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AF | PDBR | CY2012 | PD2012 01038
Original file (PD2012 01038.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXXX CASE NUMBER: PD 12 0 1038
BRANCH OF SERVICE: Army BOARD DATE: 2013 0925
Separation Date: 20020318


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV2/E-3 (91W/ Medical Specialist) medically separated for a fibromyalgia condition. She was diagnosed in 2001 and her symptoms failed to respond to conservative measures. The condition could not be adequately rehabilitated to meet the physical requirements of her Milit ary Occupational Specialty or satisfy physical fitness standards. She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The fibromyalgia condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded “right shoulder pain, largely resolved, status post shoulder arthroscopic surgery” for PEB adjudication. The PEB adjudicated fibromyalgia as unfitting and rated at 20% citing criteria of the Veteran s Affairs Schedule for Rating Disabilities (VASRD) . The shoulder condition was determined to be not unfitting. The CI made no appeals, and was medically separated.


CI CONTENTION : “Need increase at this time . Rt shoulder repair completed while in service. Still causes issues.”


 SCOPE OF REVIEW : The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specific ally requested by the CI. The rating for the unfitting fibromyalgia condition is addressed below. The requested right shoulder condition, which was determined to be not unfitting by the PEB, is likewise 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 conside ration by the Board for Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20020131
 VA - (1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Fibromyalgia
 5025 20% Fibromyalgia 5025 20% 20020416
Right Shoulder
 Not Unfitting Residuals, Injury, Right Shoulder 5299-5201 20% 20020416
No Additional MEB/PEB Entries
 Other x3 20020416
Combined: 20%
 Combined: 50%
Derived from VA Rating Decision (VARD) dated 20020627 (most proximate to date of separation [DOS])


ANALYSIS SUMMARY : The Board acknowledges the CI’s information regarding the significant impairment with which h er service-connected condition continues to burden h er ; but, must emphasize that the military Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congres s to the Department of Veterans Affairs, operating under a different set of laws. I AW 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.

Fibromyalgia Condition . The CI was recovering from right shoulder surgery when in August 2001 , she developed generalized myalgias and arthralgias. The CI was evaluated by Physical Therapy for multiple painful joints in the knees hips , shins, left shoulder and lower back. The CI was started on a trial of an antidepressant (Zoloft) and a muscle relaxant (Flexeril). X-rays and a b one scan were negative. The examiner noted tender points in the bilateral supraspinatus , bilateral trapezius , right gluteals, right greater trochanter bilateral anterior chest, right lateral epicondyle and bilateral knees along with multiple trigger points in the bilateral upper and lower back and a tightness sensation in the bilateral hamstrings in full flexion. The CI was first evaluated by Physical Medicine and Rehabilitation (PM&R) in October 2001 for pain that significantly worsened in the knees, lower back and hips. The exami ner noted tender points in the occipital area, shoulders, chest, knees greater trochanters, and gluteals along with hamstring tightness. The CI was seen in follow-up with the PM &R examiner who noted that the CI complained of headaches which increased in intensity and frequency during the prior week and were associated with times of worsened pain. The examiner noted that the physical exam findings remained unchanged and opined that the headaches were likely associated with fibromyalgia exacerbation and tension. The examiner put the CI on q uarters for fibromyalgia, severe headache and chills. The CI was evaluated by her Family Practice provider for sleeplessness, headaches, generalized aches and chills . The examiner diagnosed the symptoms as an aggravation of fibromyalgia and added an analgesic (Tylenol). The commander’s s tatement indicated that the CI was physically incapable of performing her field duties due to the chronic pain in her right shoulder, right knee, hips, ankles and shins. The CI was given a permanent P3 Profile for fibromyalgia and with specific restrictions of no APFT, n o running, no mopping or mowing grass, no stan ding greater than 20 at a time and lifting only as tolerated. The MEB Narrative Summary (NARSUM) exam accomplished approximately 2 months prior to separation noted that based on the responses that the CI had on the Modified Health Assessment Questionnaire, she was unable to participate in sports or games and had difficulty walking two miles or getting a good night ’s sleep; difficulty walking outdoors on flat ground, bending down and picking up clothing and morning s tiffness was approximately 3 hours . T he amount o f usual fatigue or tiredness over the prior w eek due to her condition was 10 out of 10 , a nd her pain was approximately 7 out of 10. The examiner noted significant improvement in her fatigue and insomnia symptoms with the Zoloft and Flexeril , as trials of non-steroidal anti-inflammatory drugs as well as intermittent use of a narcotic medication were of minimal help in reducing the arthralgias, myalgias or sleep dysfunction. The physical exam findings were that of hypermobility of the finger joints, elbows and knees but an inability to touch her palms to the floor with knees straight, and there were 18/18 positive tender points. The examiner reported that to confirm fibromyalgia and the examiner noted non-restorative slee p and tender points. The VA Compensation and Pen sion (C&P) exam accomplished a month after separation indicated that the CI had some improvement in the neck, interscapular regions and hip pains since she became pregnant ; however , she still had fatigue, tiredness, headaches and tender points about once per week . The physical exam findings were tenderness in di screte regions of the neck, on other side of her sternocleidomastoid muscles ; tenderness in the interscapular regions, especially at the level of T11 and T12, as well as in the lower lumbosacral spine at the L5-S1 region.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and the VA chose the same disability code 5 025 (f ibromyalgia ) and both rated i t 2 0%. The Board readily agreed that there was no evidence that the CI’s symptoms were controlled by medications and therefore the 10% rating was exceeded. The deliberation s focused on the 20% rating ( with symptoms that are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time ) versus the 40% ( with symptoms that are constant, or nearly so, and refractory to therapy ) rating . The Board considered that all exams proximate to separation documented that the CI’s fibromyalgia symptoms were not constant or nearly so (as required for the 40% rating) as she did have improvement in her symptoms with some medications. Additionally, the C&P exam documented that her symptoms were present “…about once per week” which is most consistent with the 20% rating under code 5025 . 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 f ibromyalgia condition.

Contended PEB Conditions. The contended condition adjudicated as not unfitting by the PEB was a r ight s houlder condition . The Board’s first charge with respect to th i s condition is an assessment of the appropriateness of the PEB’s fitness adjudication. 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. The CI was given a temporary profile for the right shoulder condition after arthroscopic surgery and th e right shoulder condition was n ever permanently profiled. Right shoulder pain was mentioned in the c ommander’s s tatement ; however, it was contained within a list of other “chronic medical problems” noted with her fibromyalgia and not as a separate condition. The right shoulder condition was not judged to fail retention standards. This condition was reviewed by the a ction o fficer and considered by the Board. The o rthopedic NARSUM accomplished approximately 4.5 months prior to separation documented “… full range of motion with very little pain. ” The examiner diagnosed right shoulder pain, largely resolved, status post arthroscopic surgery. There was no indication from the record that t h is condition separately interfered with satisfactory duty performance at the time of separation . 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 r ight s houlder condition.


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 f ibromyalgia condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended r ight s houlder condition , 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 2 0%
Right Shoulder
 Not Unfitting
COMBINED
 2 0%
invalid font number 31502


The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 120604 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record





XXXXXXXXXXXXXXXXXXXXXX , DAF
President
Physical Disability Board of Review


SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB /XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXXXX, AR20130021926 (PD201201038)


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                                                  XXXXXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)


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