RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02161
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Military Police, medically separated for “chronic right abdominal pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends he has undiagnosed and unresolved issues since separation. 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 - 20040405	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Abdominal Pain	5099-5003	10%	No VA Claim	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Right Abdominal Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s abdominal pain began in January 2003 with insidious onset.  The MEB forwarded, “chronic right-sided abdominal pain,” for PEB adjudication.  At a urology evaluation dated March 2001 the examiner noted history of a vasectomy in 1994 and that a vasovasotomy (vasectomy reversal) was a surgical option for relief of the right greater than left testicular pain that radiated to the right abdominal wall.  The examiner also recommended referral to the pain clinic.  At a neurology consultation on 1 May 2003 the CI reported right abdominal wall pain that radiated to the right testicle and scrotum.  The physical examination showed tenderness to deep palpation of the right abdomen with pain radiation to the right testicle.  The neurologist diagnosed the CI’s pain as secondary to abdominal myofascial pain syndrome and noted that it was unresponsive to extensive therapy.  
The MEB NARSUM examination on 29 January 2004, 4 months prior to separation, noted complaints of continued chronic pain in the right side of the abdomen.  The physical examination revealed mild lower right sacroiliac joint and paravertebral soreness and swelling, a tender right inguinal canal, and mild right upper quadrant discomfort, 2 inches from the naval area.  The examiner noted that the CI had been unresponsive to multiple modalities of treatment, including epidural glucocorticoid injections, transcutaneous electrical nerve stimulation (TENS), oral medications and analgesics along with physical therapy.  There was no VA Compensation and Pension evaluation or claim.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right-sided abdominal pain condition 10%, coded analogously 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The Board considered rating under 5021 (myositis); however, there was no evidence of occasional incapacitating exacerbations for a 20% rating; therefore this rating option would not result in a higher than 10% rating.  The Board considered rating options related to the myofascial abdominal pain as diagnosed by the neurologist.  The Board noted abdominal musculoskeletal pain which radiated to multiple anatomical locations and the diagnosis of myofascial pain in considering a rating analogous to 5025 (fibromyalgia).  The Board also noted that multiple treatment modalities did not alleviate the myofascial abdominal wall pain.  Board members agreed that the preponderance of evidence supports a 40% rating for pain that was constant, or nearly so, and refractory to therapy.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 40% for the chronic right abdominal pain condition, coded analogously 5099-5025.  

BOARD FINDINGS:  In the matter of the chronic right abdominal pain condition, the Board unanimously recommends a disability rating of 40%, coded analogously 5099-5025 IAW VASRD §4.71a.  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 Right Abdominal Pain	5099-5025	40%	
RATING	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150806, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160018774 (PD201502161)

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 40% 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 40% 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