RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-02449	
BRANCH OF SERVICE:  Army
DATE OF PLACEMENT ON TDRL:  20031027
Date of removal from tdrl: 20050707

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Network Switching Systems Operator) medically separated for endometriosis.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “endometriosis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated the endometriosis condition as unfitting, rated 30% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was placed on the Temporary Disability Retired List (TDRL).  Approximately 2 years later, the IPEB adjudicated the endometriosis condition as unfitting, rated 10%.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI has asked for consideration of all conditions.  Her complete submission is at Exhibit A.

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:  

Final PEB – 20050525	VA Rating Decision1 - 20040123	
TDRL Placement –20031204	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL2
Placement	TDRL3 Removal	
Endometriosis, Responsive to Depo-Provera	7629	30%	10%	Endometriosis	7629	30%	10%	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 8	
RATING:  30% → 10%	RATING:  40%	
1. Most proximate to TDRL Placement.
2. Rating derived from C&P exam dated 20031118, ~19 mos. pre-TDRL placement.  C&P missing from file but requested.
3. Rating derived from C&P exam dated 20040123, ~17 mos. pre-TDRL removal.

ANALYSIS SUMMARY:  

Endometriosis Condition.  The service treatment record (STR) augmented and substantiated the MEB narrative summary (NARSUM) dated 20 June 2003 that indicated the CI had lower abdominal /suprapubic pain since April 2002.  A pelvic ultrasound examination in July 2002 was normal except for free fluid.  Laparoscopy confirmed the diagnosis of endometriosis (uterine lining tissue found outside the uterus with symptoms of pelvic pain and infertility) in November 2002 and treatment consisted of oral contraceptives.  At an Emergency Room (ER) visit in March 2003, the CI complained of bilateral flank pain and right upper quadrant pain, which was suspected to be endometriosis.  Treatment consisted of Percocet (oxycodone, a narcotic and acetaminophen, a pain reliever) and hydration.  In May 2003 the CI reported constant pelvic pain and in June 2003 treatment with Depo Provera (medroxyprogesterone, a female hormone) was instituted.  An ultrasound study of the right upper quadrant on 19 June 2003 was normal.  The pelvic pain was significant; and, she missed time from duty and was unable to maintain her physical fitness.  Physical examination revealed the CI’s abdomen was generally soft and nontender with no palpable masses; gynecological findings were normal.  At the time of the NARSUM examination her condition was stable, but she did have continued right lower quadrant pain that was episodic in nature, cyclic, and worse just prior to and during her period with some relief after her period.  During the time of exacerbation, the severity of the pain was 8/10 (10 being the worst pain) and the duration was anywhere from 12 to 24 hours.  Her condition had not improved with time although it was not worse with time.

A P3 profile was issued on 1 April 2003 for chronic pelvic pain/endometriosis with limitations of no running, no wearing a rucksack or load bearing equipment and no lifting anything greater than 25 pounds.  At the MEB examination, the CI reported on DD Form 2807-1 dated 9 April 2003 that she had been getting hormone pills for endometriosis for the last 7 months.  The MEB physical examiner noted on DD Form 2808 dated 29 April 2003 the CI’s medical condition was endometriosis.  The commander’s statement dated 15 June 2003 indicated the CI’s profile restricted her from lifting over 25 pounds or going to the field; and, she had been out of her MOS since 1 September 2002.  As a result she was unqualified to perform her duties in a deployable division.  Additionally, she was unable to perform sit-ups or the 2-mile run for the physical fitness test.

The VA Compensation and Pension (C&P) examination dated 18 November 2003, performed approximately one month before TDRL placement, was not available for review.  Gynecologic follow-up on 14 December 2004 indicated the CI had hypomenorrhea (short or scanty periods) since she started the Depo-Provera and also had dyspareunia (difficult or painful intercourse).  The assessment noted the endometriosis was responsive to Depo-Provera and the CI was to continue the current management.  At the TDRL evaluation in March 2005, the CI, with a history of endometriosis, was noted to have had her last menstrual period on 25 July 2004.  She had bloating, difficulty with bowel movements, pain with intercourse, and painful periods [until the last one].  She received oral contraception, to include the seasonal halt of her menses, and had a good response to Depo Provera.  Pain occurred two to three times a week and she continued to receive Depo-Provera every three months.  The examiner indicated the CI’s condition was unchanged.  Examination performed in 2004 was unremarkable except for tenderness to palpation of the uterus and adnexa.  The CI continued to have symptoms, although they were improved with her current therapy.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 30% rating using code 7629 (Endometriosis) for chronic pelvic pain due to endometriosis for TDRL placement.  The VA assigned a 30% rating using coded 7629 for endometriosis.  The Board sought a route to a higher rating of 50%, but could not find one since there were no lesions involving the bowel or bladder confirmed by laparoscopy, pelvic pain or heavy or irregular bleeding not controlled by treatment, and bowel or bladder symptoms.

On TDRL removal the PEB assigned a 10% rating using code 7629 for endometriosis responsive to Depo-Provera.  The Board sought a route to a higher rating of 30%, which required pelvic pain or heavy or irregular bleeding not controlled by treatment.  While the Depo-Provera halted the CI’s menses, she still had pain two or three times a week as well as with intercourse and painful periods when they were present.  Furthermore, she did have pelvic pain marked by tenderness to palpation of the uterus and adnexa on examination.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the endometriosis condition on TDRL removal.  

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 condition, the Board unanimously recommends no change to the disability rating upon TDRL placement and a disability rating of 30%, coded 7629 IAW VASRD §4.116 upon removal from the TDRL.  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; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of her prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
		PERMANENT	
Endometriosis 	7629	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140520, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX, AR20160005108 (PD201402449)

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the
enclosed recommendation of the Department of Defense Physical Disability Board of
Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual's separation as a permanent disability retirement with the
combined disability rating of 30% effective the date of the individual's original medical
separation for disability with severance pay.

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:

a. Providing a correction to the individual's separation document showing that
the individual was separated by reason of permanent disability retirement effective the
date of the original medical separation for disability with severance pay.

b. Providing orders showing that the individual was retired with permanent
disability effective the date of the original medical separation for disability with
severance pay.

c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will
account for recoupment of severance pay, and payment of permanent retired pay at
30% effective the date of the original medical separation for disability with severance
pay.

d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP)
and medical TRICARE retiree options.

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:

Enclosure
CF:
( ) DoD PDBR
( ) DVA