DEPARTMENT OF THE NAVY

BOARD FOR CORRECTION OF NAVAL RECORDS

2 NAVY ANNEX

WASHINGTON DC 20370-5100

Docket No: 4882-02
21 January 2003

This is in reference to your application for correction of your naval record pursuant to the
provisions of title 10 of the United States Code, section 1552.

A three-member panel of the Board for Correction of Naval Records, sitting in executive
session, considered your application on 16 January 2002. Your allegations of error and
injustice were reviewed in accordance with administrative regulations and procedures
applicable to the proceedings of this Board. Documentary material considered by the Board
consisted of your application, together with all material submitted in support thereof, your
naval record and applicable statutes, regulations and policies.

After careful and conscientious consideration of the entire record, the Board found that the
evidence submitted was insufficient to establish the existence of probable material error or
injustice. In this connection, the Board substantially concurred with the comments contained
in the rationale of the hearing panel of the Physical Evaluation Board that considered your
case on 28 July 1999, a copy of which is attached. Accordingly, your application has been
denied. The names and votes of the members of the panel will be furnished upon request.

It is regretted that the circumstances of your case are such that favorable action cannot be
taken. You are entitled to have the Board reconsider its decision upon submission of new
material evidence or other matter not previously considered by the Board. In this regard,
important to keep in mind that a presumption of regularity attaches to all official records.

and
it is

Consequently, when applying for a correction of an official naval record, the burden is on the
applicant to demonstrate the existence of probable material error or injustice.

Sincerely,

W. DEAN PFEIFFER
Executive Director

Enclosure

SAN DIEGO FORMAL PEB RATIONALE

A medical board was held at
on 07 January 1999 with the

Fibromyalgia (7291)
Lumbar degenerative disk disease (72293)
Left supraspinatus tendinitis (7260)
Orthostatic hypotension (4580)
Hypoglycemia (2512)
Bilateral hallux valgus (7350)
Gastroesophageal reflux (53081)
Mitral valve prolapse (4240)
Migraine headaches (3469)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10. Pelvic pain (71945)
11. Failed bunion reconstruction (7350)

The informal Physical Evaluation Board found the member unfit for duty on
17 May 1999 under VA Code 5025, rated her condition at 20% disability and
separation with severance pay.

This member appeared before the formal PEB on 28 July 1999 requesting to
be found unfit for duty under VA Codes 5025 at 20% (fibromyalgia), 8100
(migraines) at 
40% disability and placed on the TDRL.

lo%, and 5295 (lumbosacral strain) at 10% for a total of

Accepted documentary evidence consisted of:

Exhibit A 
Exhibit B 
Exhibit C 
Exhibit D 
Exhibit E 

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-
-
-
-

Exhibit F 
Exhibit G 

PEB Case File
Additional Medical Evidence
Fitness Reports
PRT Data
Ltr from Orthopedic Association of Corpus  
Dtd 16 Jul 99
Ltr from Major M. D. Harris,

-
- Ltr from Neurology dtd 22 Jun 99

Christi

MC, USAF dtd 10 Jun 99

and,lumbosacral  strain.

The member's medical board of 7 January 1999 reports 11 diagnoses.
member appears requesting ratings for three diagnoses:
migraines,
medical board, the member's medical record indicates that she has been
worked up and extensively evaluated for pain complaints referable to
every organ system in the body.
The leitmotif of all these complaints
has been a combination of dramatic subjective symptoms with little or no
objective signs.
ratings will be addressed seriatum.

The member's three diagnoses for which she seeks

Besides the 11 diagnoses in the

fibromyalgia,

The

The first diagnosis for which the member seeks a rating is fibromyalgia.
The medical board notes that,

in the six months preceding the board, the

.

Enclosure (1)

,

members evaluations had been primarily for her right shoulder and low
back pain.
The member was diagnosed with mild tendinitis in the left
supraspinatus tendon.
the member was referred both to a
neurologist and rheumatologist to evaluate the numbness in her left arm
associated with the low back pain and the shoulder pain.
physician felt that the member probably suffered from fibromyalgia. A
work-up for rheumatologic etiologies was negative.
a presumptive diagnosis of fibromyalgia.

Subsequently,

The member was given

The evaluating

The member submitted additional medical evidence in Exhibit F, which is a
letter from a staff rheumatologist at Wilford Hall Medical Center. In
this letter, the rheumatologist, Major Mark D. Harris, MC, USAF, notes
that the member has the classical features of fibromyalgia.
on to state that fibromyalgia is simply a chronic pain disorder for which
the treatments are palliative rather than curative. Dr. Harris then
discusses the possible disability from fibromyalgia.
the civilian community, approximately 25%
received some form of disability payment.
75% of such
patients do not receive disability.
He stated that the sequelae of
fibromyalgia may significantly erode the ability of an individual to
perform work requirements of regular and consist work hours in
attendance,

He notes that, in
of fibromyalgia patients have
Conversely,

as well as accurate and complete work.

He then goes

In fact, the member's performance

her fitness reports are an official

In the most recent report covering the period from February

She
This actually has represented a gradual improvement in
the member is noted to be

With regard to the member,
documentation of her work performance.
over the past five years has always been at or above standards in all
categories.
1998 to January 1999,
the member was rated overall "must promote".
was rated above standards in all categories except the standard for
military bearing.
the past five years.
involved in multiple activities beyond her job requirements.
include volunteering at the Salvation Army and Secretary of the National
Naval Officer's Association and an active planner for the Black Heritage
month activities for that organization.
for medical surgical nursing conference,
re-certified as a basic life support instructor and certified in ACLS.
Thus, the member's fitness reports make clear that the member does not
have evidence of the kinds of deterioration to which Dr. Harris referred
when discussing possible disability from fibromyalgia.

The member also attended courses
assessing and managing COPD, and

In the comments section,

These

With regard to the member's complaint of migraine headaches, the member
testified that she loses up to two days of work per week because of her
headaches.
indicates only approximate a dozen visits complaining of headaches.
There is no evidence that the member was sent SIQ for this headaches.
Moreover, there is no evidence of prostrating headaches any where in the
member's medical record.

However, a review of the member's medical record since 1990

Enclosure (1)

The member submitted additional medical evidence. contained in Exhibit G,
which is a letter from a neurologist at Wilford Hall Medical Center.
This notes that the member takes Fiorinal for her headaches, which
relieves the headaches 75% of the time.
Fiorinal does not work,
injection of Demerol.
visits to sick call for injections of Demerol, a controlled drug.
letter notes that the member states she misses 18 to
but that is not documented any where in the member's record.

It then states that, if the
the member goes to sick call and receives an

However, there is no documentation of frequent

The
  20 hours per week,

Again, referring to the member's performance evaluations, contained in
her fitness reports,
there is-no documentation of the member's missing
half her work week on a regular  
member's above average performance,
involvement in activities beyond the Navy.

This is contradicted by the
as well as her very significant

basis.

The medical board notes an MRI of the lumbosacral area,

L5-Sl with no significant effect on the
The physical examination in the medical board notes that

With regard to the member's request for a rating on lumbosacral strain,
the member wished to have this separated from her chronic pain of
fibromyalgia.
which showed a   mild,  broad based,
paracentra.1  disk protrusion at  
nerve roots.
the member's back was tender to palpation along the  
L4 and sacral area
and the sacral iliac joints bilaterally.
The member had some decreased
range of motion, but could still reach her hands to within six inches of
the floor on forward  
degrees.
was no evidence of muscle wasting, and no asymmetry.
of motor weakness or sensory loss any where in the examination.

The deep tendon reflexes were plus 2 and symmetrical.

flexion and could extend to approximately 30

disk bulge at  

L4-5 with a small, right

There were no areas

There

The civilian physician spoke of a right herniated L5 nucleus
where the Navy physicians

The member submitted a civilian orthopedic evaluation contained in
Exhibit E.
pulposus based on a reading of the same MRI,
had read it as only a mild disk bulge.
civilian was consistent with the Navy evaluation with one exception.
Neurologic  testing showed a  
4+/5 muscle strength in the right foot
peroneals versus the left.
Apart from that, the only other discrepancy
was that back extension was only to 15 degrees versus the 30 degrees
found by the Navy physician.
abnormal reflexes, or muscle wasting, or sensory deficits.
an evaluation done by the same civilian orthopedic associates, but a
different orthopod, on 23 June 1999,
examination,
specifically noted no muscle atrophy in the calf muscles and a negative
straight leg raise test.

including no weakness and normal sensation.

However, there was still no evidence of

found an entirely normal  

The physical examination from the

neurologic
That physician

Furthermore,

Enclosure (1)

.

Again, referring to the member's performance evaluations, there is no
documentation that the member's low back pain has adversely effected her
ability to function.

In evaluating any individual,
it is of paramount importance to remember
that the mere presence of a diagnosis is not synonymous with disability.
It must be established that the medical disease or condition underlying
the diagnosis actually interferes significantly with the member's ability
to carry out the duties of her rank and rate.
In the instant case, the
member has been evaluated for subjective pain complaints referable to
every organ system in the body.
The member seeks  
careful review of the documentary record,
member has performed adequately.
subjective complaints,
Her fitness reports indicate not simply that she has performed
adequately,
the past five years.
relevant medical evidence,
continued Naval Service.

Therefore, after careful consideration of all
the formal board finds the member fit for

but rather that her performance has actually improved over

she has minimal corroborating objective findings.

While the member has multiple, dramatic

.ratings  for three of these diagnoses.

Her medical board lists 11 diagnoses,.

However, on
it is quite clear that the

Enclosure (1)