RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03663
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Intelligence Analyst, medically separated for “abdominal pain” with a disability rating of 0%.

CI CONTENTION:  “Unsure why Army discharge at 0% and VA rated 80%.”  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 - 20080408	VARD - 20090108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Abdominal Pain	7399-7319	0%	Abdominal Disability	7399-7304	NSC	20081107	
Hypothyroidism	Not Unfitting	Hypothyroidism	7903	10%	20081107	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Abdominal Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s abdominal pain began in May 2007 while deployed to Afghanistan with no known etiology, and an extensive work-up could not find the cause.  The 4 December 2007 MEB NARSUM examination, 8 months prior to separation, noted CI complaints of abdominal pain which rendered him unable to perform soldiering or administrative duties.  Physical examination showed diffuse abdominal tenderness with guarding but normal findings otherwise.  The provider documented the CI’s pain response was out of proportion to the amount of abdominal pressure applied, and later in an 18 February 2008 letter to the PEB,  stated  that the CI claimed to no longer have abdominal pain.

At the 7 November 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported heartburn when consuming highly seasoned foods.  Physical examination revealed slight upper and lower abdomen tenderness.  During the 14 November 2008 VA clinic evaluation, he reported generalized abdominal pain varying in intensity from 1-8/10.  Physical examination showed marked tenderness in all abdominal quadrants.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the abdominal pain condition 0%, analogously coded 7399-7319 (irritable colon syndrome), citing disproportionate pain in response to amount of abdominal pressure applied.  The VA did not service connect the abdominal pain condition, analogously coded 7399-7304 (ulcer, gastric), based on the C&P examination, citing no disability shown by evidence.  Members noted that there was no limitation of motion, radiographic findings or incapacitating episodes to support a rating under code 5021 (myositis), and no document moderate pulling pain on attempting work or aggravated by body movements to support a rating analogous to 7399-7317 (gall bladder, injury).  The panel also considered musculoskeletal pain in multiple anatomical locations analogous to fibromyalgia (5025), however there was no diagnosis of myofascial pain to justify such a 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 chronic right abdominal pain condition.

Contended PEB Condition:  Hypothyroidism.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The condition was not profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  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 abdominal pain condition and IAW VASRD §4.114, the panel recommends no change in the PEB adjudication.  In the matter of the contended hypothyroidism condition, the panel recommends no change from the PEB determinations 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:

Exhibit A.  DD Form 294, dated 20170411, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010167, 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