RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00750
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040224

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Indirect Fire Infantryman, medically separated for “chronic epigastric pain status-post Nissen fundoplication” with a disability rating of 10%.

CI CONTENTION:  His left knee is worse and he has PTSD.  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 - 20031112	VARD - 20040408	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Epigastric Pain…	5099-5003	10%	Epigastric Pain Post Nissen Fundoplication…	7399-7346	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Epigastric Pain Status Post Nissen Fundoplication.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI presented with abdominal pain in June 2002 and was found to have gastroesophageal reflux.  He was initially controlled with medications, but then had recurrent symptoms.  On 3 January 2003, after other possible etiologies for his symptoms were excluded, he underwent Nissen fundoplication (surgery).  Despite the surgery, he continued to have abdominal pain which precluded full duty.  No etiology was found after further evaluation other than expected post-operative changes.  

At the 1 October 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported “stomach pain due to my surgery.”  On physical examination, diffuse abdominal tenderness was present with tenderness near the gallbladder.  The 22 October 2003 NARSUM summarized the above findings.  There was no VA Compensation and Pension examination proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, coded analogous to 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also assigned a 10% rating using a 5099-7346 code (analogous to hiatal hernia), based on the STR, citing “diffuse abdominal tenderness over the epigastric region of the abdomen.”  The panel considered the evidence and determined that the 5099-7346 code employed by the VA better described the clinical presentation, but offered no rating advantage to the CI.  No route to a higher rating was found.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the epigastric pain.  

BOARD FINDINGS:  In the matter of the epigastric pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180001941, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

 	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