RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201662 SEPARATION DATE: 20061222 

BOARD DATE: 20130312 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (14T10/Patriot System Repairer) medically 
separated for chronic musculoskeletal pain. The CI injured her left hamstring in August 2003 
and subsequently experienced left knee pain. She also developed multiple areas of myofascial 
pain that was treated with physical therapy (PT), non-operative pain management strategies 
and mental health counseling. She did not improve adequately with treatment to meet the 
physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. She was issued a permanent L4 profile and referred for a Medical Evaluation Board 
(MEB). Abnormal non-physiologic gait with antalgic-like component and chronic pain syndrome 
were forwarded to the Informal Physical Evaluation Board (IPEB) as medically unacceptable IAW 
AR 40-501. Psychological factors affecting a general medical condition (meralgia paresthetica) 
and dysthymic disorder conditions, identified in the rating chart below, were identified and 
forwarded by the MEB as medically acceptable. The IPEB combined the two medically 
unacceptable conditions into one condition designated as chronic musculoskeletal pain and 
adjudicated it with specified application of the US Army Physical Disability Agency (USAPDA) 
pain policy and rated at 0%. The remaining conditions were determined to be not unfitting. 
The CI appealed to the Formal PEB (FPEB), which affirmed the IPEB findings, and she was 
medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “My condition was grouped into a catch-all and rated 0% despite being 
medically distinct and debilitating. The VASRD, not then [sic] (continued) this is a chronic 
condition that in my present state can only be maintained, rather then [sic] meaningfully 
improved, with intensive and ongoing physical therapy. Shortly after being discharged I was 
diagnosed with fibromyalgia and RSD/CRPS. The attached memorandum explains why I feel my 
PEB was flawed and needs to be reevaluated. The VA and SSA have declared me disabled at 
60% full respectively.” The CI attached a two-page statement (to the USAPDA) to her 
application that was reviewed by the Board and considered in its recommendations. 

 

 

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 
contended psychological factors affecting a general medical condition-meralgia paresthetica 
and dysthymic disorder are considered by the Board only with regard to rating the unfitting 
conditions and are otherwise outside the scope of the Board. The unfitting abnormal non-
physiologic gait with antalgic-like component and chronic musculoskeletal pain condition meets 
the criteria prescribed in DoDI 6040.44 for Board purview and is accordingly addressed below. 
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. 

 

 


RATING COMPARISON: 

 

Service FPEB – Dated 20060830 

VA (5 Mos. Post-Separation) – Effective Date 20061223 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Abnormal Non-Physiologic Gait with 
Antalgic-Like Component 

5099-5003 

0% 

Fibromyalgia 

5025 

40% 

20070522 

Chronic Musculoskeletal Pain 

Psychological Factors Affecting a General 
Medical Condition-Meralgia Paresthetica 

Not Unfitting 

Dysthymic Disorder 

Not Unfitting 

Dysthymic Disorder 

9433 

30% 

20070514 

No Additional MEB/PEB Entries 

0% x1 / Not Service-Connected x2 

20070522 

Combined: 0% 

Combined: 60% 



 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which her service-incurred condition continues to 
burden her. The Board wishes to clarify that it is subject to the same laws for service disability 
entitlements as those under which the Disability Evaluation System (DES) operates. The DES 
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 (DVA), operating under 
a different set of laws (Title 38, United States Code). The Board evaluates DVA evidence 
proximal to separation in arriving at its recommendations, but its authority resides in evaluating 
the fairness of DES fitness decisions and rating determinations for disability at the time of 
separation. While the DES considers all of the member's medical conditions, compensation can 
only be offered for those medical conditions that cut short a member’s career, and then only to 
the degree of severity present at the time of final disposition. The DVA, however, is 
empowered to compensate 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. 

 

Chronic Musculoskeletal Pain: The narrative summary (NARSUM) prepared 11 months prior to 
separation noted that the CI suffered an injury to her left hamstring, then developed left knee 
pain knee during her initial training. She had a constant, dull 6/10 non-radiating left knee pain 
treated with temporary profiles, crutches, long leg cast and physical therapy (PT) after cast 
removal for most of a 16 month period. She passed an alternate physical fitness test (walk) and 
completed advanced individual training (AIT). At her next duty station, when the same knee 
symptoms returned, she was placed back on crutches, prescribed a knee brace and began pool 
therapy. She was evaluated by orthopedics where no specific diagnosis was given and after a 
bone scan revealed activity in the left knee, she was referred to rheumatology where a 
presumptive diagnosis of fibromyalgia was made. In addition to the above, she complained of 
an 18-month history of diffuse aches and pains most prominent at the shoulders and hips 
(groins and greater trochanter areas) and that cold and rain increased her symptoms. Her sleep 
was poor and restless with constant search of a comfortable position and she woke up tired 
and stayed tired all day. She was off medications at the time due to pregnancy. She was sent 
for a gait evaluation and subsequently was seen regularly at PT and behavioral health. Physical 
examination revealed a blunted affect, guarded en-block movements and ambulation with full 
left knee brace and crutches and aided by husband. The CI’s stance and gait were evaluated 
with and without the knee brace. The changes in her stance were all reversible when asked to 
put full weight on both legs. Her gait was abnormal with and without the brace. There were 
numerous trigger points of her right and left side and upper and lower body. (This was not 
confirmed after review of the file.) No laboratory or radiographic data was available. Present 
condition and prognosis was that the CI's condition was disabling and her prognosis for 
unhindered return to the duties of an active duty Soldier was poor. Functionally speaking, she 
was hampered by insufficient coping skills to allow her to become fully independent. Her 


diagnoses were abnormal non-physiologic gait with antalgic-like component and chronic pain 
syndrome (with abnormal illness behavior) with trigger and tender points suggestive of tension 
myalgia. At the MEB exam accomplished 10 months prior to separation, the CI reported pain in 
knee, hips, shoulder, back and chest that had impaired the use of her appendages. Her left 
knee swelled, cracked, locked popped and had a grinding sensation. She used a knee brace 
from May 2004 to October 2005 and crutches since January 2004. She had a stress fracture in 
left tibial plateau and stress reaction in hips. The MEB physical exam revealed tenderness to 
palpation of the left knee, both hips and lumbar area. 

 

At the VA Compensation and Pension (C&P) exam performed 5 months after separation, the CI 
reported a history similar to the one above with the following significant additions. Many 
diagnoses were proposed: Lyme disease, malingering with psychosomatic illness and 
fibromyalgia. The CI reported having flare-ups when she could not walk at all that occurred 
once or twice a week, lasted for four to five hours and were usually triggered by the weather or 
increased activity. She would require help bathing, dressing and toileting on “bad days.” She 
did no exercise and she rarely drove because of the overall pain. The physical exam was 
significant for the fact that the CI arrived for her exam on crutches, with a severely antalgic gait. 
It took her three times the normal walking time to make her way down the hall to the exam 
room. She had difficulty standing on the scales without using her crutches. She needed help 
undoing the button on her pants. She had difficulty getting on the exam table and had to use 
crutches to boost herself up onto the table. She was obviously in pain, straining and grimacing 
with even simple tasks. Her appendicular skeleton, spine and associated musculature revealed 
no strength deficits and normal range-of-motion (ROM) was found at all joints, with the 
following exceptions: she had exquisite tenderness with the lightest palpation of her left leg, 
especially the knee, and of the back. She could barely stand to be touched and flinched and 
tried to avoid examination for fear of causing pain. There were no incapacitating episodes 
noted within 12 months of the exam. 

 

Review of the service treatment records revealed the following significant item. The CI was 
evaluated by rheumatology and physical medicine specialist on multiple occasions with an 
evaluation performed nine months prior to separation. All evaluations concluded that the CI 
did not meet the American College of Rheumatology (ACR) criteria for fibromyalgia. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
FPEB adjudicated the CI’s medically unacceptable MEB conditions as chronic musculoskeletal 
pain and rated it 0% disabling for minimal and frequent pain specifically citing the USADPA pain 
policy. The MEB condition abnormal non-physiologic gait with antalgic-like component is not 
diagnosis, but is a description of the functional result of one or more conditions. The VA 
applied Veterans Affairs Schedule for Rating Disabilities (VASRD) code 5025, fibromyalgia, and 
rated it 40% based on the presence of widespread musculoskeletal pain and tender points with 
symptoms that were constant and refractory to therapy. Prior to separation, two specialists 
specifically documented that the CI did not meet ACR criteria for fibromyalgia with only seven 
of 18 painful points present and with the most recent evaluation being nine months prior to 
separation. The FPEB DA 199 specifically stated, “The soldier does not have fibromyalgia.” The 
VARD written 7 months after separation noted 11 of 18 tender trigger points and this most 
likely represented post-separation worsening of the CI’s condition. A coding and rating scheme 
that would account for the majority of the CI’s pre-separation complaints utilizes VASRD code 
6354, chronic fatigue syndrome (CFS). It is noteworthy that data contained in both the core 
DES file and the C&P exam support the use of CFS for rating this CI’s disability. Analogous 
ratings are allowed IAW §4.20 when an unlisted condition is encountered it will be permissible 
to rate under a closely related disease or injury in which not only the functions affected, but the 
anatomical localization and symptomatology are closely analogous. The CI manifested 5 of 6 
required and 10 possible VASRD criteria for the diagnosis of CFS IAW §4.88a. Service treatment 
records (STR) document that she manifested generalized muscle aches or weakness, fatigue 


after exercise, migratory joint pains, neuropsychological symptoms and sleep disturbance. 
Manifesting six of the ten criteria fully meets the VASRD standard for the diagnosis of CFS; 
therefore, the CI’s disability picture is closely analogous to the VASRD criteria for CFS. Rating 
CFS is based on the consistency of the fatigue, the impact on daily activity or the duration of 
incapacitation if present. The CI’s symptoms were nearly constant and restricted her daily 
activities by less than 25 percent of the pre-illness level as evidenced by her ability to achieve 
“outstanding results” while performing as orderly room clerk for her unit. She experienced no 
periods of incapacitation within the 12-month period prior to the C&P exam. This meets the 
20% disability level. The next higher 40% disability level requires restriction in routine daily 
activities to 50 to 75 percent of the pre-illness level, or symptoms that wax and wane with 
periods of incapacitation of at least four but less than 6 weeks total duration per year. The 
Board also considered an alternative rating scheme for this condition that identified the left 
knee pain and left hip pain as separately unfitting with each joint rated 10% for painful motion 
IAW §4.59 as both joints had non-compensable ROM measurements. Each of these joints had 
documented injuries as the cause of their impairment. However, using this alternative rating 
scheme would not account for the additional painful areas encompassed by the PEB’s 
combined adjudication. These painful areas, left shoulder, back, right hip and right knee pain, 
were documented in the STR and after review and extensive deliberation; Board consensus was 
that none were separately unfitting. Additionally, these painful areas did not have any 
underlying pathologic process or injury as the basis for the joint pain other than that caused by 
the CFS. Application of this alternative coding and rating scheme would similarly result in a 
combined 20% disability rating that confers no benefit to the CI and does not accurately reflect 
the CI’s total disability picture. After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 Reasonable doubt, the Board recommends a disability rating of 20% for 
the chronic musculoskeletal pain condition coded analogously to CFS. 

 

 

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. As discussed above, PEB 
reliance on the USAPDA pain policy for rating abnormal non-physiologic gait with antalgic-like 
component and chronic musculoskeletal pain left shoulder, hip and back was operant in this 
case and the condition was adjudicated independently of that policy by the Board. In the 
matter of the chronic musculoskeletal pain condition, the Board unanimously recommends a 
disability rating of 20%, coded analogously as 6399-6354 IAW VASRD §4.88a. 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 her prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic Musculoskeletal Pain 

6399-6354 

20% 

COMBINED 

20% 



 

 


The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120917, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 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 xxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130006853 (PD201201662) 

 

 

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 xxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)