RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00178
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Services Craftsman, medically separated for “chronic pelvic pain” with a disability rating of 10%.

CI CONTENTION:  “I am requesting retirement and review of all my conditions.”  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 - 20040216	VARD - 20041217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pelvic Pain	7615	10%	Endometriosis with History of Fibroid Surgery, Myomectomy, Chronic Abdominal Pain…	7629	50%	20040817	
			Residuals of Bladder Surgery	7529	10%	20040817	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Pelvic Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s pelvic pain began in 1998, approximately 5 to 6 years before separation.  The CI underwent surgeries for uterine fibroids and removal of an endometrial implant on the bladder in 2000 and 2002.  A 16 July 2002 cystoscopy (evaluation of the bladder with a scope) was performed for painful menses with hematuria, urinary urgency and nocturia.  The cystoscopy showed a mass between the uterus and the bladder pressing on the posterior bladder and a periurethral mass.  The CI underwent an exploratory surgery on 31 July 2002, 21 months before separation, for removal of the mass.  At surgery the mass was noted to be intrinsic to the bladder and was removed and found to be an endometrial implant on the bladder.  The removal of the mass left a defect (4 X 6 cm) in the bladder that was surgically repaired.  A few months after the surgery the CI reported worsening pelvic pain unresponsive to usual medical management and a computed tomography (CT) scan showed a pelvic mass.  On 18 December 2002, 17 months before separation, the CI underwent another surgical procedure to remove the pelvic mass, which was a peritoneal inclusion cyst (cyst formation often related to prior surgery or endometriosis) and there was evidence of endometriosis in the posterior pelvis.  At a 12 May 2003 urology visit, 12 months before separation, the CI again reported worsening pelvic pain and worsening stress and urgency urinary incontinence.  She denied wearing a pad or history of urinary tract infections.  Bladder ultrasound performed on 19 May 2003 showed a possible left ovarian endometrioma.  Notes in the STR in June and July showed the CI was being given monthly Depo-Lupron injections (hormone treatment for endometriosis) and pain medication as needed.  A 17 July 2003 cystoscopy, 10 months before separation, noted complaints of urinary frequency, urgency, and small bladder volumes.  The cystoscopy showed an outpouching of the bladder at the site of the previous surgery and was otherwise normal.  A 28 July 2003 gynecologic visit noted complaints of suprapubic and left lower quadrant pain with the examination showing the same.  A pelvic ultrasound was performed for pelvic pain in August 2003 and showed a small amount of free fluid on the left and small cysts of both ovaries.  There were several small uterine fibroids with no other abnormalities noted.  At a 17 March 2004 primary care FPC visit, 2 months before separation, the CI reported increased abdominal pain for three days with an episode of vomiting that was slowly getting better, similar to previous flare-ups of the chronic pelvic pain.  The physical examination of the abdomen and pelvis was unremarkable and the CI was given an injection for pain.

The undated MEB NARSUM examination (performed after the July 2003 cystoscopy) noted complaints of chronic abdominal pain and urinary frequency.  Physical examination showed well healed surgical scars of the abdomen and pelvis.  The abdomen was non-distended. 

At the 17 August 2004 VA Compensation and Pension (C&P) gynecological examination, 3 months after separation, the CI reported pelvic pain and painful urination.   Physical examination showed an enlarged and irregularly shaped uterus and tender right ovary.  The VA gynecologist indicated CI had recurrent dysuria (painful urination) possibly related to endometriosis and requested a urological evaluation.  There was no VA urological examination performed proximate to the C&P GYN examination in record.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the pelvic condition 10%, coded 7615 (ovary, disease, injury, or adhesions of).  The VA rated the pelvic condition 50%, coded 7629 (endometriosis), based on the C&P examination 3 months after separation, citing lesions involving the bowel or bladder confirmed by laparoscopy, pelvic pain or heavy or irregular bleeding not controlled by treatment, and bowel or bladder symptoms and 10%, coded 7529 (benign neoplasms of the genitourinary system), based on the C&P examination 3 months after separation, citing dysuria.

The total evidence in record supports a 30% rating either under 7615 for symptoms not controlled by continuous treatment or alternatively under 7629 for persistent pelvic pain not controlled by treatment.  There is no higher rating than 30% available under 7615.  Although the CI had a history of recurrent endometriosis involving the bladder, proximate to separation, the pelvic ultrasound and bladder cystoscopy did not note any lesions of the bladder for higher rating under 7629.  The panel also considered if rating the CI’s disability due to chronic pelvic pain as a residual of the surgeries involving the bladder resulted in a higher rating than 30%.  However, there was no evidence of urinary incontinence “requiring the wearing of absorbent materials which must be changed 2 to 4 times per day” or “daytime voiding interval less than one hour, or; awakening to void five or more times per night” for higher rating under 7529 (benign neoplasms of the genitourinary system).  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 pelvic condition, coded 7615.  

BOARD FINDINGS:  In the matter of the pelvic condition, the panel unanimously recommends a disability rating of 30%, coded 7615 IAW VASRD §4.116.  There are no other conditions within the panel’s scope of review for consideration.  

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	
Chronic Pelvic Pain	7615	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160318, 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-2016-00178.

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.  The Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings