RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03727
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Supply Systems Analyst, medically separated for “chronic pain in surgical scar,” 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 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 - 20040629	VARD - 20050511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain in Surgical Scar	7804	10%	Nerve Damage Due To ... Surgery	8599-8530*	10%	20041126	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	
* Erroneous entry in VARD; 8530 does not exist; intended code was 8630 (see narrative).  

ANALYSIS SUMMARY:  

Chronic Pain in Surgical Scar.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI underwent right renal surgery (partial nephrectomy for cystic mass) in 2000, complicated by subsequent kidney stones and interventions (stent placement, followed by removal).  There was no STR evidence of any significant post-operative complaints or persistent pain following any of the procedures.  The first STR evidence for the unfitting complaint was a nephrology consult from March 2004, 5 months prior to separation.  This documented a complaint of “pain recurrences” while being administratively separated.  Her separation was placed on hold to facilitate a work-up.  This evaluation (including CT, ultrasound, and bone scan) did not identify any pathology as a possible cause of the pain.  There was a paucity of entries in the available STR addressing specific complaints or diagnosis.  There was no STR evidence for any additional symptoms or acute features.  Continued treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “post-surgical nerve pain” to the PEB.  

The NARSUM examination in June 2004, 10 weeks before separation, stated, “Patient is being administratively discharged by her unit but complains of several year history of right posterior flank pain since surgery, increasingly worse last several months requiring use of opioid analgesics.”  The physical examination recorded “oblique surgical scar along right posterior flank ...  marked point tenderness ... over the most medial aspect,” and yielded the above diagnosis submitted by the MEB.   

A VA Compensation and Pension (C&P) examination in November 2004, 3 months after separation, documented a claim of “nerve damage due to surgery for renal condition” and did not elaborate the history or duration of the pain.  At the time of the examination it was described as bilateral flank pain, most prominently on the right, with frequent “muscle spasms” and rated 3/10 as the average pain level.   The physical examination recorded bilateral flank (nephrectomy) surgical scars with “pain on light touch ... withdrawal reflex” on the right.  Pertinent negatives for other VASRD ratable scar findings were documented.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated under code 7804 (scars, unstable or painful) and its 10% determination was consistent with the “one or two scars” criterion of the code.  There was no higher rating achievable under any VASRD §4.118 scar code.  The VA, based on C&P evidence, rated analogously under the nerve code 8630 (ilio-inquinal neuritis), and its 10% determination for “severe” impairment was the maximum allowable.  It was noted that the neuroanatomy of the rated scar pain was not in the distribution of the ilio-inguinal nerve.  The scar was in a thoracic dermatome for which VASRD §4.124a does not provide specific coding.  Members considered analogous rating under code 8519 (long thoracic nerve), as equally defensible as the VA choice, which offers 20% for “severe” impairment; but, agreed that the disability in evidence was more consistent with “moderate” impairment (10% under 8519).  There was thus no advantage to nerve coding over scar coding; and, there are no other coding options under the VASRD which are applicable to this case, even for analogous 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 of the painful surgical scar condition.

BOARD FINDINGS:  In the matter of the painful surgical scar condition and IAW VASRD §4.118, 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 20140801, 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-2014-03727.

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