RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00894
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040722

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Advanced Individual Training Student, medically separated for “chronic abdominal pain status post umbilical hernia surgery” with a disability rating of 10%.

CI CONTENTION:  The CI’s condition continues to worsen.  The 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040406	VARD - 20051117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Abdominal Pain S/P Umbilical Hernia Surgery	5099-5003	10%	Umbilical Hernia, Resolved Following Surgical Repair	7399-7339	0%	20050909	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

Chronic Abdominal Pain Status Post Umbilical Hernia Surgery.  According to the service treatment record (STR) and the Medical MEB narrative summary (NARSUM), the CI’s abdominal pain began in August 2003.  The pain developed status-post umbilical hernia repair X 2 in July and August 2003.  A scan of the hernia showed no recurrence of the hernia but large uterine fibroids were demonstrated.  A February 2004 general surgery follow-up examination showed incisional pain and tenderness. The 23 January 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of persisting pain that prevented her from running for the Army Physical Fitness Test (AFPT).  Physical examination showed positive tenderness in the periumbilical area.  The pain rating was frequent and slight.  

At the 9 September 2005 VA Compensation and Pension (C&P) examination, 14 months after separation, the CI reported she had been diagnosed with a mass arising from the pelvis and representing uterine leiomyomata.  A pelvic scan showed a large abdominal mass in February 2005.  She underwent partial hysterectomy with unilateral oophorectomy in March 2005 and the abdominal pain essentially resolved after hysterectomy for uterine fibroids.  This did not affect her occupation or activities of daily living.  Physical examination showed a surgical scar that was not adhering to underlying tissue or limiting any movement.  Abdomen was soft, non-tender, and non-distended with positive bowel sounds.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “chronic abdominal pain status post umbilical hernia surgery” condition 10%, coded 5099-5003 (analogous to arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA  rated the “umbilical hernia, resolved following surgical repair” condition 0%, coded 7399-7339 (analogous to hernia, ventral, postoperative), based on the C&P examination 14 months  after separation, citing healed wounds with no disability or requirement of a supporting belt.  The panel agreed that a 10% rating, but no higher, was justified for chronic abdominal pain status post umbilical hernia surgery as reported on the MEB NARSUM examinations.  There was no evidence of additional pathology at that time.  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 for the “chronic abdominal pain status post umbilical hernia surgery” condition.  

BOARD FINDINGS:  In the matter of the “chronic abdominal pain status post umbilical hernia surgery” condition 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 modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160913, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180005775, 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