RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03022
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20071220

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Air Rescue and Firefighting Specialist, medically separated for “chronic recalcitrant left upper quadrant abdominal wall pain” with a disability rating of 10%.

CI CONTENTION:  CI requested review of all 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 - 20070830	VARD - 20080211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Recalcitrant Left Upper Quadrant Abdominal Wall Pain	5099-5021	10%	Chronic Pain Syndrome	5025	0%	20070912	
Other Chronic Pain	Not Unfitting					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 0%	
	
ANALYSIS SUMMARY:

Chronic Recalcitrant Left Upper Quadrant Abdominal Wall Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left upper quadrant abdominal condition began in October 2004 with no trauma or injury reported. Over the course of multiple subspecialists and interventions, the CI received several diagnoses that ranged from abdominal wall strain with no evidence of hernia, muscle strain, contusion-abdominal wall to a “sports hernia.” An MRI obtained in September 2005 demonstrated edema within the musculature layers of the upper abdominal muscles without discrete fascial thinning or   defect

consistent with a muscle strain. Eventually, in May 2006, the CI was diagnosed with a ‘sports hernia’ and subsequently underwent surgical placement of mesh in the left upper quadrant of his abdominal wall. Despite such surgical intervention as well as further non-invasion interventions, no apparent pain improvement was achieved.

The 23 July 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of continued left upper abdominal wall pain. His physical examination (PE) revealed local tenderness about the surgical scar in the left upper quadrant of the abdomen. There was no evidence of a hernia in the abdominal or inguinal musculature.

At the 12 September 2007 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported continued sharp pain in the left upper abdominal quadrant with any physical activity such as fast walking, shouting, running or flexing of his abdominal muscle. His pain level was a constant 2/10 and increased to 8/10 with the above stated activities. The examiner noted, “There is no functional limitation with regards to daily activities.” A detailed PE revealed normal findings within the abdomen, but tenderness was present in the left groin area.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the abdominal wall pain condition 10%, analogously coded 5099-5021 (myositis). The VA rated the condition of chronic pain syndrome 0%, coded 5025 (fibromyalgia…fibrositis), based on the C&P examination, citing various clinical parameters. Panel members first acknowledged that the coding scheme as utilized by the PEB was most consistent with the original MRI findings of muscular layer edema consistent with a strain and inflammation of the muscle tissue thus in support of a maximum of 10%. Additionally, an alternate coding consideration was a muscle code IAW VASRD §4.73; specifically coded under 5319 Group XIX, muscles of the abdominal wall. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that the VA statement of, “There is no functional limitation with regards to daily activities” would not support any degree of impairment intensity greater than a “moderate” level; equivalent to 10% impairment under 5319. This alternate rating scheme provides no additional benefit to the CI and therefore, there was insufficient cause to recommend a change in the PEB’s adjudication for the left abdominal wall pain condition.

Contended PEB Condition: Chronic Pain. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not noted on a limited duty form or implicated in the non-medical assessment and did not fail retention standards. There was no performance-based evidence from the record that the condition separately and or significantly interfered with satisfactory duty performance at or near separation. Therefore, 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 upper abdominal wall pain condition and IAW VASRD
§4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended other chronic pain, the panel recommends no change from the PEB’s 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:

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO:

1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 1 May 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

Copy to: PDBR