RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01273
BRANCH OF SERVICE:  Army  	Date of SEPARATION:  20080225

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Veterinary Food Inspection Specialist, medically separated for “chronic lower abdominal pain,” rated at 10%.  

CI CONTENTION:  The applicant’s condition continues to worsen and negatively impact her daily activities.  Her 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 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 - 20090318	VARD - 20080519  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Abdominal Pain	7699-7629	10%	S/P Ovarian Adhesions, S/P Exploratory Laparotomy with Residual Scars 	7615	0%	20080307	
			Umbilical Hernia S/P Surgical Repair with Residual Scar  	7339-7802	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Lower Abdominal Pain Condition.  The record shows that the CI had Caesarian sections in 2001 and 2004.  The latter was complicated by a wound infection, but otherwise uneventful.  She was seen in primary care for a 2-year history of right lower quadrant (RLQ) pain on 22 September 2006; the examiner recorded that the scars were well healed and non-tender.  She was tender to palpation in the left lower quadrant (LLQ) though.  She was seen again 3 days later and had persistent LLQ tenderness and a mid-line hernia.  Her pain had resolved when next seen on 13 October 2006 and the hernia was then repaired that same month.  Following surgery, she noted pain on the right side of her body when she moved wrong.  An evaluation in general surgery on 9 November 2006 was unremarkable.  The incisions were well-healed and the hernia repaired.  She was then referred to gynecology for persistent pain and in April 2007, underwent laparoscopic lysis of adhesions including freeing the left ovary from the pelvic sidewall.  This failed to resolve her symptoms.  The next clinical record in evidence, and the last prior to separation, is an emergency room note which documented RLQ pain following sit-ups during physical training.  She was thought to have non-specific abdominal pain.  A computerized tomography (CT) scan in July 2007 was normal with the surgical mesh (for the hernia repair) in place.  At the MEB examination on 24 October 2007, 4 months prior to separation, the CI reported ongoing abdominal pain which did not resolve with medications although it was improved.  On examination, the scars were noted to be well-healed, but tender to touch at the left edge.  The examination of the abdomen itself was checked normal.  The narrative summary (NARSUM) was dated 6 December 2007.  It noted persistent generalized abdominal pain which was worse in the LLQ.  On examination, the scar was noted to be mildly tender as was the LLQ.  She was thought to have chronic abdominal pain of unknown etiology, likely multifactorial and secondary to abdominal adhesions and possibly the surgical scar (C-section).  At the VA Compensation and Pension (C&P) examination performed on 7 March 2008, 2 weeks after separation, the CI reported that the condition did not affect her general health or her weight.  She denied incapacitation.  The LLQ pain was spontaneous, but also aggravated by intercourse.  She denied limitations in the activities of daily living including mowing the lawn.  On examination, multiple scars were noted which were non-tender and well healed.  The examination of the abdomen was unremarkable and non-tender.  Her gait was normal.  She was thought to have a normal examination (other than the presence of scars).  The impact on her occupation and on daily activity was minimal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic lower abdominal pain at 10% for continuous treatment, coded 7699-7629 (analogous to endometriosis).  The VA rated the CI at 0% for the history of adhesions, coded 7615 (ovarian disease) noting that the CI did not require continuous treatment.  The CI was also rated at 0% for the residual scar from the umbilical hernia repair, coded 7339-7802 (ventral hernia and superficial scars).  The Board considered the evidence and found no route to a rating higher than the 10% adjudicated by the PEB.  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 adjudication for the chronic lower abdominal pain condition.  

BOARD FINDINGS:  In the matter of the chronic lower abdominal pain condition and IAW VASRD §4.7116, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160005877 (PD201401273)

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
( ) OVA