RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00555
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Infantryman, medically separated for “chronic idiopathic left lower abdominal pain” with a disability rating of 0%.   

CI CONTENTION:  He was not given a rating at separation and hopes the board finds a mistake was made.  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 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 - 20050729	VARD - 20060103	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Idiopathic Left Lower Abdominal Pain	5099-5003	0%	Residual Scar, Status Post Appendectomy and
Laparoscopy With Renal Calculi	7508	10%	20050811	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Idiopathic Left Lower Abdominal Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s idiopathic left lower abdominal pain condition began in December of 2003 when he experienced severe pain on the lower left side of his abdomen during a patrol while deployed.  On 27 April 2004, the CI underwent a diagnostic laparoscopy and left lower quadrant abdominal wall exploration with ligation of a cutaneous sensory nerve aimed at alleviating the pain.  No abnormalities were found.  The CI noted a brief period of improvement but then his chronic persistent abdominal wall pain returned.  The CI had a series of abdominal CT scans and a testicular ultrasound in April and August 2004.  The April 2004 testicular ultrasound showed a small right epididymal cyst, but noted no left-sided anomalies. The CT scan in August showed a non-obstructing renal stone and the rest of the urinary collecting system and abdominal imaging as well as the abdominal wall was unremarkable.  

During the 20 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported that his abdominal pain restricted him physically.  Physical examination showed the abdomen was firm with normal bowel sounds and no masses.  There was excessive tenderness at the left lower quadrant and no rebound tenderness.

The 15 July 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic recurrent left lower quadrant abdominal pain.  The CI was unable to carry a fighting load for 2 miles, perform a 2-mile run or perform any push-ups or sit-ups.  Physical examination showed he was in no acute distress; the abdominal examination was significant for a firm non-distended abdomen with normal bowel sounds.  There was no evidence of masses and he was noted to be significantly tender in the left lower quadrant abdominal wall, but with no rebound tenderness.  The spleen and liver were not enlarged.  The examiner stated, “This service member has chronic abdominal and abdominal wall pain of an unclear etiology that is unresolved despite surgical exploration and medical therapy.”

At the 11 August 2005 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported he had left lower abdominal pain and was taking medication to treat the pain.  The CI reported that he was able to sustain heavy physical activities without immediate distress, and urinary and genital functions were undisturbed.  Physical examination was unremarkable other than showing his abdomen was soft without evidence of organomegaly or tenderness.  The examiner noted normal abdominal features without complications and opined that there was no pathology identified on physical examination to render a diagnosis. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the idiopathic left lower abdominal pain condition 0%, coded analogously as 5003 (degenerative arthritis).  The panel noted the absence of radiographic findings to support a rating under the 5003 code.  The panel next considered the 7509 code (hydronephrosis) and the 7508 code (nephrolithiasis); however, neither code offered a higher rating since the CI did not report or describe colic attacks.  The CI was being treated for persistent pain that was not colicky in nature.  Panel members agreed there was no coding option that would result in a compensable rating.  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 idiopathic left lower abdominal pain condition.  

BOARD FINDINGS:  In the matter of the idiopathic left lower abdominal pain condition and IAW VASRD §4.71a, the panel 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 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006522, 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