RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01934
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20140508
SEPARATION DATE:  20050630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCPL/E-3 (0656/Data Network Systems) medically separated for recurring pilonidal cyst (painful boil that occurs at the end of the tailbone).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The recurring pilonidal cyst condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “recurring pilonidal cyst” as unfitting, rated 10%, with likely application of VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I had been placed on light duty for a length of time, exceeded by rules 0.5 years.  During this time I had surgery on my tailbone 2x for a pilonidal cyst referral both times, the wound would not heal and resulted in further damage to the nerves in the area and extended length of time in which I count [sic] not move freely.  This caused further damage to my lower back and spinal area, as the damage from the procedure and non-healing wounds caused the rest of my spine to over compensate for the nerve/muscle injury.  I had complained while still on duty about a possible hernia only to be told I had no issue.  The entire time I did also have an issue with my L3 secondary to the surgical procedure.  I have been on pain medication since then and will require further surgeries to correct the issue.  My herniated disc went ignored and was not considered during by med board.  I was discharged due to Dr. errors.”  

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 recurring pilonidal cyst condition is addressed below including possible residuals; 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 Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20050103	VA - (4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurring Pilonidal Cyst	7399-7335	10%	Tender Scar, Secondary to Status Post Excision Recurrent Pilonidal Cyst	7399-7804	10%	20050204	
No Additional MEB/PEB Entries	Other x 5		
Combined:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20050712 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  The Board acknowledges the CI’s opinion that a Service medical error contributed to his disability.  It is noted for the record that the Board has no jurisdiction to investigate or render opinions in reference to such allegations.  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate 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.  

Recurring Pilonidal Cyst Condition.  Service treatment records indicate the CI initially presented with pain over the tailbone area (of a week’s duration) on 21 October 2002.  Follow on examination, 25 October 2002, raised concern “for a start of a pilonidal cyst.”  Surgery was scheduled and subsequently cancelled for January 2003.  By 7 February 2003, the cyst had been intermittently draining blood and became more painful.  A pilonidal cystectomy was carried out on 25 February 2003 with a post-operative course marked by “multiple wound dehiscences (splitting open) that required packing of the wound several times.”  A second pilonidal cystectomy was performed with a primary closure on 31 June 2003.  It opened after the CI returned to full duty.  A third cystectomy with primary closure was performed on 23 April 2004.  Intermittent reopening and drainage as well as pain followed the surgical procedure.

The MEB narrative summary of 10 November 2004 noted an “approximately 2 cm round, erythematous (redness) area in [the] intergluteal fold immediately above the anus tenderness to palpation, no discharge, flat in appearance.”  A pathology report of the 7 February 2003 surgery indicated an epidermoid cyst and pilonidal sinus tract on 26 February 2003.  A bone scan obtained to rule out osteomyelitis (bone infection) revealed [a] normal pelvis.  CI complained of persistent pain over the involved area with occasional bloody discharge and was unable to remain sitting for prolonged periods of time, to squat, or to do any heavy lifting.  Additionally, he also had difficulties with his bowel movements.

The CI noted at the MEB examination that he “had recurring back spasms and pain since [the] pilonidal cystectomy” and had a cyst of the right buttock cheek and a pilonidal cyst, both of which were removed in February 2003 as well as a second surgery “on pilo” in April 2004.  At the MEB exam dated 1 November 2004, an “approximately 2 cm round, erythematous area in [the] intergluteal fold immediately above the anus [with] tenderness to palpation, no discharge, flat in appearance” was noted.  The CI suffered “from recurrence of [the] cyst with persistent reopening approximately once a month.”  The spine component of the examination was marked with an X in the normal column.

The non-medical assessment commanding officer indicated the CI was executing his technical duties in garrison, but he was unable to perform several duties due to his limited duty status.  The VA Compensation and Pension exam, performed 2 weeks after separation, indicated the CI had “gone without any drainage for the past month, since his activity has been curtailed, but it remain[ed] tender and sensitive.”  The incisional scar from his pilonidal cystectomies measured 12 cm x 3 cm.  The cystectomy scar was well-healed and there was no indentation, but there was a marked degree of atrophy (thinning or wasting) surrounding the modestly tender scar.  There was no swelling and there were no drainage sites or ducts.  Sphincter tone appeared normal to the anus.  There was no disfigurement, ulceration, adherence, instability, tissue loss, keloid formation, hypopigmentation, hyperpigmentation, abnormal texture and limitation of motion.  No burn scars were present.  Examination of the thoracolumbar spine (lower back) revealed no complaints of radiating pain on movement.  Muscle spasm was absent.  No tenderness was noted.  There was suggestive straight leg raising on the right at 60 degrees and suggestive straight leg raising on the left at 60 degrees.  However, range-of-motion was not impaired and there was no indication that the pilonidal cyst condition or scar limited back motion.  A VARD dated 12 July 2005 indicated a single treatment report dated 25 February 2002 for lower back pain, but at the VA examination back symptoms were noted to have been present for two years “going down into the right buttock area.”  The VA back rating was 0% coded 5237 for the lower back.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10% analogous to 7335 (anal fistula), which uses the rating criteria for impairment of sphincter control.  The 10% criteria is “constant slight, or occasional moderate leakage.”  There was no evidence the CI approached the higher 30% criteria of “occasional involuntary bowel movements, necessitating wearing of pad.”  The VA also rated the condition at 10%, but used analogous coding to 7804 (painful superficial scar).  The Board considered alternate coding under 7803 (unstable scar) or 7801 (deep scar), but there was no indication that the scar was exceeded 12 square inches or limited motion of any joint or the spine to warrant any rating higher the 10% IAW the VASRD in effect at the time (NOTE skin/scar rating criteria were changed to the current criteria in October 2008).  Coding under 7804 is closer to the ideal coding as there was no involvement of the anus.  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 rating level for the recurring pilonidal cyst condition; however, coding should be changed to 7804 (versus 7399-7335).

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 recurring pilonidal cyst condition and IAW VASRD §4.118 the Board unanimously recommends changing the PEB rating coding to 7804 at 10%.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends the prior determination be modified as follows, effective the date of medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Recurring Pilonidal Cyst	7804	10%	
COMBINED	10%	

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

		

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 12 Feb 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC