RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01224
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060905

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “chronic abdominal wall pain” with a disability rating of 0%.  

CI CONTENTION:  The CI contended for his unfitting and other 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 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 - 20060712	VARD - 20070419	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Abdominal Wall Pain	5099-5003	0%	Small Intestine Neoplasm S/P Abdominal Surgery with Gastroesophageal Reflux (GERD) and Scar	7399-7346	10%	20070213	
Alpha-Thalassemia	Not Unfitting	Micro Anemia Alpha-Thalassemia with Chronic Fatigue	7700	0%	20070213	
Hamartomatous Polyp	Not Unfitting	No VA Exam in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Abdominal Wall Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s abdominal pain condition began in May 2005 after surgery to remove a small bowel benign tumor (polyp) discovered during an evaluation for anemia.  During the 12 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported chronic stomach pain and cramping leading to back pain, abdominal incisional paresthesias, and sleeping problems.  Physical examination showed diffuse abdominal tenderness and abdominal pain with torso flexion and extension.  The 12 April 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of abdominal pain.  The CI was taking narcotic-like pain medication (Tramadol).  Physical examination showed a well healed midline scar that was tender mainly in the superior aspect.  There was tenderness upon flexing his abdominal wall.  There was no evidence of hernia, peritonitis, or other abdominal pathology.  

At the 13 February 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported abdominal pain with heartburn with intermittent vomiting and use of over the counter Tums.  He denied lack of appetite, constipation, diarrhea, black stool, or change in stool color.  Physical examination showed a non-tender well healed midline abdominal scar.  There was left lower quadrant abdominal tenderness without other abnormal findings.  The examiner diagnosed small intestine neoplasm status post abdominal surgery with residuals of surgical scar, well healed, and gastroesophageal reflux disease (GERD), chronic.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the abdominal condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing “rated as moderate/intermittent” and the US Army Physical Disability Agency pain policy.  The VA rated the abdominal condition 10%, coded 7399-7346 (hernia hiatal), based on the C&P examination, noting heartburn and intermittent vomiting and citing the 10% criteria.  The panel deliberated potential analogous ratings under VASRD §4.71a (schedule of ratings—musculoskeletal system), §4.73 (schedule of ratings–muscle injuries, §4.114, (schedule of ratings—digestive system) and §4.118 (schedule of ratings–skin).  

The panel considered the probative value of the disparate examinations in evidence.  The NARSUM examination documented a painful scar which supported a 10% rating under code 7804 (scars, superficial, painful on examination) or painful torso flexing analogously under 7806 (scars) with spine rating criteria.  However, the VA examination equally far from separation documented abdominal tenderness with predominantly GERD symptoms.  Either examination warranted a 10% rating (though for different symptoms/criteria) and no higher.  The panel adjudged that analogous coding of 7346-7804 was predominant at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the abdominal condition, coded 7346-7804.  

Contended PEB Conditions:  Alpha-Thalassemia, Hamartomatous Polyp.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Alpha-thalassemia is a genetic disorder and symptoms with anemia related to this condition were corrected prior to separation.  The hamartomatous polyp (not carcinoid) was surgically removed and any residuals were considered in the unfitting abdominal condition above.  Neither of the conditions were profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the abdominal condition, the panel recommends a disability rating of 10%, coded 7346-7804 IAW VASRD §4.114 and §4.118.  In the matter of the contended alpha-thalassemia and hamartomatous polyp conditions, the panel recommends no change from the PEB determinations as not unfitting.  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, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Abdominal Wall Pain 	7346-7804	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180004936, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure