RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD1300219
BRANCH OF SERVICE:  Army	BOARD DATE:  20130917
SEPARATION DATE:  20020828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (63B/Light Wheeled Vehicle Mechanic) medically separated for abdominal pain.  The CI underwent a cesarean section in October 2000 and experienced chronic abdominal pain at the site of the surgery since that time.  She was treated with injections of steroids and Lidocaine at the site but only experienced short term relief.  The condition 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 chronic abdominal pain condition, characterized as “chronic abdominal pain, possibly due to adhesions,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “chronic incisional abdominal pain in cesarean section scar” as unfitting, rated 10%. The CI made no appeals and was medically separated.

CI CONTENTION:  “I was medically discharged from active duty with a 10% rating for a scar.  All of my medical records states chronic abdominal pain.  The medical codes used on my MEB was 789.05 (Abdominal Pain) and 614.6 (Abdominal Adhesions) yet I was MEB for a scar.  I went to the hospital for a C-Section. After the surgery I was discharged from the hospital with an infection in my stomach.  The womb seperated.  You could stick your whole wrist and part of your arm through my stomach.  I had to get the womb packed and scurbbed 3 times daily.  It was extremly painful.  My stomach was closed up for a second time with infection.  After the second closure I couldn't hardly walk, stand, stoop or strech . It felt like something was ripping inside.  I was on severe pain medication.  I was geting nerve block shots to control the pain sometimes just straight lidocaine was injected at the ER.  I still was receiving pain injections after release from active duty.  I am 100 percent disabled (individual unemployability). My condition has gotten worse. My bladder was affected by adhesions causing urinary incontinence.  I am extremely depressed. I still have extereme problems with my abdomen. the adhesion continue to grow. There is no cure for my illness. Please re-evalute my claim.  I love the Army and my country but I am a veteran in need.  Please help me." [sic]

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 chronic abdominal pain 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 20020819	VA - (~3 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Incisional  Abdominal Pain in Cesarean Section Scar	7804	10%	Incisional Abdominal Pain, S/P C-Section	7804	10%	20020514	
No Additional MEB/PEB Entries	Other x 1	20020514	
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20020924 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  The Board acknowledges the CI’s contention regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans' Affairs, operating under a different set of laws.  The Board considers VA evidence within 12 months only to the extent that it reasonably reflects the disability at the time of separation.

Chronic Abdominal Pain Condition .  The CI underwent a cesarean section on 27 October 2000, but developed an incision infection which had to be reopened and repacked.  A 15 November 2000 treatment note stated that the incision was closed and healing well with good granulation tissue.  In a January 2001 obstetrics and gynecology evaluation, the examiner noted that the incision was well healed with mild tenderness to palpation at the right 1/3 of the incision.  The CI was returned to duty and placed on a temporary clothing and activity restricting physical profile.  The narrative summary (NARSUM) conducted a month prior to separation notes that the CI continued to report chronic incisional pain despite treatment with multiple oral medications and incisional steroid injections.  The CI reported abdominal pain at the site of the surgical scar as 7 on a scale of 0-10.  The pain would emerge as the day progressed and was made worse by strenuous activity.  The CI was diagnosed with chronic abdominal pain due to adhesions and was placed on a P3 profile.  The NARSUM examination noted a 14 cm surgical scar in the mid-abdomen.  The abdominal examination documented that her abdomen was soft, nontender, not distended and without masses.  At the VA Compensation and Pension (C&P) examination performed 3 months prior to separation, the CI reported persistent tight pulling sensation as 7 on a scale of 0-10 pain daily.  The pain was made worse with strenuous activity.  She also reported difficulty lifting her son and with walking.  The VA examination was significant for a 14 cm transverse lower abdomen, non-sclerotic and nonhypertrophic surgical scar that was tender to palpation on routine touch.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and the VA adjudicated the chronic incisional abdominal pain condition as a painful scar with a service rating of 10%.  The Board considered that the MEB forwarded chronic abdominal pain possibly due to adhesions as medically unacceptable.  Treatment notes listed multiple oral medications and steroid injects as failed treatments.  A treatment note, 5 months prior to separation, states a recommendation for surgical intervention for probable adhesions.  Although distant from separation, an operative report dated 30 November 2006, documented “a very thick adhesion from the abdominal wall to the uterine fundus” that was lysed and sutured.  Ratings under the “general rating formula for disease, injury, or adhesions of female reproductive organs” are based on the need for or response to continuous medication for symptom control.  Multiple entries in the treatment record evidenced that the chronic incisional abdominal pain attributed to adhesions was refractory to treatment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the chronic incisional abdominal pain due to adhesions 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 chronic abdominal pain condition, the Board (by a vote of 2:1) recommends a disability rating of 30%, coded 7613 IAW VASRD §4.116.  The single voter for dissent (who recommended no recharacterization) did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Abdominal Pain due to adhesions	7613	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130429, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB / XXXXXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXXXXXXXXXXXXX, AR20130021822 (PD201300219)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl