RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03116
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Fuels Journeyman, medically separated for “chronic right lower quadrant abdominal pain and flank pain”, with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The 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 based upon a 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 - 20081031	VARD - 20090619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Lower Quadrant Abdominal Pain and Flank Pain	7399-7301	10%	Chronic Right Lower Quadrant/Flank Pain, S/P Renal Infarct	7399-7301	10%	20090429	
			Crohn’s Disease	7399-7323	NSC	20090429	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Right Lower Quadrant Abdominal and Flank Pain.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right lower quadrant and abdominal pain condition began in October 2006.  Initial radiographic evaluation showed a right kidney infarction.  Follow-up radiographic evaluations demonstrated left kidney cysts, scarring of the right kidney, and peritoneal adhesions (scar tissue in the abdomen).  The MEB NARSUM examination on 29 March 2007 (22 months prior to separation) noted complaints of abdominal pain with exertion.  The MEB abdominal examination was normal.  A diagnosis of right renal infarct/hemorrhage, resolved by CT was noted.  At the VA Compensation and Pension (C&P) examination in April 2009, performed 4 months after separation, the CI reported constant right lower quadrant discomfort.  He also reported intermittent episodes of constipation and loose stools.  The physical examination showed a normal abdominal examination without focalized tenderness or masses.  The examiner noted negative radiographic evaluations of the abdomen and pelvis and a negative colonoscopy.  A urology evaluation dated 11 May 2009 documented reports of right lower quadrant pain with flare ups and bloody and painful urination on 29 April 2009.  The abdominal examination was normal.  A urinalysis demonstrated large blood in the urine.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 7301 code (Peritoneal, adhesions of), citing abdominal and flank pain.  The VA also assigned a 10% rating using an analogous 7301 code (Peritoneal, adhesions of) based on the VA C&P examination 4 months after separation, citing pulling pain during movements of the body, or occasional episodes of colic, nausea, constipation (perhaps alternating with diarrhea), or abdominal distension.  There was no evidence of partial obstruction manifested by delayed motility and painful episodes (7301) or frequent attacks of colic requiring catheter drainage under 7510 (ureterolithiasis); thus the next higher 30% rating was not justified.  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 right lower quadrant abdominal and flank pain condition.  

BOARD FINDINGS:  In the matter of the chronic right lower quadrant abdominal and flank pain condition and IAW VASRD §4.114, 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 20140610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03116.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings