RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03545
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20050616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Human Intelligence Collector, medically separated for “chronic abdominal and low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Surgical procedures have created chronic pain and imbalances.  Also loss of reproductive organs has caused premature menopause systems and 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 - 20050131	VARD - 20050804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Abdominal and Low Back Pain 	7301	10%	Hysterectomy with Left Salpingo Oophorectomy	7618	30%	20050425	
			Cesarean Section Scar	7804	10%	20050425	
			Lower Back Condition	5237	NSC	20050425	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Abdominal and Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent an emergency repeat Cesarean section on 21 September 2002 due to labor and fetal distress.  Her post-operative course was complicated by persistent bleeding which resulted in three additional operations with a left salpingo-oophorectomy and sub-total hysterectomy.  Overtime, she did well but noted pulling in the inferior abdomen associated with exercise.  She was evaluated for a scar revision in plastic surgery on 2 December 2003 and was advised to allow more time for the scar to mature in the hope that her symptoms would improve.  She remained on a profile, but was able to deploy from February 2004 to July 2004.  Upon return, she noted her pain level was no longer bearable in association with her military specialty.

The 29 September 2004 MEB NARSUM examination, 9 months prior to separation, noted complaints of chronic pelvic pain, low back pain and abdominal pain.  Physical examination revealed inverted (indented, retracted) abdominal scars but the abdominal examination was otherwise unremarkable.  The back examination showed painful extension.  

On 29 October 2004, the MEB physical therapy evaluation, 8 months prior to separation, revealed back flexion of 70 degrees (normal 90) and combined ROM of 195 degrees (normal 240).  During a gynecology examination on 4 November 2004, the CI reported persistent abdominal and pelvic pain with activity despite physical therapy and reconditioning.  She reported irregular bleeding which required surgery for the removal of a necrotic (dead) intrauterine mass.

At the 25 April 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported back pain since her hysterectomy, but denied any effect on ordinary lifting, posture or gait.  She could drive a car without difficulty.  She also noted lower abdominal pain and her abdominal scar hurt and pulled.  Physical examination showed two well healed surgical scars without complications or disfigurement.  The abdomen was otherwise unremarkable and non-tender.  A pelvic examination confirmed the presence of a cervical stump (remaining cervix post hysterectomy).  The gait and neurological examinations were normal.  The ROM of the lumbar spine was normal and pain free.  Provocative testing for nerve root irritation was negative, spasm and atrophy were absent and tenderness was not documented.  X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the abdominal and low back condition 10%, coded 7301 (peritoneum, adhesions), citing multiple abdominal surgeries and a limitation in extension.  The VA rated the hysterectomy with left salpingo-oophorectomy at 30%, coded 7618 (uterus, removal of, including corpus), based on the C&P examination, citing hysterectomy.  A 10% rating was also granted for the Cesarean section, coded 7804 (one or two unstable or painful scars), citing pain on examination.

The panel observed that the C&P examination recorded non-tender abdominal scars that were well healed.  Additionally, the back condition was not service connected based on a lack of pathology noted on the C&P examination; coded 5237 (lumbosacral strain).  The STR noted adhesions were suspected, but adhesions were not confirmed by imaging or direct observation.  The C&P examination showed the CI improved in function after the necrotic tissue was removed and after the MEB NARSUM examination.  The VA rendered a 30% rating based on the hysterectomy which was not an unfitting condition and not ratable by this panel.  The scar was not specifically addressed by the PEB, was not contended by the CI, and therefore outside this panel’s scope of review.  The PEB noted back pain; however, the STR and VA evidence do not support the presence of a separately unfitting back condition at separation.  After due deliberation, considering all of 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 and low back condition.

BOARD FINDINGS:  In the matter of the abdominal and low back condition and IAW VASRD §4.71a, 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170331, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180009205, 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.

Sincerely,					      
Enclosure