RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03038
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20071003

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

CI CONTENTION:  “Review 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 - 20070808	VARD - 20080312	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pelvic Pain due to Laparoscopically Verified Endometriosis…	7629	0%	Endometriosis	7629	30%	20070928	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Chronic Pelvic Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s pelvic condition began in February 2006 when she experienced sharp lower abdominal pain while participating in the unit’s physical training session. She was started on oral hormones (OCP) and subsequently underwent a laparoscopy (surgery on her lower abdomen), which confirmed the diagnosis of endometriosis. A CT scan on 5 January 2007 revealed a 2 cm left ovarian cyst. During the 14 May 2007 gynecology examination, 5 months prior to separation, the CI complained of chronic pelvic pain with unsuccessful trials of hormonal treatment (multiple birth control pills). Any activity caused burning sharp cramping in her pelvis. She complained of painful intercourse, menorrhagia (heavy periods-going through 40 super tampons per day   and

awakening to change tampons), and dysmenorrhea (painful periods) with some relief from using Motrin. Physical examination revealed well healed laparoscopy scars, with a soft and non-tender abdomen. On pelvic examination, the uterus and bilateral adnexa were tender. A transvaginal ultrasound was normal with multiple follicles under 1 cm (normal). The CI was prescribed daily hormones (Micronor - norethindrone).

During the 19 May 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI complained of gynecologic problems including endometriosis with continuing pain and sharp pains, cysts on the ovaries, irregular PAP smear, and change in menstruation sometimes having it twice a month. Physical examination referenced the 14 May 2007 gynecology examination. The 12 July 2007 MEB NARSUM examination, 3 months prior to separation, was authored by the gynecologist who evaluated the CI on 14 May 2007 and noted complaints of chronic pelvic pain with significant limitation of activities. The history and physical were substantively the same (but less detailed) as the gynecologist’s 14 May 2007 examination.

At the 28 September 2007 VA Compensation and Pension (C&P) examination, one week before separation, the CI reported problems with abdominal and perineal pain and occasional spotting and menstrual cycle irregularity. She had been started on hormones but still had problems with perineal and abdominal pain. The examiner found a soft abdomen, no rebound tenderness and good bowel sounds. There were no masses or hernias noted. There was mild pain with palpation of the perineum and abdomen. The diagnosis was endometriosis with mild residuals of perineal and abdominal pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the pelvic condition 0%, coded 7629 (endometriosis), citing no reported irregular or heavy bleeding. The VA rated the pelvic condition 30%, coded 7629, based on the STR and C&P examinations, citing pelvic pain and irregular bleeding not controlled by treatment. The panel noted that the 14 May 2007 gynecology examination was the source of the MEB and NARSUM histories and examinations. The more detailed gynecologist’s SF 600 entries documented heavy and painful menstruation, as well as pelvic pain and tenderness. Hormone therapy was also restarted at that visit and the medication profile indicated that it was dispensed. The MEB history additionally noted irregular menses. Endometriosis was laparoscopically confirmed without evidence of bowel or bladder lesions or symptoms. The 30% criteria under code 7629 is “pelvic pain or heavy or irregular bleeding not controlled by treatment,” and the CI had STR and C&P examination evidence of pelvic pain that was not controlled by treatment, supporting the 30% rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the pelvic pain/endometriosis condition, coded 7629.

BOARD FINDINGS: In the matter of the pelvic pain/endometriosis condition, the panel recommends a disability rating of 30%, coded 7629 IAW VASRD §4.116. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pelvic Pain Due to Laparoscopically Verified Endometriosis…	7629	30%	

The following documentary evidence was considered:

	PD-2017-03038

[AR NUMBER], XXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a permanent disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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

	PD-2017-03038