RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE: PD-2014-00145
BRANCH OF SERVICE:  Army		SEPARATION DATE: 20050106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Combat Medic, medically separated for “chronic back, right hip, right buttock and right-sided abdominal pain” with a 10% disability rating.

CI CONTENTION:  “Each year the pain increases and more deterioration occurs.” The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 Veterans Affairs Schedule for Rating Disabilities (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

SERVICE PEB - 20050210	VARD - 20060518	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back, Right Hip, Right Buttocks and Right Sided Abdominal Pain	5237	10%	Chronic Low Back Strain with Degenerative Joint
Disease includes Groin Pain	5242	10%	20050506	
			Osteoarthritis Right Hip	5010-5252	0%	20050506	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Pain Right Hip, Right Buttock and Lower Back.  This CI has had right hip and right buttock pain since May 2001.  She frequently would sit on her left buttock, to shift the weight off the right side.  She was seen by numerous specialists, and had many different tests done.  In spite of all treatment efforts, her pain persisted and a medical Evaluation Board (MEB) was initiated.  In October 2004, her back range of motion (ROM) and right hip ROM were measured by physical therapy.  Those measurements are summarized in the charts below.  The MEB narrative summary (NARSUM) was dated 2 November 2004.  The CI reported that her pain was constant.  On physical examination there was mild tenderness to palpation (TTP) over the lateral right hip, but no TTP of the right buttock or the right sciatic notch.

On 6 May 2005, the CI had a VA Compensation and Pension (C&P) examinaiton.  She reported pain in her right hip, right groin and lower back.  The pain was aggravated by bending, stooping, walking, or heavy lifting.  She was using Ibuprofen (Motrin) on an “as needed” basis.  In the previous 12 months, she had not missed any work due to this chronic musculoskeletal pain condition.  On physical examination she was able to walk briskly, without any assistive device.  Gait and posture were normal.  She was able to walk on heel and toe, and fully squat.  There was no low back tenderness.  Straight leg raise was negative, and neurological exam was normal.  There was some discomfort with internal rotation of the right hip.  

IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional impairment and functional loss due to painful motion.  There was no path to a higher rating for this condition, since there was insufficient evidence of a seriously disabling bone, joint, or muscle abnormality that would justify a higher rating.  These bundled conditions do meet criteria for a 10% disability rating, IAW VASRD §4.40, §4.45, §4.59, and §4.71a.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the chronic musculoskeletal pain condition; involving right hip, right buttock and lower back.

Chronic Abdominal Pain.  In 1982, this CI had a laparoscopic appendectomy.  In May 2001, a second laparoscopy was done, for lysis of adhesions.  After that, she continued to have abdominal pain in the right lower quadrant (RLQ).  At the November 2004 MEB examination, there was no hepatosplenomegaly or masses.  She had mild to moderate tenderness to palpation in the RLQ.  The NARSUM diagnosis for the abdomen was “chronic right abdominal pain.”  At the May 2005 C&P exam, the CI did not complain of abdominal pain.  The abdomen was not examined.

The Board directed its attention to its rating recommendation based on the evidence.  The May 2005 C&P examination was just 4 weeks before the date of separation, and therefore had significant probative value.  At that examination, the CI did not complain of abdominal pain.  The chronic pain in the abdomen had apparently resolved.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 0% for the chronic abdominal pain.

BOARD FINDINGS:  In the matter of the chronic musculoskeletal pain involving the right hip, right buttock, and lower back, the Board unanimously recommends a disability rating of 10%, coded 5299-5237, IAW VASRD §4.71a.  In the matter of the chronic post-surgical abdominal pain, the Board unanimously recommends a disability rating of 0%, coded 7399-7301, IAW VASRD §4.114.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Pain (Right Hip, Right Buttock and Lower Back)	5299-5237	10%	
Chronic Post-Surgical, Right-Sided Abdominal Pain	7399-7301	0%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131224, with attachments
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, AR20160006623 (PD201400145)

1.  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, accept the Board’s recommendation to modify the individual’s disability description without modification of the combined rating or re-characterization of the individual’s separation.  This decision is final.  

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.   

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:

CF: 
(  ) DoD PDBR
(  ) DVA