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.  She has low back pain (LBP) that started in 
1985 following a motor vehicle accident and exacerbated by a fall down the stairs in 1998.  She 
was referred to a chronic pain specialist who diagnosed her with severe lumbar neuritis and 
possible  early  fibromyalgia.    She  also  has  exercise  induced  bronchospasm  that  started  in 
February  1999  with  shortness  of  breath  during  physical  training.    The  CI  could  not  be 
adequately  rehabilitated  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).  The MEB forwarded early fibromyalgia and 
exercise  induced  bronchospasm  as  medically  unacceptable  IAW  AR  40-501.    Dysmenorrhea, 
gastroesophageal reflux disease (GERD), bladder spasms, migraine headaches, scoliosis, sickle 
cell trait and seasonal allergic rhinitis conditions, identified in the rating chart below, were also 
identified  and  forwarded  by  the  MEB.    The  Physical  Evaluation  Board  (PEB)  adjudicated  the 
fibromyalgia  and  asthma  conditions  as  unfitting,  rated  10%  and  10%  respectively,  with 
application  of  the  Veteran’s  Affairs  Schedule  for  Rating  Disabilities  (VASRD).    The  remaining 
conditions were determined to be not unfitting and not rated.  The CI made no appeals, and 
was medically separated with a 20% disability rating. 
 
 
CI CONTENTION:  The CI elaborated no specific contention in her application. 
 
 
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.    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 service Board for Correction of Military Records. 
 
RATING COMPARISON: 
 

Service IPEB – Dated 20011219 

VA (7 Mos. Pre -Separation) – All Effective Date 20020301 

Condition 

Fibromyalgia 
Asthma  
Dysmenorrhea 
GERD 
Bladder Spasms 
Migraine Headaches 
Scoliosis 
Sickle Cell Trait 

Rating 
10% 
10% 

Code 
5025 
6602 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

Condition 

Fibromyalgia 
Asthma 

GERD 
Bladder Spasms 
Migraine HA 

NO VA ENTRY 

Code 
5025 
6602 

Rating 
20% 
10% 

Exam 

20010726 
20010726 

7399-7346 
7599-7517 

8100 

10% 
0% 
0% 

20010727 
20010726 
20010726 

NO VA ENTRY 
NO VA ENTRY 

NO VA ENTRY 

0% X 2  

Combined:  40% 

Seasonal Allergic Rhinitis 

Not Unfitting 

Combined:  20% 

↓No Additional MEB/PEB Entries↓ 

in  DoDI  6044.40,  however,  resides 

20010726 
ANALYSIS SUMMARY:  The Board notes 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.  This role and authority is granted 
by  Congress  to  the  Department  of  Veterans  Affairs  (DVA).    The  Board  utilizes  DVA  evidence 
proximal  to  separation  in  arriving  at  its  recommendations;  and,  DoDI  6040.44  defines  a  12-
month interval for special consideration to post-separation evidence.  The Board’s authority as 
defined 
in  evaluating  the  fairness  of  DES  fitness 
determinations  and  rating  decisions  for  disability  at  the  time  of  separation.    Post-separation 
evidence therefore is probative only to the extent that it reasonably reflects the disability and 
fitness implications at the time of separation. 
 
Fibromyalgia Condition.  Fibromyalgia is described in the VASRD as widespread musculoskeletal 
pain  and  tender  points  with  or  without  fatigue,  sleep  disturbance,  stiffness,  paresthesias, 
headache,  irritable  bowel  symptoms,  depression,  anxiety,  or  Raynaud’s  like  symptoms.    The 
rating  is  based  upon  the  frequency  of  symptoms  without  regard  to  severity  or  impact  on 
function.  A 10% rating applies when the symptoms are controlled by medication; a 20% rating 
applies when the symptoms are episodic, with exacerbations, present more than one third of 
the time;  a 40%  rating  applies  when  symptoms  are  constant,  or  nearly  so,  and  refractory  to 
treatment.  At the VA Compensation and Pension (C&P) exam, 7 months prior to separation, 
the  CI  reported  body  pains,  muscle  spasms,  sleep  disturbance,  and  chronic  fatigue.    She 
reported daily symptoms with some relief with Celebrex, Tylenol #3, Skelaxin, and Vicodin.  The 
physical examination was significant for 11 tender points.  At the time of the narrative summary 
(NARSUM)  and  a  rheumatology  consultation,  6  months  and  4  months  prior  to  separation 
respectively,  the  CI’s  symptoms  had  been  present  for  more  than  3  years.    These  symptoms 
included  upper  and  LBP,  substernal  chest  pain,  left  lower  extremity  pain,  fatigue,  sleep 
disturbance,  paresthesias,  and  headaches.    The  CI  was  on  multiple  pain  medications  (anti-
inflammatory  and  narcotic),  muscle  relaxants,  and  an  antidepressant  for  control  of  her 
fibromyalgia symptoms.  The CI was placed on a P3 profile with no running, jumping, marching, 
or weight bearing greater than 25 pounds.  The NARSUM examination noted multiple tender 
points at the knees, iliac spines, scapula, chest, and sternum.  The rheumatologist indicated that 
headaches occurred daily, and that average daily pain severity was 7/10.  Medication was noted 
to  be  helpful  in  reducing  the  pain  severity.    One  sick  slip  was  in  evidence  for  fibromyalgia 
related pain, dated 26 December 2001.  
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB rated the fibromyalgia condition at 10% coded 5025, while the VA assigned a 20% rating 
under the same code.  Board members agreed that the 40% criteria were not present in this 
case,  and  debated  between  a  10%  and  20%  rating.    The  Board  considered  that  there  were 
several  entries  in  the  service  treatment  record  describing  chronic  daily  symptoms  but  that 
combined medication therapy was helpful.  However, the Board majority concluded that the 
paucity  of  sick  slips  and  the  absence  of  emergency  or  acute  care  visits  failed  to  describe  a 
clinical picture consistent with symptoms “that are episodic, with exacerbations present more 
than one third of the time” as required for a 20% rating.  Symptoms that “require continuous 
medication for control” is considered the most accurate depiction of the condition.  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. 
 

Asthma Condition.  The NARSUM notes exercise induced bronchospasms diagnosed by a board 
certified  allergist  in  1998.    The  CI  was  placed  on  a  permanent  profile  and  treated  with  as 
needed  Albuterol. 
in  evidence,  with 
documentation of additional ratable criteria, which the Board weighed in arriving at its rating 
recommendation; as summarized in the chart below.   
 

  There  were  3  pulmonary  function  tests  (PFTs) 

Pulmonary Exam 
FEV1 (% Predicted) 

FEV1/FVC 

Meds 

VA ~7 Mo. Pre-Sep 

Pulmonary 2 Mo. Pre-Sep 

Pulmonary at Separation 

102% 
75% 

Results pre-bronchodilation 

are normal; as needed 
Albuterol. Beclovent 

115% 
72% 

96% 
73% 

As needed Albuterol 

As needed Albuterol 

§4.97 Rating 

10%  

10% 

10%  

Fibromyalgia 
Asthma 

 

 
At the VA Compensation and Pension (C&P) examination 8 months prior to separation, the CI 
reported  shortness  of  breath  and  persistent  cough  with  overexertion,  exposure  to  paint  or 
smoke, and respiratory illnesses.  Her asthma attacks were controlled by rest and use of the 
Albuterol and Beclovent.  The NARSUM examiner 6 months prior to separation noted that the 
only  active  medication  for  asthma  was  an  inhaled  bronchodilator  for  exercise  induced 
bronchospasm.  A review of pharmacy records for the year 2001 and an outpatient note on 26 
December  2001  (2  months  prior  to  separation)  did  not  indicate  that  an  inhaled  steroid 
medication  was  prescribed  or  being  used.    The  Board  directs  attention  to  its  rating 
recommendation  based on the  above  evidence.   Both  the PEB  and  the VA  rated  the asthma 
condition at 10%, for intermittent inhalational bronchodilator therapy and coded 6602, asthma, 
IAW VASRD §4.97.  There was no evidence in the treatment record for a higher rating of 30% 
based  on  PFTs,  daily  inhalational  or  oral  bronchodilators  or  inhalational  anti-inflammatory 
medications.  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 asthma 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  fibromyalgia  condition,  the  Board  by  a  vote  of  2:1 
recommends  no  change  in  the  PEB  adjudication.    The  single  voter  for  dissent  (who 
recommended 20%) did not elect to submit a minority opinion.  In the matter of the asthma 
condition  and  IAW  VASRD  §4.97, 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 

5025 
6602 

COMBINED 

10% 
10% 
20% 

The following documentary evidence was considered:   
 
Exhibit A.  DD Form 294, dated 20120703, w/atchs   
Exhibit B.  Service Treatment Record   
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXX, DAF 
           Acting Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXX, AR20130003777 (PD201201128) 
 
 
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)