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AF | PDBR | CY2012 | PD2012 01824
Original file (PD2012 01824.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201824        
BRANCH OF SERVICE: Army  BOARD DATE: 20130627
Date of SEPARATION: 20021018    


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (67U20/Helicopter Mechanic) medically separated for fibromyalgia syndrome. She was diagnosed with fibromyalgia in 1998 followed by years of chronic treatment. The condition could not be adequately rehabilitated to meet the physical requirements of her Military 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 and no other conditions were submitted by the MEB. The PEB adjudicated the fibromyalgia syndrome as unfitting, rated 20%. The CI made no appeals, and was medically separated with a 20% disability rating.


CI CONTENTION: “The Veteran Affairs rated the Fibromyalgia Syndrome at 40% with an overall rating of 70% with their first decision dated September 15, 2003.”


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; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions 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.


RATING COMPARISON:

Service IPEB – Dated 20020715
 VA - (9 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Fibromyalgia Syndrome
 5025 20% Fibromyalgia Syndrome 5025 40% 20030723
No Additional MEB/PEB Entries
 Other x 3 20030723
Combined: 20%
 Combined: 70%
Derived from VA Rating Decision (VA RD ) dated 200 30915 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the Veterans Affairs Schedule for Rating Disabilities (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.

Fibromyalgia Syndrome. The service treatment record (STR) in 1998-99 reported chronic, worsening pain in the shoulders, back, and other joints, bilateral hip pain, “numbness,” intermittent chest pain, migraine headaches, fatigue, stiffness, depression, and difficulty with memory. X-rays of the hips, sacro-iliac joints, and lumbosacral spine, a bone scan (1997), rheumatologic laboratory tests, and physical exams were negative for inflammatory or arthritic disease. In 1999, she began the first of six antidepressant trials, and was also formally diagnosed with fibromyalgia. The CI was temporarily profiled twice in 1999 for joint pain and/or fibromyalgia; she was permanently profiled (L2) in April 2000 for fibromyalgia, with limitations restricted to running at own pace and distance, bicycling, sit-ups, and some calisthenics. A psychiatric consultation in August 2001 resulted in a diagnosis of depressive disorder not otherwise specified and a global assessment of functioning score of 55 (moderate symptoms or moderate impairment). A rheumatology consultation in October 2001 noted the history of fibromyalgia symptoms since around 1998. The CI reported diffuse, daily pain averaging 5 out of 10 (1-10 scale), worse in the low back, neck, and hips. Exacerbations with standing or stooping more than five minutes, prolonged sitting or stationary position, and bending also occurred. Other symptoms included irritable bowel symptoms, migraine headache, severe dysmenorrhea, and poor sleep with morning fatigue, as well as concurrent depression and anxiety. Pool therapy was noted to be beneficial. The physical exam reported 13/18 tender points, tenderness over the iliotibial band insertion and origin and the paraspinal lumbar region. There were no objective joint abnormalities, and strength was normal. The rheumatologist concurred with the diagnosis of fibromyalgia, and opined that it was possibly amplified by depression and anxiety. An outpatient clinic note on 20 November 2001 stated that a medication for depression helped her to feel “a lot better.” A new pain medication “works okay.” A topical medicated cream “really helps with her muscle aches” and the pool therapy continued to be helpful for general body aches. At a follow-up visit a month later it was noted that “her current medications are working well,” although she still had some difficulty sleeping, concentrating and feeling down. The commander’s statement (June 2002) noted that the CI was competent and hardworking, but that the condition “does at times prevent her from performing her duties as a helicopter mechanic…has caused her on occasion to forget critical tasks and has prevented her from performing her job…because of extreme pain. The unpredictability of her condition and the uncertain affects [sic] on her performance makes her a high-risk mechanic.” In the narrative summary (NARSUM) dictated in June 2002 (4 months before separation) the CI stated that she was “able to perform her current duties, but usually in some sort of pain or feeling dizzy, also known as a fibro fog or some loss of memory.” She was able to walk, bike, and swim at her own pace; to lift up to 20 pounds; but not to run, jump, march, wear load-bearing equipment, or to stand for a prolonged time. She felt fatigued for several days after field or range exercises. She performed physical training (PT) in a pool, and found this to be the most helpful treatment for her fibromyalgia. Her symptoms fluctuated; she was able to perform all of her work and PT on some days and, on other days, felt drained of energy and was able to accomplish little. The examiner noted concurrent irritable bowel syndrome, temporomandibular joint pain, migraine headaches, depression, and anxiety. The examiner reported that she complied with the medications, physical therapy, and pool PT; the medication regimen included daily medications for pain, arthritis, anxiety, depression, and insomnia; and four medications to treat pain as needed. All laboratory tests and a chest X-ray were normal. The physical exam was normal, including normal range-of-motion (ROM) of back and extremity joints, and full muscle strength; normal neurological exam; and normal mental status exam and “psychiatric exam.” The exam did not specify the presence of tenderness. The examiner noted that the CI required follow-up with her physician “…to ensure that the medications are continuing to work.” He opined that she would require a civilian job that allowed her to take frequent breaks. At the VA Compensation and Pension (C&P) exam in July 2003 (9 months after separation) the CI’s major complaint was tiredness; other symptoms were muscle and joint pain, and headaches. She took three medications for pain, including one narcotic medication, and medications for depression and anxiety. The medication and physical therapy she received while in the service “helped a little bit.” She was a full-time college student in a paralegal program and maintained a 3.75 grade point average. The physical exam noted bilateral temporomandibular joint crepitus, normal ROM except for slightly decreased back extension, normal strength, and normal neurological exam. The neck and knees were non-tender.

The Board directs attention to its rating recommendation based on the above evidence. Under the 5025 code, a 20% rating is appropriate when symptoms are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but are present more than one third of the time. A 40% rating, the maximum rating available under this code, is warranted when fibromyalgia is constant, or nearly so, and refractory to therapy. Board members agreed that the PEB’s 20% rating was supported by the evidence, but debated if the next higher 40% rating was justified. It was noted that fibromyalgia symptoms were helped by medications and especially by pool therapy. The commander’s statement reported her to be competent and hardworking, but that her condition interfered with duty “at times,” consistent with the NARSUM examiner who stated that her symptoms fluctuated. She could participate in self-directed activities such as walking, biking and swimming, and after separation became a full-time student. The Board therefore finds the evidence does not most nearly approximate a disability picture characterized by symptoms that are constant and refractory to therapy, and therefore the 40% rating is not warranted. 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.


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 fibromyalgia syndrome condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. 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 Syndrome
 5025 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121010, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130018488 (PD201201824)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA


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