Search Decisions

Decision Text

AF | PDBR | CY2012 | PD2012 01603
Original file (PD2012 01603.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD1201603
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20131016
SEPARATION DATE: 20021105


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (T4A071/Formal Training Instructor) medically separated for chronic muscle pain. The CI experienced an onset of symptoms in 2001, and after numerous immunology, neurology and rheumatology consults, was diagnosed with probable fibromyalgia. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards. She was issued a profile and referred for a Medical Evaluation Board (MEB). The fibromyalgia condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. The MEB also identified and forwarded seven other conditions (see rating chart below) for the PEB adjudication. The PEB adjudicated “fibromyalgia-like syndrome” as unfitting, rated 20%, citing criteria of Veterans Affairs Schedule for Rating Disabilities (VASRD). Five of the remaining conditions were determined to be C ategory II (can be unfit ting , but not ratable/ compensable ) and two were not addressed by the PEB . The CI made no appeals and was medically separated.


CI CONTENTION: “I continue to have issues and receive treatment for problems I was discharged for, which have left me unemployable and led to my depression. I enjoyed being an instructor of military training. High blood pressure, depression/anxiety, cold urticaria, fibromyalgia, skin problems, spinal problems, Raynauds.”


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 specifically requested by the CI. The rating for the unfitting fibromyalgia condition is addressed below. As well, the contended cold urticaria, spine, and requested hypertension condition will be discussed as not unfitting conditions. The allergic rhinitis, gastro-intestinal reflux, right carpel conditions and breast adenoma condition were not contended and will not be addressed. The contended depression/anxiety, skin and Raynaud’s conditions were not identified by the MEB or PEB and are not within the DoDI 6040.44 defined purview of the Board. 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 Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; 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 20020925
 VA* - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Fibromyalgia like Syndrome
 5025-5099 20% Fibromyalgia with Headaches, IBS, Depression and Raynaud's-Like Symptoms 5025 40% 20030219
Low Back Pain, DDD L5-L6
 Category II Low Back Pain, Degenerative Disc Disease L5-L6 5293 10% 20030219
Hypertension
 Not Rated Hypertension 7101 0% 20030219
Non-allergic Rhinitis
 Category II Allergic Rhinitis with Secondary Hypertrophied Nasal Turbinates 6599-6522 0% 20030131
Cold Induced Urticaria
 Category II Cold Induced Urticaria 7118-7806 0% 20030219
GERD
 Category II Gastro-esophageal Reflux 7346 NSC 20030219
History, Right Breast Fibroadenoma
 Not Rated Right Breast Fibroadenoma 7699-7628 NSC 20030219
Right Carpal Tunnel Syndrome
 Category II Right Carpal Tunnel 8515 NSC 20030219
No Additional MEB/PEB Entries
 Other x 4 20030131
Combined: 20%
 Combined: 50%
* Derived from VA Rating Decision (VA RD ) dated 200 30620 (most proximate to date of separation ( DOS ) )


ANALYSIS SUMMARY:

Fibromyalgia-like Condition. In 2001 the CI developed a medical condition consisting of muscle aching and stiffness, headaches, rhinitis, fatigue, cutaneous cold intolerance and diarrhea. An extensive immunologic evaluation revealed no immunologic etiology and a diagnosis of “probable” fibromyalgia was subsequently made. During clinic visits from 2001 until November 2002, the CI reported diffusely stiff muscles intermittent in her neck, back, shoulders, arms and legs. This was characterized as generalized stiffness in the morning with either improvement or worsening with increasing activity. During a neurologic evaluation on 30 November 2001, the CI reported her neck to be tight “all the time” and the “rest of body tightens up with activity.” On exam she was in no apparent distress (NAD). Diffuse tenderness to palpation of all muscles was present and range of motion (ROM) of all joints was normal. A diagnosis of early stage of “Stiff Man” syndrome was made. During an allergy evaluation on 6 February 2002, the CI reported muscle spasms with stiffness and itching. During the neurology exam performed the same day, the CI noted stiffness and aching appearing with repetitive activity and symptoms improving with oral vitamin B therapy. Motor strength of the back and all extremities was normal. At another neurology evaluation performed on 25 April 2002 at the National Military Medical Center Bethesda, the CI reported constant back pain and “burning” but no stiffness in her muscles. She noted that her muscles were diffusely “tight” after work and that aching pains were brought on by activity. During a mental health visit on 14 May 2002, a social worker reported no Axis 1 diagnosis, a Global Assessment of Functioning of 80 and opined that the multiple frequent medical visits since onset of symptoms were due to “referrals or staff changes, rather that the patient seeking different providers.” During the rheumatology evaluation on 4 June 2002, the CI reported generalized “burning” pain on both sides of her body with no “specific” area. She further noted generalized stiffness in the morning, improving with increasing activity and generalized stiffness and pain if remaining in one position for a prolonged period of time. The CI noted that the vitamin B had helped her symptoms, but that she had discontinued this vitamin to “give her body a rest from medicines.” On examination, the CI was in NAD and no synovitis was noted in the shoulders, wrists, elbows, knees or ankles. Tender points were noted on 14/18 sites and a diagnosis of “most likely fibromyalgia” was rendered. At the MEB narrative summary exam on 18 August 2002, 3 months prior to separation, the CI was in NAD. On musculoskeletal exam, multiple tender points were present but no synovitis was reported (hands, wrists, elbows, knees, and ankles). Motor strength, sensation and reflexes were normal in all extremities without pain.
Five VA Compensation and Pension (C&P) exams were performed within 1-3 months after separation. At the C&P general exam on 19 February 2003, the CI reported continued daily muscle spasms with burning sensation, headaches, reported as both “daily” and “twice a week” and diarrhea once a week. She noted “severe limitation of activity,” but “forces herself to go to the grocery store occasionally.” On physical examination the CI was in NAD with normal posture and gait. Multiple trigger points were recorded without tenderness along the total back. ROM of the back was normal (flexion: 90 degrees) with normal reflexes and motor strength of all extremities. At the C&P mental health exam performed the same day, the CI reported sleeping 7 hours nightly with medication and being able to perform cleaning and related activities for the care of her home. She reported usually eating out and having no difficulty maintaining personal appearance or activities of daily living, and being “close” to obtaining a bachelor’s college degree. At this time she was unemployed, but was applying for a job. She reported having had surgery in January and had been told to not work for a month. On examination the CI appeared in pain.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and the VA both rated the condition as fibromyalgia, coded 5025, IAW 4.71a; the PEB at 20% and VA at 40% (the highest rating for this code). The 40% rating requires symptoms to be “constant, or nearly so, and refractory to therapy.” The Board then had a discussion concerning the 20% versus the 40% rating. The Board determined that the symptoms were not constant, nor consistently severe, and demonstrated response to therapy. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously agreed that the disability rating of 20% for the fibromyalgia-like condition was appropriately recommended in this case.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that contended back pain, cold induced urticaria and hypertension conditions were not unfitting. 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.

Back Pain. The CI had a 5-year history of radiating back pain. Magnetic resonance imaging demonstrated a disc at the L5-S1 area. Lumbar discogram on 19 July 2002, revealed an L5 disc annular tear. Electromyography study was normal. Examination of the back on 4 May 2002, 5 months prior to separation, revealed ROM, no tenderness or spasm, normal motor, sensation and reflexes.

Hypertension. The CI was diagnosed with mild hypertension (blood pressure [BP]) in 2000. BP control was achieved with medication. At the C&P general exam, BP was slightly elevated, but the CI noted she had discontinued medication and was self-treating with flax seed oil and garlic. There are no records of emergency room (ER), unscheduled clinic visits, hospitalizations or medical complications for this condition.

Cold Induced Urticaria. The CI was diagnosed with cold induced urticaria in 2001. This consisted of burning, itching and hives in the direct area of cold contact with the skin. The condition was mild, self-limited and resolved without treatment in 15-20 minutes. The condition was never associated with angioedema, pulmonary wheezing or systemic symptoms. Immunologic tests were negative. Ice testing produced a reaction only at the site. There are no records of ER, unscheduled clinic visits, hospitalizations or medical complications for this condition.

The contended conditions for back pain and hypertension were not profiled, but the cold induced urticaria condition received a temporary profile in 2001. The temporary profile was converted to a permanent profile in March 2002 to “avoid exposure to cold, swimming; and activities in the winter time.” None of these conditions were implicated in the commander’s statement nor were judged to fail retention standards. All were reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that 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 any of the contended conditions, and therefore no additional disability ratings are 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-like condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended back pain, cold induced uticaria and hypertension 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-like Condition 5025-5099 20%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120823, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         XXXXXXXXXXXXXXXXXXXX, DAF
         President
         Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX :

          Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2012-01603.
         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.
         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.
                                                               Sincerely,





 XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings


Similar Decisions

  • AF | PDBR | CY2012 | PD2012-01128

    Original file (PD2012-01128.pdf) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW BRANCH OF SERVICE: ARMY SEPARATION DATE: 20020228 NAME: XXXXXXXXXXXXXXXXXXX CASE NUMBER: PD1201128 BOARD DATE: 20130129 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (91B10/Medical Specialist), medically separated for fibromyalgia with 11/18 tender points, with chronic pain, daily headache, sleep disturbance and asthma with normal spirometry....

  • AF | PDBR | CY2012 | PD2012 01707

    Original file (PD2012 01707.rtf) Auto-classification: Denied

    The Physical Evaluation Board (PEB) adjudicated the FM (which considered the LBP and depression to be an integral part of FM and not independently unfitting) as unfitting, rated 20%, with application of the Department of Defense Instruction (DoDI) 1332.39.The remaining condition, OSA, was determined to be not unfitting and therefore not rated. There was normal ROM in all joints with pain.Neurological exam was normal.The Board noted the PEB to combine the depression and LBP conditionsand...

  • AF | PDBR | CY2009 | PD2009-00718

    Original file (PD2009-00718.docx) Auto-classification: Denied

    In considering the rating, the Board readily agreed that the MEB, VA examinations, and the service treatment record all indicated that the CI’s symptoms were not controlled by medications, and that the pain was present daily. Other PEB Conditions. Exhibit C. Department of Veterans' Affairs Treatment Record.

  • AF | PDBR | CY2011 | PD2011-00993

    Original file (PD2011-00993.pdf) Auto-classification: Approved

    The CI was medically separated with a 10% disability rating. 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...

  • AF | PDBR | CY2010 | PD2010-01241

    Original file (PD2010-01241.doc) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: BRANCH OF SERVICE: Army CASE NUMBER: PD1001241 SEPARATION DATE: 20030604 BOARD DATE: 20120203 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92G, Food Service Specialist) medically separated for fibromyalgia. The PEB adjudicated the Fibromyalgia condition as unfitting, rated 20% with application of the Veterans Administration Schedule...

  • AF | PDBR | CY2011 | PD2011-00213

    Original file (PD2011-00213.docx) Auto-classification: Denied

    The VA exam, two months pre-separation, documented a normal knee exam, and the VA adjudicated the condition as not Service connected (NSC). The CI’s unfitting fibromyalgia considered the impact of all musculoskeletal pain symptoms and conditions associated with fibromyalgia as noted above. The CI’s unfitting fibromyalgia considered the impact of all musculoskeletal pain symptoms and conditions associated with fibromyalgia as noted above.

  • AF | PDBR | CY2014 | PD-2014-00766

    Original file (PD-2014-00766.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. At the MEB examination on 11 May 2004, 10 months prior to separation, the CI complained of painful bilateral shoulders (which popped all the time), constant back pain, foot pain, tender “knots” on both of the knees,...

  • AF | PDBR | CY2013 | PD-2013-01378

    Original file (PD-2013-01378.rtf) Auto-classification: Denied

    The MEB also forwarded fibromyalgia (FM) and seasonal allergic rhinoconjunctivitis conditions as medically acceptable.The Informal PEBadjudicated “degenerative disk disease associated with herniated nucleus pulposus L5-S1 with left radicular pain” as unfitting, rated 20%, citing the VA Schedule for Rating Disabilities (VASRD). 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...

  • AF | PDBR | CY2010 | PD2010-00108

    Original file (PD2010-00108.docx) Auto-classification: Denied

    Based upon the lack of episodes during the last twelve months of service, the Board considered the appropriate rating to be 0% at the time of separation. The Board therefore has no basis for recommending any additional unfitting conditions for separation rating. I have carefully reviewed the evidence of record and the recommendation of the Board.

  • AF | PDBR | CY2012 | PD2012 01824

    Original file (PD2012 01824.rtf) Auto-classification: Denied

    (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 specifically requested by the CI.The rating for the unfitting fibromyalgiacondition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. The Board reviews medical records and other available evidence to assess the fairness of PEB rating...