RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02870
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090924

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-1, Equipment Repair Operator, medically separated for right lower quadrant pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty, but was authorized to perform an alternate aerobic physical fitness test.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right lower quadrant pain with physical activity status post right pyeloplasty” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Administratively Corrected Informal PEB adjudicated “right lower quadrant pain after right pyeloplasty evaluated analogous to hydronephrosis” as unfitting, rated 10% citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  “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 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 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:  

Admin Corr IPEB – Dated 20090910	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Lower Quadrant Pain…..	7599-7509	10%	Renal Stone With Hydronephrosis Also Claimed As Right Kidney Condition And Stones	7509	10%	20091109	
Other x 0 (Not In Scope)	Other x 4 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20091228 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY  

Right Lower Quadrant Pain Condition.  Treatment records evidence the CI had presented with severe right flank pain in April 2009.  A computed tomography (CT) scan performed on 21 April 2009 demonstrated right ureteral pelvic junction obstruction.   A stent was placed to allow the CI to complete basic training.  The CI later underwent a laparoscopic pyeloplasty (surgical reconstruction of the renal pelvis [a part of the kidney] to drain and decompress the kidney).  The CI presented to the emergency department (ED) in July2009 with reports of abdominal pain with passage of a kidney stone at the ED.  A CT scan performed 22 July 2009 demonstrated mild hydronephrosis (swelling of the kidney due to a build-up of urine), multiple kidney stones, and surgical clips.  Despite surgical and conservative management the CI continued to report intermittent right abdominal and flank pain.  At the narrative summary examination 7 August 2009 the CI reported 2/10 right lower quadrant abdominal pain which increased to 8/10 with running, push-ups, and sit-ups.  The pain radiated to his back and scrotum.  The physical examination demonstrated a well healed surgical scar, no significant abdominal tenderness, and no palpable masses.  A diagnosis of right lower quadrant pain with physical activity status post right pyeloplasty was rendered.  

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported abdominal pain with straining and lifting.  The physical examination revealed right lower quadrant tenderness to palpation, non-tender laparoscopic scars, and some abdominal discomfort with deep palpation.  A diagnosis of renal stone with hydronephrosis was rendered.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the unfitting right lower quadrant pain at 10%; coded 7599-7509 and 7509 (Hydronephrosis) respectively.  The Board considered whether the evidence supported a higher than 10% rating.  There was no evidence of frequent attacks of colic, requiring catheter drainage for a higher rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the right lower quadrant pain condition was appropriately recommended in this case.

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 right lower quadrant pain after right pyeloplasty condition and IAW VASRD § 4.115b, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  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 20140605, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

JUL 1 4 2016

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160005128 (PD201402870)

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