RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03389
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated from the Temporary Disability Retired List (TDRL) for “chronic recurrent abdominal pain and diarrhea” with a disability rating of 20%.  

CI CONTENTION:  “Three surgeries in Sept and have high blood pressure, CPAP, sugar MS, both knees bad.  See attached.”  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 - 20060928	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Recurrent Abdominal Pain and Diarrhea	7329	20%	No VA Exam Proximate to Separation in Evidence	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Recurrent Abdominal Pain and Diarrhea.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s abdominal condition began in September 2000 with onset of severe recurrent abdominal pain that lead to a prolonged hospitalization in the same month.  The CI was separated and placed on TDRL on 1 November 2002.  During the 13 July 2006 TDRL NARSUM evaluation, 3 months prior to TDRL removal, the CI reported he continued to have episodic abdominal pain occurring on average about twice a month with pain occurring spontaneously, not secondary to any overt inciting event.  It usually lasted 6 hours and resolved spontaneously.  He also had postprandial diarrhea approximately 10 minutes after each meal that resulted in five to six loose bowel movements a day for which Imodium (loperamide) provided a limited, temporary response.  He described no blood in the stool and no other significant symptoms or weight loss.   Physical examination revealed well-healed incisions.  His abdomen was soft, non-distended, and nontender.  Bowel sounds were normal.  The CI indicated his symptoms appeared to be relatively stable and unchanged from his prior TDRL examination.  The examiner felt the CI could resume activities in the military despite continued diarrhea and high risk for bowel obstruction in the future.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the abdominal pain and persistent diarrhea condition 20%, coded 7329 (intestine, large, resection of), citing moderate symptoms.  The panel noted the dichotomy in ratings between the PEB at the time of TDRL removal and TDRL placement.  The issue before the panel is how to determine whether the CI’s symptoms at the time of separation were severe or moderate.  The CI had frequent diarrhea at the time of TDRL placement and at TDRL removal.  Bowel movements with diarrhea that are not particularly responsive to medication is indicative of an ongoing abnormality, which in this case was a direct result of a hemicolectomy and removal of small bowel obstructions.  While the CI had frequent bowel movements with or without diarrhea, his abdominal pain was less frequent at TDRL removal as compared to TDRL placement and he was able to work, had not lost weight, and had normal laboratory results.  The examiner at the TDRL removal examination recommended the CI be returned to duty and could be deployed in his MOS as a wheeled vehicle mechanic.  Therefore, the panel determined at the time of TDRL removal his overall condition and symptoms were more consistent with moderate disability rather than severe disability.  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 pain condition.  

BOARD FINDINGS:  In the matter of the abdominal pain condition and IAW VASRD §4.114, 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.  

AR20180015337, 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.