RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00516
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Wheeled Vehicle Mechanic, medically separated for “chronic bilateral flank pain with recurrent nephrolithiasis,” with a disability rating of 0%.

CI CONTENTION:  The CI contends that he had other medical conditions that “should have been addressed at the time of separation.”  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 on 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 - 20061220	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Flank Pain with Recurrent Nephrolithiasis	7508	0%	No VA Examination Proximate to Separation In Evidence	
Antisocial Traits	Not Unfitting		
Plantar Fasciitis	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Bilateral Flank Pain with Recurrent Nephrolithiasis (Kidney Stones).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s kidney stone condition became symptomatic in May 2002 while deployed.  Despite repeated interventional treatment procedures (scopes with stent placement in September 2004 and April 2005) as well as drug and diet therapy, the CI continued to produce bilateral kidney stones and was unable to be rehabilitated to meet the physical requirements of his military specialty. He was then referred for an MEB which forwarded “chronic bilateral flank pain with recurrent nephrolithiasis” for PEB adjudication.  

The MEB NARSUM examination on 20 August 2006, 4 months prior to separation, noted complaints of bilateral flank pain with activity.  His general physical examination (PE) conducted 2 months earlier (6 months prior to separation) was unremarkable.  He was not on medication at the time of this examination.  His diagnosis remained unchanged.  There was no VA Compensation and Pension examination performed proximate to separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral kidney condition at 0%, coded 7508 (nephrolithiasis) citing the CI’s chronological medical history.  First, it is clarified that the bilateral flank pain condition is not clinically separate from the unfitting kidney stone condition.  Such painful flank symptoms are subsumed under the Board’s rating recommendation for the primary kidney stone condition.      

Board members then agreed that the PEB’s use of VASRD code 7508 was a direct correlation to the submitted unfitting diagnosis of nephrolithiasis.  VASRD guidelines specifically state the following under code 7508: “Rate as hydronephrosis (kidney swelling) VASRD code 7509, except for recurrent stone formation requiring one or more of the following:  (a) diet therapy, (b) drug therapy, or (c) invasive or non-invasive procedures more than two times per year.”   This case met at least one of the above “exception” criteria and hence supported a rating under code 7508.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a disability rating of 30% for the kidney stone condition, coded 7508. 

Contended Conditions: Antisocial Traits, Plantar Fasciitis, Chronic Low Back Pain, and Hyperlipidemia.  The Board’s main charge is to assess the fairness of the PEB’s determination that any of the above listed contended conditions were not unfitting.  None of the contended conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the STR that any of these conditions significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB’s fitness determinations and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the bilateral kidney stone condition, the Board unanimously recommends a disability rating of 30%, coded 7508 IAW VASRD §4.115b.  In the matter of the contended antisocial traits, plantar fasciitis, chronic LBP, and hyperlipidemia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Bilateral Flank Pain with Recurrent Nephrolithiasis 	7508	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, 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-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170004801 (PD-2015-00516)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

			       
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA