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AF | PDBR | CY2013 | PD-2013-01859
Original file (PD-2013-01859.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-01859
BRANCH OF SERVICE: Army  BOARD DATE: 20140730
SEPARATION DATE: 20060423


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard SSGT/E-6 (92Y30/Supply Specialist) medically separated for a fibromyalgia condition. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS). She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The fibromyalgia condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The informal PEB adjudicated “fibromyalgia, with diffuse pain, poor sleep and moderate fatigue” as unfitting, rated at 20%. The CI made no appeals and was medically separated.


CI CONTENTION: “I was sooo depressed & hurt that I threw the denial letter away! I gave all! And I lost everything. I owned & had built for me my four children-(a single Mom mind you) and was treated 4 depression, forever it seems, and was rejected again! LIFE SUCKS AS A VET!”


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 20050929
 VA - (16 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Fibromyalgia 5025 20% Fibromyalgia 5025 20% 20070830
Other MEB/PEB Entries X 0
 Other x 5
Combined: 20%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 20071015 ( most proximate to date of separation in evidence [ DOS ] ).


ANALYSIS SUMMARY:

Fibromyalgia Condition. The rheumatology MEB narrative summary (NARSUM) dated 28 June 2005, 10 months prior to separation, noted the CI was diagnosed with fibromyalgia in August 2004 by rheumatology consultation. The CI was found to have 15 (out of the 18) American College of Rheumatology’s tender points located above and below the waist, occurring symmetrically on both sides of the body, associated with diffuse pain greater than 3 months and severe fatigue. On the day of the examination she reported she was doing fair, but worse than a month prior. She reported morning stiffness lasting for 1 to 2 hours, poor non-restorative sleep, moderate fatigue and severe pain involving the upper, middle and lower back, right buttock, right wrist, right first metacarpal-phalangeal joint, bilateral knees, and bilateral ankles. She denied swelling except the right wrist, right hand (due to previous hand surgery) and right knee after running. She complained of dry mouth at night and shortness of breath due to continued smoking. She denied photophobia, red eyes, swollen glands in the neck, history of iritis, oral or nasal ulcers, pericarditis, Raynaud’s phenomemon, deep venous thrombosis, pulmonary embolism, pleurisy, psoriasis, dactylitis, seizures, psychosis, thrombocytopenia, leukopenia, dysphagia, heartburn, hematochezia, diarrhea, dysuria, hematuria, alopecia or skin rashes. She reported significant impact upon her ability to perform her activities of daily living including dressing herself, getting in and out of bed, walking outdoors on flat ground, washing and drying her body, bending down to pick up objects from the floor, getting in and out of a car, bus, train or airplane, walking two miles, participating in sports and games as she desires, getting a good night’s sleep, and dealing with feelings of depression. The symptoms also affected her ability to perform the duties required of her MOS including running, lifting more than twenty pounds, prolonged sitting, running, and walking. She also had difficulty driving long distances. Physical examination was notable for absence of synovitis (inflammation of the joints) and presence of trigger points involving the occipital muscles bilaterally, supraspinatus muscles bilaterally, gluteal muscles bilaterally, greater trochanteric points bilaterally, lateral epicondyles bilaterally and medial knees bilaterally. The medications were Percocet (narcotic), Vicodin (narcotic), and Mobic (nonsteroidal anti-inflammatory) and Trazadone (sedative antidepressant) for sleep.

At the VA Compensation and Pension (C&P) exam performed 30 August 2007, 16 months after separation, the CI reported symptoms that occur constantly, which means more than two-thirds of the time per year, and precipitated by drastic change in environmental temperature. She reported favorable response to treatment with narcotic medications, with side effects of depression and moodiness. Her pain was 6 out of 10; elicited by physical activity and relieved by rest. She can function without medication. She stated she could not keep up with her normal work requirements because of physical limitations. She reported being able to brush teeth, take a shower, vacuum, drive a car, cook, climb stairs, dress herself, take out the trash, walk, shop, garden and push a lawnmower. Physical examination revealed normal muscle strength, normal sensation and reflexes and significant for 18 tender points. Ranges-of-motion were normal at the shoulders, elbows, wrists, hips, knees, ankles, fingers and spine. The examiner’s findings were findings of subjective pain and objective tender points, with functional impairment and poor sleep. The effect of the condition on the claimant’s daily activity was determined to be moderate by the examiner.

The Board directs attention to its rating recommendation based on the above evidence. The Board considered VASRD diagnostic code 5025 (fibromyalgia) used by both the PEB and the VA for a 20% rating. The Board did not find evidence the symptoms were refractory to therapy for a higher adjudication, since the CI reported doing fair and reported favorable response to treatment with narcotic medications. There were however, symptoms of widespread musculoskeletal pain and tender points, with associated fatigue, sleep disturbance, stiffness, and depression, which were episodic, with exacerbations often precipitated by the environmental stress of changes in temperature, or by overexertion, that were present more than one-third of the time for a 20% rating. The Board did not find alternate VASRD codes that provided a higher rating. 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. 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 and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131022, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                          
         XXXXXXXXXXXXXXXXXX
         President
         Physical Disability Board of Review


 SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150001036 (PD201301859)

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                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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