RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01731
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Food Service Specialists) medically separated for gynecological conditions.  These conditions could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty, although she was authorized to perform alternate physical fitness testing.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  “Chronic pelvis pain, endometriosis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “endometriosis, with chronic pelvic pain” as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Chronic pelvic pain, PCOS [poly cystic ovary syndrome], endometriosis, migraines, sleep apnea, diabetes type II, PTSD, anxiety depression”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

IPEB – Dated 20040211	VA* -  Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Endometriosis, with Chronic Pelvic Pain	7629	10%	Endometriosis with Chronic Pelvic Pain	7629	30%	STR	
			Polycystic Ovary Syndrome	7699-7615	0%	STR	
Other x 0 (Not In Scope)	Other x 1	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20040726 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Endometriosis with Chronic Pelvic Pain.  According to the narrative summary (NARSUM), the CI was diagnosed with chronic pelvic pain (CPP) and endometriosis by laparoscopy on 24 April 2003.  Notes in the service treatment record indicated that the CI was treated for pelvic pain with dysfunctional uterine bleeding (DUB).  A gynecology (gyn) evaluation on 1 July 2002, noted a history of obesity, late menarche with irregular menses, and current symptoms of CPP with frequent and heavy menses.  The CI had previously been tried on oral contraceptives (OC) but stopped due to side effects, including significant weight gain.  Pelvic ultrasound reportedly showed multiple ovarian cysts without other abnormality.  Polycystic ovary syndrome (PCOS) was diagnosed and the CI was prescribed daily OC treatment.  The CI initially reported improvement on the medication, but then frequent and excessive DUB returned.  Laparoscopy on 24 April 2003 noted lesions in front of and behind the uterus and biopsies were diagnosed as endometriosis.  At a primary care visit on 5 August 2003 the CI reported pelvic pain and bleeding for a day and was advised to follow-up with gyn the next day at her scheduled appointment.  At the gyn evaluation on 6 August 2003 the CI reported that she stopped taking the OC due to side effects.  The CI requested a MEB because she had been on temporary duty for 2 years and had been flagged for her weight.  The pelvic examination was normal, blood work indicated the CI was not anemic, and the gyn examiner again prescribed OC medication.  At an emergency room visit on 4 February 2004 the CI reported abdominal pain and cramping (without bleeding) after a pelvic examination by gyn earlier in the day and that the symptoms were the same as usual following an examination.  Her last menses was noted to have been in October 2003 (not unusual for PCOS), and a pregnancy test was negative.  The exam noted the abdomen was soft, with mild localized lower abdominal tenderness to palpation.  The CI was in the middle of an evaluation by an endocrinologist for other causes of her weight gain at the time of separation and an outpatient VA treatment note on 19 July 2004 indicated a recent full endocrine work-up was negative.

At the MEB NARSUM examination on 12 January 2004, 3 months prior to separation, the CI reported CPP and the MEB examiner noted that the CI was using OC.  The exam cited the MEB DD Form 2808, Report of Medical Examination, dated 21 October 2003 which was normal and the 12 August 2003 gynecology examination (8 months prior to separation) reviewed above, which noted an unremarkable pelvic examination.

There was no VA Compensation & Pension examination prior to the original VARD which was based upon service medical records.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the endometriosis with CPP condition 10%, coded 7629 (endometriosis).  The VA rated it 30%, coded 7629 and also rated PCOS 0%, coded 7699-7615 (analogous to disease, injury, adhesions of the ovary).  The evidence in record supports that the CI was diagnosed by laparoscopy with endometriosis and PCOS.  The Board noted that there was conflicting information regarding whether the CI was taking the OC medication or not.  However, notes in the STR proximate to separation indicated that after a period of stopping it, the CI was again prescribed OC medication, and the NARSUM indicated the CI was using OC.  Regardless, the Board noted that the evidence supports that proximate to separation the CI’s symptoms were much improved.  Although irregular menses continued, there was no evidence in the 11 months prior to separation of continued frequent or excessive DUB.  Following the diagnostic laparoscopy in April 2003, examinations were normal or noted mild lower abdominal tenderness and blood work documented that the CI was not anemic.  Members agreed that based on the evidence in record the disability due to the endometriosis condition met the 10% rating coded either as 7629 or as 7699-7615 according to the general formula for rating disease, injury, or adhesions of the female reproductive organs, both specified as symptoms that require continuous treatment, but did not meet the next higher evaluation of 30% characterized as symptoms not controlled by continuous treatment.  The Board notes that the CI’s pelvic symptoms cannot be rated both as endometriosis and separately as PCOS in consideration of VASRD §4.14. (Avoidance of pyramiding).  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the CPP 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 endometriosis and CPP condition and IAW VASRD §4.116, the Board unanimously recommends no change in the PEB adjudication.

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131021, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20150018463 (PD201301731)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA