RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00714
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060403

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Network Switching Systems Operator/Maintainer, medically separated for “abdominal pain most likely due to adhesions,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his condition continues to worsen and negatively impact his daily activities.  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 - 20051221	VARD - 20061006	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Abdominal Pain…	7301	10%	Surgical Residuals of Perforated Duodenal Ulcer, to Include Surgical Scar	7805-7305	20%	20060314	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Abdominal Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s abdominal pain condition began in April 2004 following a laparotomy for a ruptured duodenal ulcer.  Esophagogastroduodenoscopy (EGD) in January 2005 showed active chronic gastritis and duodenitis with H. Pylori infection (“cause” of ulcers), and the CI was treated with antibiotics.  Surgery specialist evaluation diagnosed chronic abdominal pain secondary to exploratory laparotomy and development of adhesions.  Pain Clinic evaluation diagnosed adhesive disease with a neuropathic component and the CI was continued on narcotic pain medication.  Despite treatment, the abdominal condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “abdominal pain” for PEB adjudication.  

The MEB NARSUM Addendum examination on 1 January 2006, 3 months prior to separation, noted complaints of chronic right upper quadrant abdominal pain made worse with activity (debilitating) or worsened with stress.  Eating small frequent meals prevented exacerbations and relaxation decreased pain somewhat.  Narcotic pain medication had been helpful, and the CI reported having lost 25 pounds since undergoing surgery [weight on service entry examination dated November 2003 was 150 pounds; weight in May 2004 was 155 pounds, and on MEB examination dated August 2005 was 151.5 pounds].  Abdominal ultrasound from February 2005 was negative aside from a slightly dilated cystic duct.  A small bowel follow thru study in January 2006 showed no abnormalities.  Physical examination showed mild tenderness in the right upper quadrant.  There were normal bowel sounds and no peritoneal signs, and the abdomen was soft.  The diagnoses were moderate chronic abdominal pain with a neuropathic component, secondary to exploratory laparotomy and possible adhesive disease; and, chronic active duodenitis, secondary to H. Pylori infection, status post antibiotic treatment.  The examiner stated that H. Pylori infection was still present and that chronic gastritis and duodenitis may be contributing to the CI’s symptoms.  

At the 14 March 2006 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported constant dull abdominal pain at rest with “overwhelming” pain with vigorous physical activity.  He reported modified eating limiting food at one sitting and loss of 20 pounds over 2 years.  He took Prevacid (decreases stomach acid) on an as needed basis as it gave him diarrhea.  Physical examination showed weight of 151 pounds with a well healed, non-tender, hypopigmented abdominal scar.  There was mild tenderness in the right upper quadrant with no masses or organomegally or “other overt deformity noted.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the abdominal condition 10%, coded 7301 (peritoneum, adhesions of), citing pain increased with activity and no evidence of partial obstruction.  The VA rated the surgical residuals of a perforated duodenal ulcer condition 20% coded 7805-7305 (scars, other – ulcer, duodenal), based on the VA C&P examination 1 month after separation, citing complaints of abdominal pain which may be due to adhesions from surgery to repair an ulcer, and no scar tenderness, no overt deformity of the abdomen and no abnormalities on ultrasound or small bowel follow thru.  

The Board considered the tenants of VASRD §4.113 (coexisting abdominal conditions) given that the CI had abdominal pain likely due to adhesions with a neuropathic component, continued H. Pylori infection after treatment, chronic gastritis and duodenitis, but no longer had an active duodenal ulcer.  Analogous coding under 7301 (peritoneum, adhesions of), 7305 (ulcer, duodenal), and 7307 (gastritis) was considered.  Analogous coding under VASRD §4.124a (neurologic conditions) under 8310 (neuritis of the tenth (pneumogastric, vagus) cranial nerve) would not provide for any higher rating.  There was no partial bowel obstruction or delayed motility to support any higher rating under code 7301.  There was no evidence of gastric multiple small eroded or ulcerated areas for higher rating under code 7307.  There was no documented significant weight loss, impairment of health, or incapacitating episodes, and the Board therefore discussed if the CI’s abdominal condition more nearly approximated a 20% rating analogous to 7305, with the coexisting abdominal conditions.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the abdominal condition, coded 7301-7305.  

BOARD FINDINGS:  In the matter of the abdominal pain condition, the Board unanimously recommends a disability rating of 20%, coded 7301-7305 IAW VASRD §4.114.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Abdominal Pain …	7301-7305	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150605, 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, AR20170000058 (PD201500714)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

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.   

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:

CF: 
(  ) DoD PDBR
(  ) DVA