RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04887
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Health Care Specialist, medically separated for “hernia, ventral, post-operative,” with a disability rating of 20%.  

CI CONTENTION:  Surgical intervention for unfitting condition resulted in complications.  The CI requested review of additional conditions identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) but determined not unfitting.  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 - 20081201	VARD - 20090814	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hernia, Ventral, Post-Operative 	7339	20%	Recurrent Postoperative Ventral Hernia with GERD	7346-7339	20%	20090520	
GERD	Not Unfitting					
Low Back Pain	Not Unfitting	Lumbar and Thoracic Spine Stain	5237	20%	20090814	
Thoracic Back Pain	Not Unfitting					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Hernia, Ventral, Postoperative.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent surgical repair of a ventral hernia in 1990.  In September 1992, the CI entered the Army with no reported issues.  In July 1995, he suffered hernia issues again and underwent another surgical repair.  During the period between 1998 and 2007, the CI underwent four ventral hernia repairs and in 2007, underwent a bilateral inguinal surgical repair.  Mesh used in the 2000 surgical repair was replaced in 2007 by explorative laparoscopy since it was deemed faulty.  The last post-op note cited, “chronic intermittent abdominal pain likely related to multiple hernia repairs.  No hernia.” The CI reported he was unable to perform core strengthening exercises due to back pain.   

At the 10 September 2008 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported chronic abdominal pain.  Aggravating factors were prolonged standing and sitting and increased level of activity.  An upper GI showed a small hiatal hernia.  Physical examination showed a soft, non-tender abdomen, with bowel sounds in all quadrants, no masses or organomegaly.  Surgical scars were non-tender and well healed.  

The 18 September 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued residual pain secondary to scar tissue from the multiple surgeries.  The CI could stand 25 minutes at most and march less than one mile.  He reported fatigue after activities and it took 1 or 2 days to rebound.  Pain also worsened while under stress.  A CT scan showed ventral graft placement with mild bulging in the anterior peritoneal wall and diastasis of the linea alba (opening of abdominal wall).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hernia condition 20%, coded 7339 (hernia, ventral, post-operative).  The VA also rated the hernia condition 20%, dual coded 7346-7339 (hiatal hernia-hernia, ventral post-operative) based on the C&P examination, citing recurrent hernia with weakening of the abdominal wall.  The NARSUM and the C&P examinations documented multiple hernia repairs and the recurrence of a new hernia.  There was no evidence of a large hernia or the use of a belt to contain the hernia.  The CI did not have evidence of persistent recurrent epigastric distress with difficulty swallowing, heartburn or regurgitation, accompanied by substernal, arm or shoulder pain, to justify a 30% rating under code 7346, nor was there evidence of a large hernia, not well supported by a belt for a 40% rating.  The panel agreed there was no higher rating for the post-operative hernia condition.  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 hernia condition.  

Contended PEB Conditions: Gastroesophageal Reflux Disease (GERD), Low Back Pain and Thoracic Back Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the hernia condition and IAW VASRD §4.114, the panel recommends no change in the PEB adjudication.  In the matter of the contended GERD, low back and thoracic back conditions, 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. 

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Dear XXXXXXXXXX:

	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