RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01699
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030320

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Combat Engineer, medically separated for “chronic abdominal wall pain status post Nissen fundoplication,” with a disability rating of 10%.

CI CONTENTION:  The CI contends that his back condition existed at the time of separation and should be rated.  He indicates that his abdominal wall pain is beginning to reoccur and that he has had an operation on his knee since he left the service.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20021223	VARD - 20030817	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Abdominal Wall Pain Status Post Nissen Fundoplication	5099-5003	10%	Gastroesophageal Reflux Disease (GERD), Status Post Nissen Fundoplication	7399-7346	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Abdominal Wall Pain Status Post Nissen Fundoplication.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a several-year history of abdominal pain treated with medications.  A gastroenterology evaluation in August 2001 showed gastroesophageal reflux esophagitis (GERD) and a hiatal hernia.  The CI was referred for a surgical consultation and in November 2001 underwent laparoscopic surgery with plication of the stomach.  Following the surgery, the CI continued to report epigastric discomfort at times described as a “burning” feeling, bloating and tenderness.  Abdominal tenderness with distention, and increased bowel sounds, were noted on multiple acute examinations in record.  A repeat scope of the upper GI tract (EGD) was normal and radiographic studies showed that the surgical procedure was intact with no GERD or obstruction.  The CI was treated with medications to aid gastric motility (metaclopromide).  In August 2002, the CI was evaluated with reported epigastric pain with left anterior chest pain that radiated to the left arm.  He was evaluated for heart issues (screening testing was negative) and the symptoms were thought possibly due to inflammation of the stomach.  The CI’s weight increased from approximately 157 pounds to 165 pounds from the time of the surgery to the MEB NARSUM examination.  The 3 December 2002 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic epigastric abdominal pain.  There was no physical examination performed.  There was no VA Compensation and Pension examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic abdominal wall pain condition 10%, with an analogous code 5003 (degenerative arthritis) citing application of the US Army Physical Disability Agency pain policy.  The VA rated “gastroesophageal reflux disease, status post Nissen fundoplication” 10%, coded analogously to 7346 (hiatal hernia), an analogous code for GERD.  There was evidence of persistent epigastric distress, and at times, the CI described the pain as burning (pyrosis) as well as radiating to the left arm; which supports the 10% rating under 7346.  There was no additional evidence of persistent dysphagia or regurgitation “productive of considerable impairment of health” to support the next higher rating.  The panel considered alternative VASRD gastrointestinal codes, but all were less applicable.  The panel noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating and therefore, no change to the PEB’s code is recommended.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the abdominal wall pain condition.  

BOARD FINDINGS:  In the matter of the chronic abdominal wall pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150629, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008718, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,