RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02126
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040806

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “right upper quadrant pain” with a disability rating of 0%.

CI CONTENTION:  The CI contends for right abdominal pain. 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 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 - 20040528	VARD - 20041022	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Upper Quadrant Pain…	5099-5003	0%	Chronic Right Upper Abdominal Pain Syndrome	7399-7317	0%	20040805	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Upper Quadrant Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right upper quadrant pain condition began in August 2002 after certain movements such as squatting.  There was no history of injury or trauma.  The CI had an extensive work-up by general surgery, two gastrointestinal specialists, and orthopedics.  All testing and X-rays, CT, and MRI were normal with the exception of benign gall bladder polyps.  No cause of the pain could be determined on his many examinations he intermittently had some mild right sided tenderness.  The CI reports that’s the pain is usually a 2-3 on the 0-10 pain scale and 7-8 "when I do certain things.  Run, sit up, eat certain foods."  However, the CI only required occasional use of Tylenol or Motrin for control of his pain.  The MEB forwarded “chronic right upper quadrant pain of unknown etiology” for PEB adjudication.  The MEB NARSUM examination on 29 April 2004, 3 months prior to separation, noted complaints of recurring right sided pain due to squatting or eating spicy or fatty foods.  Physical examination revealed some mild right sided tenderness to palpation.  At the 5 August 2004 VA Compensation and Pension (C&P) evaluation, performed 1 day before separation, the CI reported chronic right upper quadrant abdominal pain.  Physical examination was normal.  The examiner opined that the CI’s right upper quadrant abdominal wall pain was secondary to muscle spasms which were not present on physical examination.  The examiner noted that a diagnosis could not be rendered.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right upper quadrant pain condition 0%, using an analogous 5099-5003 code (degenerative arthritis), citing “rated for pain.”  The VA also rated the right upper quadrant pain condition 0% using an analogous 7399-7317 code (injury of gall bladder), based on the VA C&P examination 1 day before separation, citing ‘mild’ symptomatology.  The Board considered a rating analogous to 5021 code (Myositis); however, there were no radiographic findings or incapacitating episodes.  The Board considered an analogous 7399-7317 code (injury of gall bladder) rating.  The Board noted that the CI reported increased pain with running, sit-ups, and activities which required abdominal stress.  There was mild tenderness to palpation noted on the NARSUM examination.  The commander noted that the CI could not perform the physical training requirements and his duties as a military policeman secondary to his “unknown stomach pain.”  Board members agreed that the evidence supports a 10% rating for moderate pulling pain on attempting work or aggravated by movements of the body.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right upper quadrant pain condition. 

BOARD FINDINGS:  In the matter of the right upper quadrant pain condition, the Board majority recommends a disability rating of 10%, analogously coded 7399-7317 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	
Right Abdominal Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150801, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004081, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,