RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02548
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070522

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 “chronic abdominal pain…” with a disability rating of 10%.  

CI CONTENTION:  The applicant suffers from multiple chronic pain conditions and a behavioral condition that worsened.  The CI’s 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 - 20070425	VARD - 20071003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Abdominal Pain Secondary to Peritoneal Adhesions	7301	10%	Peritoneal Adhesions with Chronic Abdominal Pain	7301	10%	STR	
Depression	Not Unfitting	Major Depressive Disorder	9434	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Abdominal Pain Secondary to Peritoneal Adhesions.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first complained of abdominal pain in May 2006 (12 months before separation) upon returning from maternity leave.  The etiology of the pain was definitively established as peritoneal adhesions.  She had a history of pelvic infection, and adhesions were incidentally noted at the time of a cesarean section for her delivery.  In October 2006 she underwent laparoscopic lysis of multiple pelvic adhesions.  
Several radiographic studies and STR clinical entries confirmed the absence of obstruction (even partial) or ileus (bowel distention); and, there was no evidence to the contrary.  There was ample corroboration of all of the NARSUM evidence by STR clinical entries, and no entries were contrary to it.  These included consultations by surgery, gynecology, and gastroenterology.  The symptoms did not improve after the laparoscopic procedure, and no further surgical intervention was indicated.  

The 06 April 2007 NARSUM examination, 6 weeks before separation, documented daily “cramping” abdominal pain rated 3-4/10 (with flares to 8-9/10) and frequent (1-2/month) quarters assignments.  The pain was triggered “with activities, especially with doing sit-ups or push-ups or any strenuous activity.”  There was no nausea, vomiting, diarrhea, or constipation; and, the examiner specified the absence of any “noted disturbance of motility [or] history of actual or partial obstruction.”  The physical examination was normal without abdominal tenderness or distention.  

The CI failed to report for a scheduled VA examination, and there was no other probative post-separation evidence in this case.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 7301 (peritoneum, adhesions of) cited the “moderate” criterion of that code, specifically noting “no evidence of obstruction.”  The VA, based on the same STR evidence, conferred the same rating under the same code and also noted the absence of evidence for obstruction.  The 10% criteria for code 7301 are “Moderate; pulling pain on attempting work or aggravated by movements of the body, or occasional episodes of colic pain, nausea, constipation (perhaps alternating with diarrhea) or abdominal distension.”  Those for the next higher 30% rating are “Moderately severe; partial obstruction manifested by delayed motility of barium meal and less frequent and less prolonged episodes of pain.”  

Code 7301 is quite specific for the condition under consideration, and panel members agreed that no alternative VASRD §4.114 code was reasonably applicable or justifiable even for analogous rating.  As invoked by both the PEB and the VA, the higher 30% rating requires episodes of at least partial obstruction.  The latter was unequivocally refuted by the evidence; thus, panel members agreed that the higher rating threshold was not satisfied.  

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 of the chronic abdominal pain secondary to peritoneal adhesions.  

Contended PEB Condition:  Depressive Disorder.  The CI was referred for mental health (MH) evaluation while undergoing the MEB for her abdominal pain.  She complained of “increased anxiety, depression, and stress since childhood” and was “overwhelmed” by multiple personal stressors (including divorce).  She was diagnosed with depression that was opined by psychiatry to meet retention standards.  There was no psychiatric profile throughout service.  The commander’s performance statement did not identify any MH diagnosis or impairment, and the CI was functioning adequately in an administrative position.  

The panel directed attention to its recommendation based on the above evidence, and its main charge was an assessment of the fairness of the PEB’s determination that the depression was not unfitting.  The panel agreed that there was no performance-based evidence that indicated the condition interfered with duty requirements to an extent that would have prohibited further military service.  

After due deliberation in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the depression; thus, it was not eligible for service rating.  

BOARD FINDINGS:  In the matter of the chronic abdominal pain secondary to peritoneal adhesions and IAW VASRD §4.114, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended depression, the panel unanimously recommends no change from the PEB determination as not unfitting.  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 20151119, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013317, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure