RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201836 SEPARATION DATE: 20030831 

BOARD DATE: 20130404 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an Active Duty SGT/E-5 (73D, Accounting Specialist), medically 
separated for fibromyalgia. She 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 P3 profile and referred for a Medical Evaluation Board (MEB). Fibromyalgia 
was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-
501. Posterior scleritis of chronic etiology, recurrent bronchitis and sleep apnea conditions, 
identified in the rating chart below, were also identified and forwarded by the MEB as medically 
acceptable. No other conditions were listed on the DA Form 3947. The PEB adjudicated the 
fibromyalgia condition as unfitting, rated 20%, with application of the Veterans Affairs Schedule 
for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. 
The CI made no appeals, and was medically separated with a 20% disability rating. 

 

 

CI CONTENTION: “Members original diagnose was not fully understand. VA Disability Rating 
100%.” 

 

 

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 ratings 
for unfitting conditions will be reviewed in all cases. The posterior scleritis of chronic etiology, 
recurrent bronchitis and sleep apnea conditions requested for consideration and the unfitting 
fibromyalgia condition meet the criteria prescribed in DoDI 6040.44 for Board purview, and are 
accordingly addressed below. The depression and sinusitis conditions, as per the contention, 
were not identified by the MEB or PEB; and, thus are not within the Board’s purview. These 
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 contention that suggests a higher service rating should have 
been granted at the time of separation. IAW DoDI 6040.44, the Board’s authority is limited to 
making recommendations on correcting disability determinations. The Board’s role is thus 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating determinations, compared to VASRD standards, based on ratable severity at the time of 
separation and, to review those fitness determinations within its scope (as elaborated above) 
consistent with performance-based criteria in evidence at separation. 

 

 

 


RATING COMPARISON: 

 

Service IPEB – Dated 20030725 

VA (STR-Pre-Separation) – All Effective Date20030901 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Fibromyalgia 

5025 

20% 

Fibromyalgia 

5025 

20%* 

STR 

Posterior Scleritis of 
Chronic Etiology 

Not Unfitting 

Bilateral, Posterior Scleritis 

6002 

10% 

STR 

Recurrent Bronchitis 

Not Unfitting 

Sleep Apnea and Recurrent 
Bronchitis 

6847 

50% 

STR 

Sleep Apnea 

Not Unfitting 

No Additional MEB/PEB Entries 

Other x 5 

STR 

Combined: 20% 

Combined: 70% 



Derived from VA Rating Decision, dated 20031209 (most proximate to the date of separation) 

*No change to rating with subsequent C&P exams 

 

 

ANALYSIS SUMMARY: 

 

Fibromyalgia Condition. The CI sought care for articular pain in July 2002 reporting a 2 year 
history of progressive joint pain, stiffness, painful paresthesia of her legs, hips and hands with 
subjective swelling of upper and lower limbs joints. The CI was started on a non-steroidal anti-
inflammatory medication. At the time of follow up with the physician, on 13 September 2002, 
joint pain was “almost gone” with medication treatment. The encounter note refers to a 
rheumatology evaluation for a positive antinuclear antibodies (ANA) test concluding there was 
no current evidence of active autoimmune disease. However symptoms of joint pain recurred 
and MEB process was initiated. At the time of the MEB physical exam, on 11 February 2003, 
there was no evidence of inflammation of in her hands, elbows, knees or feet and range-of-
motion (ROM) was normal. There was no evidence of inflammation on laboratory testing. X-
rays of the knees, hips and hands, 12 February 2003, were normal. On 6 March 2003, the CI 
was seen by rheumatology and symptoms of joint pain, non-restorative sleep and fatigue were 
recorded. On examination, there was no evidence of arthritis (no swelling and full ROM of all 
joints). The presence of multiple tender points characteristic of fibromyalgia were noted (16 of 
18). The rheumatologist diagnosed fibromyalgia and medication treatment was initiated at that 
time. The MEB NARSUM, 1 July 2003, reported that the CI continued to experience joint and 
muscle pain with the sensation of swelling. Increased doses of medication had not improved 
her symptoms. The symptoms were exacerbated with prolonged standing or exertion which 
prevented the CI to continue her military duties including physical training, road marches or 
running. She also complained of fatigue that decreased her concentration. The commander’s 
letter, 14 January 2003, stated that the CI’s physical profile prevented meeting the physical 
standards of basic soldiering, but noted performance of duties was otherwise “excellent.” 
There was no VA Compensation and Pension (C&P) examination proximate to separation and 
the VA rated the condition based on service treatment record (STR). 

 

The Board directs attention to its rating recommendation based on the above evidence. Both 
the MEB and VA rated the CI fibromyalgia condition 20% under the code 5025. The VA 20% 
rating was continued on subsequent evaluations over the following 6 years. The Board 
considered whether a higher rating for fibromyalgia was supported at the time of separation, 
but concluded the preponderance of evidence more nearly approximated the 20% rating. 
Although the condition prevented participation in strenuous military duties such as road 
marching, but performance of in-garrison duties was excellent. The Board noted the post 
separation diagnosis of undifferentiated connective tissue syndrome and subsequent service 
connected rating for this condition. The CI was evaluated twice by rheumatologists prior to 
separation without findings of an active autoimmune disease other than the history of 
posterior scleritis (discussed below) and the positive ANA test. While this subsequent diagnosis 
may underlie the symptoms diagnosed as fibromyalgia, an additional rating is not warranted 
since it would be based on the same disability used to rate fibromyalgia and two rating based 
on the same disability is prohibited by §4.14 (avoidance of pyramiding). 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 fibromyalgia condition. 

 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
were posterior scleritis of chronic etiology, recurrent bronchitis and sleep apnea. The 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. Posterior scleritis 
(inflammation of the back wall of the globe of the eye) was discovered incidentally during an 
eye examination for refractive laser eye surgery, primarily the left eye. The cause of the 
condition was considered to be autoimmune and chronic in nature. There was some problem 
with glare conditions, but visual acuity met retention standards. The MEB narrative summary 
(NARSUM) noted the CI had a history of intermittent bronchitis over the preceding 8 years 
responsive to medication treatment. At the time of the MEB NARSUM, the CI was undergoing 
evaluation for possible sleep apnea. The CI’s in-garrison duty performance was excellent prior 
to diagnosis and post separation evaluation noted good response to use of a CPAP machine. 
Routinely obstructive sleep apnea (OSA) is not considered unfitting solely on the basis of field 
and operational impediments to the use of CPAP. There is no evidence in this case that OSA 
was associated with any unfitting impairments not corrected by CPAP. The PEB’s fitness 
adjudication was therefore expected and reasonable. 

 

The conditions were reviewed and considered by the Board. None were profiled, implicated in 
the commander’s statement; and, none were judged to fail retention standards. 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. The Board did not 
surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD 
were exercised. In the matter of the fibromyalgia condition and IAW VASRD §4.71a, the Board 
unanimously recommends no change in the PEB adjudication. In the matter of the contended 
posterior scleritis of chronic etiology, recurrent bronchitis and sleep apnea 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 

20% 

Posterior Scleritis 

Not Unfit 

- 

Recurrent Bronchitis 

Not Unfit 

- 

Sleep Apnea 

Not Unfit 

- 

COMBINED 

20% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120901, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx (PD201201836) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)