RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02867
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Gas Turbine System Electrician, medically separated for “chronic left lower quadrant abdominal pain,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  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 - 20050418	VARD - 20060207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LLQ Abd Pain	7804	10%	S/P L Inguinal Nerve Entrapment	8530	10%	20050217	
			C-Section Scar	7805	0%	20050217	
Migraine with Aura	Not Unfitting	Migraines	8100	10%	20050217	
Multiple Psychosocial Stressors	Not Unfitting 	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Left Lower Quadrant Abdominal Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s abdominal pain condition began after lifting about 40 pounds on 21 February 2003.  She felt a sharp “pop” near the left side of the scar from her prior cesarean sections (1991 and 1994) and had the immediate onset of pain.  It did not resolve over the next few days and an ultrasound was then performed on 6 March 2003.  It showed a uterine fibroid (an abnormality in the muscle of the uterus), but was otherwise normal.  A subsequent ultrasound of the left inguinal region (left groin) was normal without evidence of a hernia.  She was treated with light duty, a period of limited duty (LIMDU), and pain management including medications and injections without resolution.  On 6 November 2003, scar revision was accomplished and complicated by wound opening (dehiscence).  It subsequently healed well.  On 9 February 2004, a second 8-month LIMDU was recommended.  However, the CI then discovered that she was pregnant and was placed on light duty for that.  She underwent an uncomplicated repeat cesarean section on 29 September 2004.  Her pain persisted despite medications and additional injections.  She was then referred for MEB.  The MEB report was dated 12 November 2004, 8 months prior to separation.  It noted that the CI could not perform full duty as her pain was aggravated by twisting, bending, and prolonged walking.  She denied incontinence and had no change in her bowel habits.  She was on a regular diet.  On examination, the left lateral aspect of the cesarean section scar was tender, but well healed and without evidence of herniation or infection.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 22 November 2004 and 15 February 2005, 9 and 5 months prior to separation, respectively, the CI reported ongoing pain from nerve entrapment.  On examination, she was noted to have tenderness in the left lower quadrant (LLQ), but without signs of an underlying abdominal problem (rebound and/or guarding).  Her gait was normal.  The scar was well healed without tenderness or adherence.  The VA Compensation and Pension (C&P) examination was performed on 17 February 2005, 5 months before separation.  The CI reported left groin pain for 3 years despite treatment.  She was unable to perform heavy lifting or carrying, prolonged walking or standing, or other strenuous activities.  She reported that she could walk, climb stairs, vacuum, and drive a car; however, she could not shower, shop, dress herself, or take out the trash.  On examination, she was noted to have tenderness in the LLQ, but again, without signs of an underlying abdominal problem (rebound and/or guarding).  Her gait was normal.  The scar was well healed without tenderness or adherence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LLQ abdominal pain at 10%, coded 7804 (unstable or painful).  The VA rated the scar at 0%, coded 7805 (other effects of scars), but also rated the CI at 10% for left inguinal nerve entrapment, coded 8530 (severe to complete paralysis of the ilio-inguinal nerve).  The Board noted that while the PEB and VA chose different coding options for the LLQ pain, both rated the condition at 10%.  The Board found no route to a higher rating.  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 left lower quadrant abdominal pain” condition.  

Contended PEB Conditions:  Migraine with aura and multiple psychosocial stressors.  The migraine with aura and multiple psychosocial stressors conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance based evidence from the record that the migraine condition significantly interfered with satisfactory duty performance at separation.  The multiple psychological stressors is not a diagnosis.  Rather, it denotes ongoing issues in her personal life such as her mother’s severe illness.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic left lower quadrant abdominal pain condition and IAW VASRD §4.118 and §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine with aura condition, the Board unanimously recommends no change in the PEB adjudication as Category III, not unfitting and not contributing to the unfitting condition.  In the matter of the multiple psychosocial stressors condition, the Board unanimously recommends no change in the PEB adjudication as Category IV, a condition which is not a physical disability.  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, 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 6 Jul 16

      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:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						 	 (Manpower & Reserve Affairs)