RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02052
BRANCH OF SERVICE:  Air Force 	Separation date:  20031231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aircraft Armament Systems, medically separated from the Temporary Disability Retired List (TDRL) for “endometriosis associated with chronic pelvic pain” with a disability rating of 10%.

CI CONTENTION:  The CI contended endometriosis and PTSD.  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 - 20031110	VARD - 20030402	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Endometriosis	7629	10%	Endometriosis	7629	30%	20030313	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Endometriosis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s endometriosis condition began in November 2000 and endometriosis was diagnosed by laparoscopy in March 2001.  The CI was placed on TDRL on 16 March 2002 with a 30% rating.  

There was no separate TDRL evaluation for the endometriosis condition found in the record.  There were many medical records of gynecologic treatment for persistent pelvic pain and heavy or irregular bleeding from the time of TDRL placement until permanent separation.  The CI was treated with multiple types of medication for management of endometriosis.  She underwent another surgical procedure on 23 April 2002, 1 month after TDRL placement, with a post-operative diagnosis of recurrent endometriosis.  Following the second surgery, the CI continued with pelvic pain and medications for disease management were adjusted and intermittent notes indicated prescription of narcotic pain medications for pain relief.  

At the 13 March 2003 VA Compensation and Pension (C&P) Gynecological (GYN) examination, 10 months before TDRL removal, the CI reported continued bleeding and use of opiate medication for pain (Percocet) with good relief.  A nurse deemed a full evaluation was not necessary and advised the CI to have her private gynecological treatment notes forwarded to the VA Regional Office.  No other notes for the C&P gynecological examination were in record.  

At the 13 March 2003 C&P Mental Disorders examination, 10 months before TDRL removal, the CI reported that since her last C&P examination, her uterine pain had increased.  She had started treatment with a new long-acting injectable medication (one shot monthly) in December 2002 and repeat surgery was being considered.  Her current pain was graded 7/10, with the best being 5/10 and worst 10/10.  She reported the pain interfered with her ability to attend school and she had quit her job due to poor attendance for fear of being fired.  The CI reported taking Percocet for pain as needed.

The 8 October 2003 GYN follow-up visit noted that the CI did not respond to the second injectable medication and she needed stronger pain medication (opiate pain medication) than anti-inflammatory medication.  A repeat surgery was scheduled.  In a 6 November 2003 letter addressed “to whom it may concern” her treating gynecologist indicated the CI would be undergoing repeat surgery for her pelvic pain with endometriosis and pelvic adhesions.  The 16 December 2003 surgical operative report indicated the CI had agreed to participate in a clinical trial for adhesion prevention.  The surgery noted the presence of “abundant adhesions” and there were sites of active endometriosis not involving the bowel or bladder.  

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from TDRL with a permanent disability disposition of separation with severance pay at 10%, coded 7629 (endometriosis).  The Informal PEB (IPEB) cited the CI’s medical condition “has improved since being placed on TDRL, and appears to have stabilized.”  The CI appealed to the Formal PEB (FPEB) and the FPEB concurred with the IPEB.  The FPEB remarks are excerpted below.  

The member quit three jobs because of an excessive number of days missed due to her condition. She testified her medication has had a limited affect in controlling her symptoms. The Board opines, based on the member's testimony, medical evidence, and level of functionality that the member's endometriosis is appropriately rated at 10 percent. The member testified she has been enrolled in Beauty School since Sep '03 through the Veteran's Administration Vocational Rehabilitation Program and has not missed any classes due to her condition.  She testified to taking Vicodin for her pain on a fairly regular basis. The Board found in her medical records that she was allergic to Vicodin, could not determine who prescribed it and it was not listed as a medication in her most recent medical documents.  

The VA increased the endometriosis rating to 30% from 10%, based on the C&P examination 10 months before separation, citing pelvic pain or heavy or irregular bleeding not controlled by treatment.  There was evidence of ongoing pelvic pain and bleeding not controlled by medication proximate to permanent separation.  Notes in the STR indicated that between the time of TDRL placement and TDRL removal, the CI was engaged in frequent and aggressive treatment by specialists for ongoing endometriosis symptoms with many medication trials and two additional surgeries.  At the December 2003 surgery, 2 weeks before separation, pelvic adhesions and sites of active endometriosis were identified and treated.  Panel members agreed that the code 7629 threshold for a 30% rating was reasonably satisfied in this case on the basis of endometriosis not controlled by treatment.  There was no evidence of endometrial lesions involving the bowel or bladder with bowel or bladder symptoms in record for higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the endometriosis condition at the time of TDRL removal coded 7301 (peritoneal adhesions). 

Contended PEB Conditions:  Post Traumatic Stress Disorder (PTSD).  The panel noted the PEB listed PTSD as Category II (conditions that can be unfitting but are not currently compensable or ratable) at the time of TDRL removal.  IAW DoDI 1332.38 conditions newly diagnosed during TDRL shall be compensable when the condition is unfitting; and the condition was caused by the condition for which the member was placed on TRDL; or was an unfitting disability at the time the member was placed on the TDRL.  Otherwise the condition is non-compensable under Chapter 61 of 10 U.S.C.  The panel determined the PTSD was not caused by the endometriosis and was not unfitting when the CI was placed on the TDRL and is therefore non-compensable.

BOARD FINDINGS:  In the matter of the endometriosis condition, the panel unanimously recommends a disability rating of 30%, coded 7629 IAW VASRD §4.116.   In the matter of the contended PTSD condition, the panel unanimously agrees the condition is not compensable IAW DoDI 1332.38.

The panel 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	
Endometriosis	7629	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150714, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02052.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be recharacterized to reflect disability retirement, rather than separation with severance pay.  I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.

The office responsible for making the correction will inform you when your records have been changed.  Corrected documents will involve a retirement order to place you on the retired rolls by reason of physical disability and, if appropriate, a new DD Form 214, Certificate of Release or Discharge from Active Duty.  Once you receive these documents, you may proceed to the nearest military personnel flight to secure a military identification card for you and any eligible dependents.

If you require assistance for matters not involving military pay actions, please contact the PDBR Intake Unit at Randolph AFB, XXXXXXXXXXXXXXXXXX.  Any inquiry concerning your pay may be addressed to DFAS – Indianapolis Center, Department 3300 (ATTN:  Correction of Records/Claims), XXXXXXXXXXXXXXXXXX.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment: Record of Proceedings