RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01704
BRANCH OF SERVICE:  Army	BOARD DATE:  20140730
SEPARATION DATE:  20050224

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve SFC/E-7 (31B/Military Police) medically separated for tender scars with intermittent pain, status post (s/p) four operative procedures in treatment of umbilical/ventral hernia.  The tender scars s/p umbilical/ventral hernia repair could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  His profile allowed for alternate aerobic events to satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  “Slight, intermittent abdominal pain, status post ventral hernia repair with mesh” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “tender scars with intermittent pain, status post four operative procedures in treatment of umbilical/ventral hernia” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI stated, “Please consider all conditions.”

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 tender scar s/p four hernia repairs is addressed below; 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 20041022	VA - (17.5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tender Scars…s/p Four Operative Procedures in Treatment of Umbilical/Ventral Hernia	7339-7804	10%	Status Post Ventral Hernia Repair with Mesh and Surgical Scar	7339	20%*	20060808	
Other x 0 (Not in Scope)	Other x 5	20060808	
Rating:  10%	Combined:  30%*	
Derived from VA Rating Decision (VARD) dated 20061106 (most proximate to date of separation [DOS]).  *VARD Decision Review Officer added 10% coded 7804 (tender scar) effective 20050225 (combined 40%) by VARD dated 20080311.

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.  The VASRD criteria for rating scars (7804) in effect at the time of separation were used (prior to the criteria change effective 23 October 2008).

Tender Scars with Intermittent Pain, s/p Four Operative Procedures in Treatment of Umbilical/Ventral Hernia.  The narrative summary noted a history of recurrent umbilical and ventral (abdominal) hernias with four operative repairs.  First surgery was in 1986 and the last surgery in September 2002 included a mesh repair.  Following the mesh repair, there was no hernia recurrence or intestinal problems.  At the MEB exam, the CI reported persistent “abdominal wall pains and tenderness.”  He was unable to do sit-ups or push-ups because it aggravated the abdominal surgery site and caused tenderness and pain.  The MEB physical exam noted a well-healed surgical scar with no evidence of any recurrent hernias.  The six inch mid-line scar was slightly tender to palpation.  The examiner indicated limited functional capabilities due to “tenderness and pain in the abdominal wall.”  Profile restrictions included lifting limited to 30 pounds, no marching, push-ups or sit-ups.

At the VA Compensation and Pension exam performed 17.5 months after separation, the CI reported constant and low-grade pain and discomfort at the area of his hernia surgery.  He reported that large meals, straining and lifting would cause pain in the abdomen in the area of the hernia repair.  He reported “being told to avoid straining and lifting and to avoid strenuous activity, as there is a good chance of having yet another rupture.”  Exam documented an 8x0.2 cm linear tender scar.  The scar had no depression, adherence or skin breakdown.  The mesh was palpable under the scar.  Abdominal exam documented tenderness over the scar from the ventral hernia repair and was otherwise normal (no hernia or guarding).  The examiner indicated problems with lifting and carrying, as well as “moderate” problems with chores, exercise, sports and feeding.  Additional comment was “unable to lift/strain or engage in strenuous activity due to possibility of repeated ventral hernia repair rupture.”

The Board directs attention to its rating recommendation based on the above evidence.  The PEB combined the tender scar and intermittent abdominal pain conditions under a single disability rating, coded analogously to 7339 (hernia, ventral, postoperative) and 7804 (scars, superficial, painful on examination) at 10%.  The VA initially coded the combined conditions as 7339 at 20%, but on appeal added a separate 10% rating for 7804 (painful scar).  The VASRD allows separate ratings for separately compensable conditions and the Board must follow suit (IAW DoDI 6040.44) if the PEB combined adjudication is not compliant with the tenants of VASRD §4.7 (higher of two evaluations), provided that each “unbundled” condition can be reasonably justified as separately unfitting in order to remain eligible for Service rating.  If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7, separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  The Board’s initial charge in this case was therefore directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.

The Board adjudged that the CI’s duty post-multiple surgeries (including mesh) treatment of his umbilical/ventral hernia led to unfitting activity restrictions and a weakened abdominal wall that was unfitting and best approximated the 7339 (hernia, ventral, postoperative) 20% rating criteria.  There was insufficient evidence that the tender scar was reasonably separately unfitting, therefore, no additional rating can be recommended.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the tender scars with intermittent pain s/p four operative procedures in treatment of umbilical/ventral hernia 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 tender scars with intermittent pain s/p four operative procedures in treatment of umbilical/ventral hernia condition, the Board unanimously recommends a disability rating of 20%, coded 7339 IAW VASRD §4.114 (schedule of ratings–digestive system) and a not separately unfitting scar condition.  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, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Tender Scars with Intermittent Pain Status Post Four Operative Procedures in Treatment of Umbilical/Ventral Hernia	7339	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140416, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150006331 (PD201401704)

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,   I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization 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:

Encl			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA