RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02659
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070522

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic left flank pain” with a disability rating of 10%.  

CI CONTENTION:  In addition to left flank pain and PTSD, the CI requested other conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070209	VARD - 20070912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Flank Pain 	5099-5003	10%	Nephrolithithiasis 	7508	0%	20070711	
PTSD	Not Unfitting	PTSD 	9411	30%	20070628	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Left Flank Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left flank pain began in 2005 with hematuria.  He was evaluated and diagnosed with two kidney stones.  At times he had gross hematuria.  He was evaluated by urology, nephrology, vascular surgery and hematology for flank pain and gross and painless hematuria.  No urological cause was identified.  A CT scan in August 2005 showed a 1 cm left adrenal adenoma and a left ureteropyeloscopy on 19 August 2005 resulted in a diagnosis of nephron-ureteral colic without evidence of stones.  A CT scan of the abdomen on 25 August 2006, was unremarkable.  

During the 19 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the examiner noted the CI was unable to perform job specific duties due to flank pain that had not resolved despite extensive workup.  Physical examination, noted a very tender epigastric area.  Routine lab studies were normal.  The 5 December 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of pain located over the entire left flank.  The pain and hematuria were exacerbated with activity but they did not always occur together.  Pain was relieved by narcotic medications, but the CI had four to six night time awakenings per night.  

At the 11 July 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported the blood in his urine was due to flank pain.  Multiple procedures had been performed but no stones were found.  He reported it was not certain whether or not the left adrenal gland mass was cancerous or not and he was discharged with an undiagnosed renal condition with hematuria.  Radiographs of the abdomen on 11 July 2007 showed small calcifications in the pelvis, most likely salts in a gland.  Physical examination was essentially unremarkable.  The 14 April 2008 C&P examination, 11 months after separation, showed the CI had no current symptoms and the kidney stones had resolved with no effect on work or daily activities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left flank pain 10%, analogously coded 5099-5003 (degenerative arthritis), citing moderate and frequent pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the flank pain 0%, coded 7508 (nephrolithiasis), based on the C&P examination, citing evidence during service that established treatment for nephrolithiasis.  The NARSUM noted the intermittent presence of left flank pain and hematuria without a diagnosis despite an extensive evaluation.  The July 2007 C&P examination confirmed the continued presence of symptoms, again without definitive diagnosis.  The April 2008 C&P examination noted symptoms had resolved and there was no effect on activity or work.  The panel concluded there was no evidence to support a rating higher than the 10% adjudicated by the PEB.  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 left flank pain.  

Contended PEB Condition:  PTSD.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The condition was not profiled or implicated in the commander’s statement and did not fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left flank pain and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the contended PTSD condition, the panel recommends no change from the PEB determination as not unfitting.  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 20170305, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007067, 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.