RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE: PD-2017-03900 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090528

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Rifleman, medically separated for “GERD” with a disability rating of 10%.

CI CONTENTION: Review of additional conditions not identified by the Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB) requested.  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090310	VARD - 20100719	
Condition	Code	Rating	Condition	Code	Rating	Exam	
GERD	7399-7346	10%	GERD	7346	0%	
20091208	
Peptic Ulcer Disease	Cat II	Stomach Ulcers	7304	NSC		
		Gastritis	7307	NSC		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	
	
ANALYSIS SUMMARY:

GERD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s GERD began in July 2007 with symptoms of persistent nausea, epigastric tenderness and rare bloody emesis. The CI underwent three separate upper gastro-esophageal-duodenal (EGD) endoscopies in late 2007 and 2008; all of which revealed erosive esophagitis and or gastritis as well as a hiatal hernia in July 2008. Consistently, the CI was treated with medication and avoidance of aggravating foods.

The 5 December 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic dyspepsia (aka…indigestion; a persistent or recurrent pain or discomfort in the upper abdomen) which is aggravated by certain foods, drinks and physical exertion. His physical examination (PE) revealed lower abdominal tenderness. Current medications included Nexium and Carafate.

At the 8 December 2009 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported heartburn with spicy foods, soda and caffeine. Additionally, he endorsed having a “good response” with his current medications without any adverse side effects.  His physical examination (PE) was detailed and normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the GERD condition 10%, analogously coded 7399-7349 (hernia hiatal). The Navy PEB’s Category II diagnosis of peptic ulcer disease is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed under the same rating. Utilizing the same primary code, the VA rated the same condition 0%, based on the C&P examination, citing no evidence of a second symptom associated with epigastric distress. A non-compensable evaluation is assigned unless there are two or more of the following symptoms associated with epigastric distress: dysphagia, pyrosis, regurgitation, or substernal or arm or shoulder pain.

As per VASRD Guidance, the PEB correctly analogized the GERD condition under the hiatal hernia code 7346. A positive impairment rating under this code is dependent on the number of persisting physical symptoms with two symptoms as the minimum for a 10% rating. This case did not show evidence of at least two associated symptoms near separation and therefore, no positive impairment rating is supported. Therefore, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the GERD condition.

BOARD FINDINGS: In the matter of the GERD 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.

2	PD-2017-03900

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER  TD,
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 26 Jul 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.