RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-02620
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “intermittent abdominal pain” and “bilateral hallux limitus,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  No specific contention 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 - 20060919	VARD - 20071018	
Condition	Code	Rating	Condition	Code	Rating	Exam	
History of Intermittent Abdominal Pain…	7399-7307	10%	Irritable Bowel Syndrome	7319	10%	20070112	
Bilateral Hallux Limitus	5299-5281	0%+0%	Bilateral Mild Pes Planus with Hallux Limitus S/P Bunionectomy of Both Feet	5276	0%	20070116	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Intermittent Abdominal Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s abdominal condition began in 1999 after having abdominal cramping that was associated with occasional nausea but no vomiting and no reported weight loss.  During the 25 May 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported chronic pain in the lower right side.  The CI had a history of three caesarian sections, a fibroid uterus, bilateral tubal ligation, full abdominoplasty, and a diagnostic laparoscopy in March 2006.  Physical examination revealed a normal abdominal examination and deferred gynecologic evaluation.  

The gynecology examination the following day noted complaints of intermittent severe abdominopelvic pain that was not cyclic in nature.  Diagnostic laparoscopy was negative for adhesions or endometriosis.  Gynecologic examination was normal.  The examiner indicated the abdominal pain was of uncertain etiology, not gynecologic.  Subsequent pelvic and abdominal CT scans showed a large uttering fibroid with metallic-appearing foreign bodies in the right anterior pelvis and left upper quadrant.  The 23 June 2006 upper gastrointenstinal and small bowel follow-through revealed mild duodenal and proximal ileum wall thickening which may represent duodenitis not seen on a 9 June 2006 examination.  

The 2 June 2006 MEB NARSUM examination was focused on the CI’s bilateral foot condition.  The 4 October 2006 general surgery examination, 2 months prior to separation, was for follow-up of chronic intermittent right lower quadrant (RLQ) abdominal pain associated with nausea but no vomiting.  Physical examination revealed a soft, non-tender abdomen with normal bowel sounds.  Scars were well healed with no RLQ masses palpable and pain was not reproducible.  

At the 12 January 2007 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported multiple episodes of loose stool associated with cramping pain since 1999, with occasional nausea but no vomiting.  Physical examination showed a soft abdomen with normal bowel sounds.  There was no tenderness, hepatosplenomegaly, or organomegaly.  The gynecologic examiner found a 4-5 cm moderately tender mass lateral to the uterus.  The examining official indicated the CI’s RLQ pain was not caused by the leiomyoma of the uterus (fibroid).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the abdominal condition 10%, analogously coded 7307 (hypertrophic gastritis), citing duodenitis and “rated analogous to gastric hypertrophy as duodenitis is an inflammation of the duodenum resulting in temporary equivalent hypertrophy.  Note that this appears to be intermittent in nature as noted in the X-ray report.”  The VA also rated the abdominal condition 10%, coded 7319 (irritable colon syndrome [spastic colitis, mucous colitis, irritable bowel, etc.]), based on the STR and the C&P examination, citing frequent episodes of loose stools associated with abdominal cramping.  

The panel noted there was insufficient evidence of chronic multiple small eroded or ulcerated areas for the next higher rating under code 7307, and insufficient evidence of severe diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress for any alternative higher rating under code 7319.  After due deliberation, considering all 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 abdominal condition.  

Bilateral Hallux Limitus.  According to the STR and MEB NARSUM, the CI underwent right foot surgery with first metatarsal (great toe) osteotomy/bunionectomy in October 2000, and left foot bunionectomy in January 2006.  During the 25 May 2006 MEB examination, 7 months prior to separation, the CI reported bilateral foot pain.  Physical examination showed mild tenderness of both first metatarsal phalangeal joints with well healed scars.  Pes planus was documented.  

The 2 June 2006 MEB NARSUM examination, 6 months prior to separation, noted complaints of painful bilateral great toe deformities.  Pain was in both great toes with prolonged walking.  The CI was cleared for use of shoes of choice with limited usage of military combat boots.  X-rays showed well healed osteotomies.  Physical examination revealed well healed scars over the bunion surgery sites.  There was first metatarsal joint tenderness bilaterally with range of motion (ROM) in degrees of (right/left) dorsiflexion of 20/25 and plantar flexion 10/15.  The left great toe had moderate bursa and erythema.  

At the 16 January 2007 C&P examination, one month after separation, the CI reported pain in both feet, particularly with standing and walking.  X-rays of both feet revealed mild hallux valgus on the left and postoperative bunionectomy changes to both feet.  Physical examination noted a normal gait.  There were well healed bilateral bunionectomy scars.  There was no swelling, heat, erythema, or tenderness.  Temperature, color and vasculature were normal.  All digits except the first had normal ROM.  There was mild bilateral pes planus but no significant callus formation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral foot condition 0% for each foot, analogously coded 5281 (hallux rigidus, unilateral, severe), citing each foot did not meet the minimum rating criteria.  The VA also rated the bilateral foot condition 0%, coded 5276 (flatfoot, acquired), based on the C&P examination, citing a noncompensable evaluation.  

There was no resection of either metatarsal head and symptoms were not equivalent to amputation of the great toe for any rating higher than that adjudicated by the PEB.  Each foot separately would rate 0%, or both feet considered together would rate 0% under alternate coding.  After due deliberation, considering all 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 bilateral foot condition.  

BOARD FINDINGS:  In the matter of the abdominal condition and IAW VASRD §4.114, the panel recommends no change in the PEB adjudication.  In the matter of the bilateral foot (hallux limitus) 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 20170316, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

 	 PD-2017-02620

AR20190012360, XXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	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.

	

 	 PD-2017-02620