,  the  Board  concluded  that  there  was 
insufficient cause to recommend a change in the PEB’s adjudication for the cognitive disorder 
condition. 
 
Migraines  Condition:    The  reconsideration  PEB  made  the  following  comment  concerning  the 
CI’s migraine headaches, “…migraines are also considered manifestations of fibromyalgia and 
cannot be separately rated due to pyramiding.  Unfit because he is unable to run, wear Kevlar 
or  body  armor.    Although  symptoms  were  refractory  to  multiple  medications  for  2  years, 
Soldier and treating physician now confirm that his symptoms have improved markedly on new 
medication regiment.”  Although the headaches were profiled, they were not implicated in the 
commander’s statement.  The headaches were not judged to separately fail retention standards 
by  the  PEB.    The  Migraine  headache  condition  was  reviewed  and  considered  by  the  Board.  
After  due  deliberation  in  consideration  of  the  preponderance  of  the  evidence,  the  Board 
concluded that there was insufficient cause to recommend a change in the PEB’s adjudication 
for the migraine headache condition. 
 
After  Board  deliberations  settled  on  keeping  all  PEB  combined  conditions  under  the 
fibromyalgia condition, applying the rating for VASRD code 5025 was undertaken.  The rating 
criteria for fibromyalgia are based on the symptom frequency and their response to therapy.  
The  board  considered  the  totality  of  the  documented  evidence 
its 
recommendation with particular attention to the CI’s written statement to the PEB describing 
his condition proximate to the day of separation.  While the entire record paints a somewhat 
different disability picture, the CI’s written statement one and a half months prior to separation 
said, “I have learned to manage my disease.  I am now able to work out on a regular basis which 
has helped to control a great degree of the pain.  I have learned what activities affect my pain 
so  I  have  significantly  better  coping  skills.”    The  CI’s  fibromyalgia  did  require  continuous 
medication  but  was  not  under  “control”  as  required  for  a  10%  rating,  so  the  deliberations 
settled  on  a  20%  vs.  40%  rating  recommendation.    A  40%  rating  for  fibromyalgia  requires 
symptoms that are constant, or nearly so, and refractory to therapy while a 20% rating requires 
symptoms  that  are  episodic,  with  exacerbations  often  precipitated  by  environmental  or 

in  arriving  at 

emotional  stress  or  by  overexertion,  but  that  are  present  more  than  one-third  of  the  time.  
With the Board’s decision to place significant “probative” value on the CI’s written statement,   
after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt),  the  Board  majority  recommends  a  disability  rating  of  20%  for  the  fibromyalgia 
condition. 
 
Chronic  Plantar  Fasciitis  Condition.    The  NARSUM  notes  bilateral  heel  pain  since  December 
2005.    The  CI  was  evaluated  and  treated  by  Podiatrist  using  arch  supports,  NSAIDs, 
immobilization and steroid injections with only temporary relief.  Physical exam revealed mild 
pes planus with mildly tender plantar fascia bilaterally.  X-rays performed in April 2006 showed 
small  bilateral  Achilles  tendon  spurs.    Podiatry  consultation  performed  on  9  May  2007 
diagnosed bilateral plantar fasciitis that fails Army retention standards.  At the MEB exam, the 
CI  reported  “But  heels  still  hurt.    Insoles,  injections  do  not  work.”    The  MEB  physical  exam 
noted  mildly tender  plantar fascia.    At  the  C&P  exam,  the  CI  reported  intermittent,  burning, 
sharp ripping pain of 8-9/10 intensity located at bottom of both feet 2-3 times daily lasting for 
1-2 hours.  Pain is elicited by physical activity, sleeping, or just stress and CI has to rest and take 
NSAID  medication  and  use  insoles.    With  severe  pain  he  is  unable  to  walk.    Examination 
revealed no signs of abnormal weight bearing or callous formation.  His gait is normal and he 
does  not  have  flat  feet.    Palpation  of  the  plantar  surface  of  the  feet  reveals  no  tenderness.  
Examination of the Achilles tendons reveals good alignment. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
VASRD does not have a specific code for plantar fasciitis and it must be rated analogously.  The 
Board  considered  the options  used by  the  PEB and  VA.    The  PEB  coded  the bilateral  plantar 
fasciitis as 5399-5310, Muscle Group X disability, and rated it 0% for slight disability.  The VA 
coded the same condition as 5024-5284, Foot injuries other, and awarded an evaluation of 10% 
for each foot.  With regard to the 5310 muscle code utilized by the PEB, the Board noted that 
there  was  no  disorder  of  the  muscles  of  the  feet  present,  however,  the  5310  code  includes 
“other important plantar structures: plantar aponeurosis, long plantar and calcaneo-navicular 
ligament, tendons of posterior tibial, peroneus longus, and long flexors of great and little toes” 
and therefore the selection of this code by the PEB is reasonable.  The ratings under this code 
apply  separately to each  foot  and  are based  on  a judgment  of  severity  (slight 0%;  moderate 
10%; moderately severe 20%; and severe 30%).  The Board agrees that both of the CI’s feet are 
unfit  for  continued  military  duty  and  the  analogous  code  must  be  applied  to  both  feet.    A 
judgment of slight or moderate disability was considered for each foot.  Again, using the CI’s 
written statement as the most probative document proximate to separation, his words of, “I 
am now able to work out on a regular basis…” indicated that his feet were not so limiting as to 
preclude regular exercise.  After due deliberation, considering all of the evidence and mindful of 
VASRD  §4.3  (reasonable  doubt),  the  Board  majority  recommends  a  disability  rating  of  0%, 
slight, for each foot with the plantar fasciitis condition. 
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were  depressive  disorder,  hypertension,  left  shoulder  osteoarthritis,  bilateral  tinnitus,  fatty 
liver,  gastroesophageal  reflux,  stable  pulmonary  nodules,  cervical  degenerative  disc  disease, 
hypertriglyceridemia  and  rosacea.    Fatty  liver  and  hypertriglyceridemia  are  lab  abnormalities 
and do not constitute physical disabilities.  The bilateral tinnitus, GERD, pulmonary nodules and 
rosacea were mentioned in the review of systems without any indication of duty impairment.  
Hypertension was controlled on medication. 
 
Sleep apnea was profiled.  The PEB indicated obstructive sleep apnea (OSA) was well controlled 
by continuous positive airway pressure (CPAP), but “afternoon fatigue which is also a symptom 

of fibromyalgia, persists and occasionally requires prescription stimulant.”  Routinely OSA (sleep 
disturbance) is not considered unfitting solely on the basis of field and operational impediments 
to the use of CPAP.  There is little evidence in this case of any unfitting impairments from sleep 
disturbance  treated  with  medication  and  OSA  treated  with  CPAP.    The  PEB’s  implied  fitness 
adjudication for OSA and inclusion of the residual sleep disturbance requiring medication was 
therefore reasonable.  All evidence considered, there is not reasonable doubt in the CI’s favor 
supporting  recharacterization  of  the  PEB  adjudication  for  the  OSA  and  sleep  disturbance 
conditions. 
 
None  of  the  other  conditions  were  profiled  proximate  to  separation  or  implicated  in  the 
commander’s  statement;  and,  none  were  judged  to  fail  retention  standards  at  the  time  of 
separation.  All were reviewed and considered by the Board.  There was no indication from the 
record that any of these conditions significantly interfered with satisfactory duty performance.  
After  due  deliberation  in  consideration  of  the  preponderance  of  the  evidence,  the  Board 
concluded  that  there  was  insufficient  cause  to  recommend  a  change  in  the  PEB  fitness 
determination for the any of the contended conditions and, therefore, no additional disability 
ratings can be recommended. 
 
 
BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent  with  the  VASRD  in  effect  at  the  time  of  the  adjudication.    In  the  matter  of  the 
fibromyalgia and bilateral plantar fasciitis conditions, the Board, on a vote of 2-1, recommends 
a disability rating of 20%, coded 5025 and a disability rating of 0% for each foot, coded 5399-
5310, all IAW VASRD §4.71a.  The single voter for dissent, who recommended a combined 40% 
rating (5025 at 20%, plus each foot coded 5310-5020 at 10%), submitted the appended minority 
opinion.    In  the  matter  of  the  contended  depressive  disorder,  hypertension,  left  shoulder 
osteoarthritis, bilateral tinnitus, fatty liver, gastroesophageal reflux, stable pulmonary nodules, 
cervical  degenerative  disc  disease,  hypertriglyceridemia,  and  rosacea  conditions,  the  Board 
unanimously recommends no change from the PEB determinations as not unfitting.  There were 
no other conditions within the Board’s scope of review for consideration.   
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation: 
 

UNFITTING CONDITION 

VASRD CODE 

RATING 

5025 

5399-5310 
5399-5310 

COMBINED (w/ BLF) 

20% 
0% 
0% 
20% 

Fibromyalgia  
Chronic Plantar Fasciitis - Left  
Chronic Plantar Fasciitis - Right 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111006, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 

 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 

MINORITY  OPINION:    The  CI’s  numerous  disabilities  with  overlapping  symptoms  of  unfitting 
fibromyalgia  and  unfitting  foot  conditions  should  be  rated  as  fibromyalgia  20%  plus  10%  for 
each foot condition coded 5310-5020 (combined 40%).   
 
The  medical  documentation  paints  a  disability  picture  that  is  more  debilitating,  active  and 
refractory  to  treatment  than  the  recommended  20%  rating  implies.    The  single  piece  of 
evidence present in the entire record that supports a 20% combined rating is the CI’s written 
statement as that affects both fibromyalgia and feet symptoms and ratings.  This statement was 
written  after  the  CI  was  “on  medical  hold  for  3½  years”  while  undergoing  the  medical 
evaluation of his condition.  The PEB had just adjudicated his condition as fibromyalgia, rated 
40% and placed him on TDRL.  The CI indicated he “just want out of here” and submitted this 
statement to the PEB with similar wording in a congressional correspondence.  The crux of this 
case and foundation for the majority recommendation was the CI’s written statement of being 
able to “work out on a regular basis.”  This statement was in direct conflict with the entirety of 
the medical record, as noted by the PEB President upholding the 40% determination following 
the  CI’s  appeal  letter,  and  by  subsequent  VA  records.    The  specialist  exam  of  the  feet 
documented  tenderness  to  the  plantar  fascia  at  the  heels  with  radiographs  of  mild  bilateral 
degenerative  changes  in  the  great  toe  joint  and  probable  bilateral  pes  planus.    Symptoms 
increasing with walking and prescribed insoles are noted in the body of the ROP.  Functional 
limitations included no prolonged driving and no prolonged standing/walking.   
 
Given the separately unfitting finding for bilateral chronic plantar fasciitis “partially responsive 
to orthotics but still unable to march or run”; each foot and symptoms related to ambulation 
should  be  rated  IAW  VASRD-only  guidance.    The  PEB  coding  choice  of  (analogous  to)  5310 
(muscle coding IAW §4.73 (Schedule of Ratings–Muscle Injuries) was not the most appropriate 
analogous coding choice and under-rated the CI’s feet condition.  Muscle Injury ratings rely on 
§4.55  (Principles  of  combined  ratings  for  muscle  injuries)  and  §4.56  (Evaluation  of  muscle 
disabilities) which emphasize gunshot wound or fragment injury patterns.  The CI did not have 
an  injury  to  his  muscle  and  had  additional  foot  pathology  noted.    The  VA’s  10%  rating  IAW 
§4.71a (Schedule of ratings–musculoskeletal system) was based on exam findings substantially 
similar  to  those  in  the  service  record.    The  AO  strongly  recommends  rating  each  foot 
analogously to 5020 (Synovitis) which is equally valid to the VA’s 5284 coding with granting the 
minimal  compensable  rating  (10%)  to  each  foot  IAW  the  tenant  of  §4.7  (higher  of  two 
evaluations), §4.40 (functional loss) and §4.59 (painful motion).  The disability picture of the CI 
proximate to separation clearly justifies a 10% rating for the right foot and a 10% rating for the 
left foot, in addition to the 20% rating for fibromyalgia.   
 
RECOMMENDATION:    The  AO  recommends  that  the  CI’s  prior  determination  be  modified  as 
follows;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of his prior medical separation:   
 

UNFITTING CONDITION 

VASRD CODE 

RATING 

5025 

5310-5020 
5310-5020 

COMBINED (w/ BLF) 

20% 
10% 
10% 
40% 

Fibromyalgia  
Chronic Plantar Fasciitis - Left  
Chronic Plantar Fasciitis - Right 

 
 

 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXXXXXXX, AR20120019890 (PD201100993) 
 
 
1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review 
(DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  
Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s 
recommendation to modify the individual’s disability rating to 20% without recharacterization 
of the individual’s separation.  This decision is final.   
 
2.  I direct that all the Department of the Army records of the individual concerned be corrected 
accordingly no later than 120 days from the date of this memorandum.    
 
3.  I request that a copy of the corrections and any related correspondence be provided to the 
individual concerned, counsel (if any), any Members of Congress who have shown interest, and 
to the Army Review Boards Agency with a copy of this memorandum without enclosures. 
 
 BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)