RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03522
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Automated Logistical Specialist, medically separated for “chronic abdominal pain” with a disability rating of 10%.

CI CONTENTION:  The CI asserts that she suffers from headaches, back pain, neck pain, shoulder pain and pain from behind her rib cage.  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 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 - 20060803	VARD - 20061118   	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Abdominal Pain	7301	10%	Pelvic Inflammatory Disease of Unknown Etiology	7614	0%	20060814	
COMBINED RATING:  10%	COMBIEND RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Abdominal Pain Condition.  The CI presented to acute care on 4 May 2005, 3 weeks after accession, with a history of vomiting after meals for the past 3-4 years.  One month later, on 13 June 2005, she was treated for a urinary tract infection (UTI).  She was seen several more times over the next few months for a UTI and an infection of the kidney.  On 14 September 2005, she reported chronic abdominal pain associated with nausea and vomiting present for the past 2 years.  She was again treated for a UTI and later treated for pelvic inflammatory disease (PID).  She continued to have pain and was seen on a regular basis for this condition.  She was evaluated in gastroenterology (GI) on 27 December 2005, and reported pelvic pain for a year, but denied a prior history of pain.  She was noted to have tested positive for Chlamydia and been treated several times without change in her symptoms.  She was thought most likely to have endometriosis (implants of uterine tissue in the pelvis, an abnormal condition) or possible adhesions (internal fibrous bands in the abdomen), but it was recommended that further evaluation be done to exclude a GI source of her pain.  She subsequently had an endoscopic (a flexible lighted instrument which is inserted into the body for diagnosis and also for treatment) examination (esophageal gastro-duodenoscopy [EGD] and colonoscopy) which was normal.  She was referred to obstetrics-gynecology (OB-GYN) for a laparoscopy (examination of the pelvis with an endoscope).  This was done on 15 February 2006 and showed adhesions which were treated.  Endometriosis was not seen.  She initially had improvement in her pain, but it recurred and persisted despite treatment.  On 10 April 2006, she was noted to have persistent, chronic pain with no firm diagnosis despite an extensive evaluation.  Referral for MEB was recommended.  At the MEB examination on 17 April 2006, the CI reported abdominal pain and recurrent cystitis.  The examiner noted that her abdomen was tender in all quadrants, but otherwise the examination was unremarkable.  A pelvic examination accomplished on 19 April 2006, was normal.  On 27 April 2006, she was treated in OB-GYN for a different condition; she denied current abdominal or pelvic pain.  Four days later she was evaluated for a bladder infection (cystitis).  A CT scan of the abdomen and pelvis on 18 May 2006, was normal.  The narrative summary (NARSUM) was dated 6 June 2006, 4 months prior to separation.  The CI reported her pelvic pain persisted after the laparoscopy, but was improved over the past 2-3 months.  The only thing that really helped her pain was Percocet and that she took about 1 a day.  On examination, her abdomen was mildly tender to palpation, but without other significant findings.  The scars were well healed.  Her diagnosis was chronic abdominal pain.  On 27 June 2006, the CI submitted a memorandum stating that her abdominal pain began in June 2005 while finishing basic training.  

At the VA Compensation and Pension (C&P) GYN examination performed on 14 August 2006, approximately 5 weeks before separation, the CI reported continued abdominal and pelvic pain.  The abdominal and pelvic examinations were remarkable for multiple piercings as well as a discharge (not diagnosed) in the vagina.  She was diagnosed with mild dysplasia of the cervix and chronic abdominal and pelvic pain.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB initially determined that the chronic abdominal pain existed prior to service (EPTS) without service aggravation.  The CI non-concurred and requested a Formal PEB.  Based on the testimony of the CI and a review of all the records, the PEB rated the chronic abdominal pain at 10%, coded 7301 (adhesions of the peritoneum).  The VA did not rate the CI for the abdominal pain, but did give non-compensable ratings for interstitial cystitis, coded 7512 (chronic cystitis), pelvic inflammatory disease, coded 7614 (fallopian tube disease, injury, or adhesions), and condyloma (venereal warts), coded 7899-7806 (analogous to dermatitis).  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 abdominal pain condition.  

BOARD FINDINGS:  In the matter of the chronic abdominal 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 20140708, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

27 JUL 2016

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 XXXXXXXXXXXXXXXXXX, AR20160011480 (PD201403522)

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.

Enclosure
CF:

( ) DoD PDBR
( ) DVA