RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201086 SEPARATION DATE: 20020511 

BOARD DATE: 20130416 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Reserve CAPT/0-3 (66H/medical surgical nurse), 
medically separated for fibromyalgia (FM). FM was diagnosed in 1998. The CI did not improve 
adequately to meet the physical requirements of her Military Occupational Specialty (MOS) or 
satisfy physical fitness standards. She was issued a permanent P2, U3 profile and referred for a 
Medical Evaluation Board (MEB). FM, degenerative disc disease (DDD) of the neck, 
hypothyroidism and biliary cirrhosis were forwarded to the Physical Evaluation Board (PEB) IAW 
AR 40-501. No other conditions were submitted by the MEB. The Physical Evaluation Board 
(PEB) adjudicated the FM as unfitting, rated 10%, with application of the Veteran’s Affairs 
Schedule for Rating Disabilities (VASRD). The CI originally requested a Formal PEB (FPEB), but 
reconsidered, concurred with the IPEB, and was then medically separated with a 10% disability 
rating. 

 

 

CI CONTENTION: “With no history of colon cancer, a low fat diet, and active life, the primary 
biliary cirrhosis is believed to be the cause of colon cancer diagnosis in January 2007. These 
records are at the VA Hospital JP campus Boston MA. The sensitivity to medications as a result 
of Hypothyroidism, Hashimoto's Disease is another cause for review. The sensitivity to 
medication has made it difficult to manage the elevated cholesterol along with pain 
management for the arm and shoulder pain associated with the cervical myalgia. The fatigue 
with both the primary biliary cirrhosis and the fibromyalgia complicates the ability to sustain 
the repetitive computer work, causing headaches, jaw and shoulder pain at the end of the day. 
Currently with the cervical disorder, I am unable to sleep throughout the night, awakening 
often to reposition my arm which becomes numb during the night. Fatigue, pain and lack of 
sleep are my most problematic symptoms resulting in the inability to meet the physicality of 
meeting the demands of production in case reviews, in home care nursing, and inpatient hands-
on patient care.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in 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 rating for 
unfitting FM conditions are within the DoDI 6040.44 defined purview of the Board. The 
unfitting biliary cirrhosis, DDD of cervical spine and hypothyroidism conditions were contented 
and, thus are within Board purview and are all addressed below. The Hashimoto's Disease; 
elevated cholesterol; arm and shoulder pain associated with the cervical myalgia; headaches, 
jaw and shoulder pain; and sleep disturbance, as per the contention, were not identified by the 
MEB or PEB; and, thus are not within the Board’s purview. Those and any condition 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. The Board acknowledges the CI’s information regarding the significant impairment 
with which his service-connected conditions continue to burden him; but, must emphasize that 
the Disability Evaluation System has neither the role nor the authority to compensate members 
for anticipated future severity or potential complications of conditions resulting in medical 


separation. That role and authority is granted by Congress to the Department of Veterans 
Affairs, operating under a different set of laws. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20011221 

VA (14 Mos. Post-Separation) – All Effective Date 20020512 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Fibromyalgia 

5025 

10% 

Fibromyalgia 

5025 

0% 

20030708 

DDD 

Not Unfit 

DDD C-Spine 

5293-5003 

10% 

20030708 

Primary Biliary Cirrhosis 

Not Unfit 

Primary Biliary Cirrhosis 

7312 

10% 

20030708 

Hypothyroidism, 
Hashimoto Disease 

Not Unfit 

Hypothyroidism, Hashimoto 
Disease 

7903 

0% 

20030708 

No Additional MEB/PEB Entries 

Other x 1 

20030708 

Combined: 10% 

Combined: 20% 



Derived from VA Rating, dated 20030801 (most proximate to the date of separation) 

 

 

ANALYSIS SUMMARY: 

 

Fibromyalgia Condition. The CI’s medical records document evaluations for diffuse myalgias, 
arthralgias and fatigue as early as 1998. A rheumatology evaluation performed in July 1998 
notes improvement in symptoms in response to medication. In October 1998, the CI’s 
endocrinologist and primary physician noted symptoms of FM. The primary care physician 
started medication and the CI was referred for rheumatology evaluation. The 25 November 
1998 rheumatology evaluation noted improvement with medication and exercise. On 
examination there were no tender points present. The CI’s endocrinologist, in memorandum 
dated 27 November 1998, noted significant improvement in symptoms with medication. A 
medication refill is documented in July 1999 after which primary records no longer show a 
medication for the condition on medication lists. Due to difficulty performing recruiting duties, 
an MEB was initiated in January 2001. Rheumatology evaluation on 27 February 2001 recorded 
active symptoms off of medication including fatigue, headaches, and shooting pains in her 
extremities. On examination, tender points characteristic of FM were present. The remainder 
of the examination was normal. There was full range-of-motion (ROM) of extremities without 
evidence of joint inflammation. Exercise and medication was advised. At the time of a 
separation examination 10 May 2001, the CI reported her health to be good and experiencing 
good results from medication treatments. At the time of follow up in the rheumatology clinic 
6 August 2001, there was improvement in her symptoms and tender points were no longer 
present. The commander’s letter 15 November 2001 noted her condition prevented 
performance of recruiting duties that required extensive travel and had been detailed to the 
hospital where she served as a nurse. The physical profile dated 28 November 2001 noted that 
the CI’s “…physical profile does not prevent her from performing nursing duties.” The MEB 
narrative summary (NARSUM) 4 December 2001, recorded that FM was “currently under 
control…with regular exercises including yoga” and noted she walked 5 days per week for 
exercise and passed the alternate physical fitness test (walking). On examination there was 
some tenderness of the upper trapezius muscles bilaterally, and some left shoulder pain with 
ROM. The remainder of the examination was normal. The MEB concluded FM was well under 
control with treatment and concluded that the CI “meets the standards for retention.” 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
Board noted service treatment records indicating the condition responded to medication in 
1998 and again in 2001 supporting consideration of the 10% rating. At the time of the MEB 
NARSUM in December 2001, the condition was controlled with exercise and yoga alone, and 
the CI was not taking medication for FM, more nearly approximating the 0% rating. Subsequent 
treatment records after the MEB NARSUM and prior to separation also document no 


resumption of medication treatment for FM. The Board noted the VA Compensation and 
Pension examination 14 months after separation reporting recurrent symptoms off of 
medication. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
(reasonable doubt), the Board concluded that there was insufficient cause to recommend a 
change in the PEB adjudication for the FM condition. 

 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
were DDD (cervical spine), hypothyroidism and primary biliary cirrhosis. This Board’s first 
charge with respect to these conditions is an assessment of the appropriateness of the PEB’s 
fitness adjudications. The Board’s threshold for countering 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. 

 

Degenerative Disc Disease, Cervical Spine Condition. The CI first noted neck pain and left 
shoulder pain in 1996 without identified precipitating injury except that the CI noted having 
fallen onto her left shoulder in 1993. Evaluations noted pain with paresthesias in the left arm 
and hand. Examination at the time revealed full cervical ROM and tenderness over the left 
lower trapezius and left infraspinatus muscles. Motor and sensory examination was normal, as 
was nerve conduction velocity (NCV) and electromyogram (EMG). Neurosurgical evaluation, on 
26 February 2001, documented chronic neck pain with radiculopathy that responded to 
physical therapy. Symptoms were described as “reasonably in abeyance” but exacerbated by 
physical training or long distance driving. Examination revealed full cervical ROM, with some 
mid-paraspinal tenderness and pain with extension and left head tilt. Neurological examination 
was normal. Magnetic resonance imaging (MRI) revealed DDD at C5-6 and C6-7, but without 
“major disk herniation.” At the MEB NARSUM examination December 2001, there was no 
cervical pain on flexion or extension, and the ROM was full. There was some left shoulder pain 
on range of, with tenderness in the upper trapezius bilaterally. The MEB NARSUM noted that 
her DDD of the cervical spine was “well under control with treatment,” and concluded that the 
CI met the standard for retention. 

 

Hypothyroidism Condition. The thyroid condition was first diagnosed, prior to commissioning, 
as a goiter in 1989. In July, 1994, prior to her coming onto active duty, she was diagnosed with 
Hashimoto’s thyroiditis and multi-nodular goiter. In October, 1998, it was noted that the CI had 
been on thyroid replacement therapy since 1997, and that laboratory parameters showed the 
condition to be well controlled with Synthroid. An endocrinology consultation in 2001 
documented that the CI was “clinically and biochemically euthyroid”; that is, well controlled 
with medication without side effects. The MEB NARSUM noted a diagnosis of thyroiditis since 
1994, and no thyromegaly. 

 

Primary Biliary Cirrhosis Condition. The CI was evaluation of abnormal liver blood tests 
prompted evaluation with a liver biopsy in 1998 that resulted in the diagnosis of primary biliary 
cirrhosis, for which she was prescribed medication. At the MEB NARSUM examination, the 
condition was controlled with medication. There were no symptoms or liver function 
abnormalities. The MEB physical exam noted a normal abdominal examination, mild elevations 
of liver function tests, and no systemic evidence of liver disease. The MEB concluded that she 
met the standard for retention for this condition. 

 

The Board noted the physical profile report dated 28 November 2001 stating that the CI’s 
“…physical profile does not prevent her from performing nursing duties.” All conditions were 
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 fitness determination for the any of the contended conditions; 
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 FM 
condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB 
adjudication. In the matter of the contended DDD of the cervical spine, hypothyroidism and 
primary biliary cirrhosis 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, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Fibromyalgia 

5025 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120707, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130009613 (PD201201086) 

 

 

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 and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 

 

BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)