RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-03488
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Command Post Journeyman, medically separated for “chronic pain in upper gluteal cleft” with a disability rating of 10%.  

CI CONTENTION:  “The issued rating should not be changed.  My condition has not improved, but rather worsened.”  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 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 - 20070510	VARD - 20080617	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain In Upper Gluteal Cleft	7820-7804	10%	Scar, Residual Excision Pilonidal Cyst 	7819-7804	10%	20080103	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Chronic Pain in Upper Gluteal Cleft.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s underwent pilonidal cyst excisions in January 2004 and January 2006, but continued to experience pain in the upper gluteal cleft although bone and CT scans were negative.  The 6 February 2007 MEB NARSUM examination, 4 months before separation, noted complaints of continued pain at the pilonidal cyst excision site, which was controlled with an anti-inflammatory medication as needed.  She was unable to run, sit for longer than 3 hours, or perform sit-ups.  Physical examination revealed area tenderness and a healed surgical scar without erythema, drainage, warmth, or edema.  The examiner noted that the cyst removal resulted in scarring which was the source of pain.  A pelvis CT scan was negative for abscess.  

At the 3 January 2008 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported scar tissue due to pilonidal cyst excision, and pain with prolonged sitting.  Symptoms occurred intermittently, with 6 flare-ups in the past year during which time she had difficulty sitting.  She had not received any treatment for the condition over the past 12 months, and had been employed since discharge working as a crane operator for the previous 2 months with no lost time from work.  Physical examination revealed a level scar at the upper buttocks measuring 2.2 cm by 1 cm.  The scar was tender, with hypopigmentation of less than 6 square inches.  There was no disfigurement, ulceration, adherence, instability, tissue loss, inflammation, edema, keloid formation, hyperpigmentation and abnormal texture.  Posture and gait were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the upper gluteal cleft condition 10%, analogously coded 7820-7804 (infections of the skin not rated elsewhere-scar(s), unstable or painful).  The VA also rated the upper gluteal cleft condition 10%, but analogously coded 7819-7804 (benign skin neoplasm-scar(s), unstable or painful), based on the C&P examination, citing a superficial scar that is painful on examination.  Panel members noted that the PEB rated the upper gluteal cleft pain according to VASRD rules which state that infections of the skin not listed elsewhere are rated as disfigurement of the head, face or neck (7800), scars (7801-7805), or dermatitis (7806), depending upon the predominant disability.  The NARSUM examiner documented the presence of 1 painful but not unstable scar, thereby meeting criteria for 10% rating.  There was no evidence of 3 or 4 unstable or painful scars to warrant a 20% disability rating.  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 condition.  

BOARD FINDINGS:  In the matter of the upper gluteal cleft pain and IAW VASRD §4.118, 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.  

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03488.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.