Citation Nr: 18143221 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 16-10 341 DATE: October 18, 2018 REMANDED Entitlement to service connection for fibromyalgia is remanded. Entitlement to a rating greater than 10 percent for right knee retropatellar pain syndrome is remanded. Entitlement to a rating greater than 10 percent for left knee retropatellar pain syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1996 to November 1998. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision of the Department of Veterans (VA) Affairs Regional Office (RO). Fibromyalgia The Veteran has a complicated disability picture. It is pertinent to note that the Agency of Original Jurisdiction (AOJ) granted service connection for Ehlers-Danlos syndrome in March 2016 and assigned a 100 percent rating effective September 11, 2014. That disability shares some of the same symptoms as fibromyalgia, including multi joint pain. The evaluation of the same "disability" or the same "manifestations" under various diagnoses is not allowed. See 38 C.F.R. § 4.14. A claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his or her earning capacity." Brady v. Brown, 4 Vet. App. 203, 206 (1993) (interpreting 38 U.S.C. § 1155). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. However, if a veteran has separate and distinct manifestations attributable to the same injury, they should be compensated under different diagnostic codes. See Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225, 230 (1993). The attribution of certain symptoms to certain disabilities is a finding of fact. The Veteran asserts that she has fibromyalgia due to physical trauma in service involving a leg/knee injury and a head, neck, and shoulder injury. Her service treatment records show that she was seen in 1997 for right calf and hamstring pain that began while on a run with the onset of bilateral knee pain shortly thereafter. They also show that she sustained a head injury due to a fall in basic training in November 1996, and she is service-connected for a traumatic brain injury. In support of her assertion, the Veteran submitted published medical articles which suggest that physical trauma can be a trigger for fibromyalgia. In light of this evidence, the Board finds that the requirements under McLendon v. Nicholson, 20 Vet. App. 79 (2006) have been satisfied with respect to affording the Veteran a medical examination in order to determine the nature and etiology of her claimed fibromyalgia. 38 U.S.C. 5103A(d). Greater than 10 Percent Ratings for Right and Left Knee Retropatellar Pain Syndrome The Veteran’s claims for higher ratings for right and left knee retropatellar pain syndrome are inextricably intertwined with her claim for service connection for fibromyalgia and must be deferred. This is so since a grant for service connection for fibromyalgia could significantly impact the knee disability ratings. 38 C.F.R 4.14; see also Harris v. Derwinski, 1 Vet. App. 180 (1991). Moreover, the Veteran asserted in March 2016 that her leg and knee problems were actually symptoms of fibromyalgia and that she was misdiagnosed as having right and left knee patellofemoral pain syndrome. She said that further testing would have shown this. As is noted above, the RO granted service connection for Ehlers-Danlos syndrome in March 2016 and assigned a 100 percent rating effective September 11, 2014. The Veteran is rated for Ehlers-Danlos syndrome by analogy to Diagnostic Code 5002 for rheumatoid arthritis as an active process. 38 C.F.R. 4.71a. The note to this code provides that ratings for the active process will not be combined with the residual ratings for limitation or motion or ankylosis. Instead, the highest evaluation is to be assigned. Accordingly, the Veteran would not be entitled to higher knee ratings for the period from September 11, 2014, based on limitation of motion. Also, any outstanding VA and private treatment records should be obtained and associated with the claim file. 38 U.S.C. 5103A(b), (c). The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claim file. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of her claimed fibromyalgia. The examiner should review the file and provide a complete rationale for all opinions expressed. The examiner must first determine whether the Veteran meets the criteria for a diagnosis of fibromyalgia. If so, the examiner should opine as to whether it is at least as likely as not (50 percent probability or higher) that any diagnosed fibromyalgia is related to an in-service injury, event, or disease, including treatment in service for leg and knee pain and for a head injury. 3. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Shawkey, Counsel