RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05490
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070726

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “external right flank and abdominal pain” with a disability rating of 10%.

CI CONTENTION:  “Review all 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 - 20070712	VARD - 20080123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
External Right Flank and Abdominal Pain	7399-7301	10%	Residuals, Status Post Elective Left Nephrectomy 	7500	NSC	20071012	
Atypical Depressive Disorder	Not Unfitting	Adjustment Disorder 	9413	0%	20071012	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%*	

ANALYSIS SUMMARY:  

External Right Flank and Abdominal Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s external right flank and abdominal condition began in February 2007 after donating his left kidney.  In March 2007, the CI participated in a 12-mile road march where he felt dizzy and developed burning-cramping right flank pain along with gastrointestinal symptoms.  He developed similar symptoms in April 2007.  A CT scan was negative for kidney stones and lab studies were normal with the exception of slightly elevated serum creatinine related to the kidney donation.  Internal medicine, pulmonary, and gastroenterology evaluations were essentially negative; including cardiac stress test, colonoscopy, and diagnostic imaging.  He was diagnosed with chronic right abdominal/flank pain of unknown etiology.

During the 9 May 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported “severe ‘cramping’ pressure on bladder and intestinal irregularities;” changes in urine color with occasional urgency and burning; and nighttime awakening to urinate.  Physical examination revealed right-sided abdominal tenderness, no abdominal masses and benign scars.  The 14 June 2007 MEB NARSUM examination, 1 month prior to separation, noted complaints of chronic right abdominal/flank pain increased with any activity.  Physical examination performed on 27 April 2007 reported no significant abnormalities.  The examiner opined that the CI’s pain may be related to postoperative scarring and adhesions, but the risks of exploratory laparoscopy or laparotomy have to this point outweighed the potential benefits of surgery.

At the 12 October 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported daily incapacitating 45-minute episodes of abdominal pain, frequent daytime and nighttime voiding and one to two episodes of gross hematuria (blood in urine) associated with increased activity.  The CI also complained of multiple constitutional symptoms including weakness, lethargy, intermittent anorexia, fluctuating weigh and exercise limits.  Physical examination revealed the CI was well developed and nourished.  Scars were well healed and non-tender.  There was marked right upper quadrant and right lower quadrant abdominal guarding with pronounced tenderness to deep palpation.  Bowel sounds were normal with no hepatosplenomegaly, hernias or masses.  A urinalysis, blood urea nitrogen, and complete blood count (no anemia) were normal.  Blood testing showed an elevated creatinine (1.4).  The CI was diagnosed with “mild renal insufficiency, intermittent hematuria, chronic right abdominal pain, and associated constitutional symptoms of weakness, lethargy, anorexia and weight loss.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right flank and abdominal condition 10%, analogously coded 7399-7301 (peritoneum, adhesions), citing “rated as analogous to peritoneal adhesions, moderate, aggravated by strenuous movement.”  The VA did not service-connect the abdominal condition, coded 7500 (kidney, removal of one), based on the STR and C&P examination, citing voluntarily donation of kidney.

The panel agreed that the PEB’s analogous coding of 7301 best represented the disability from the unfitting exertional right flank and abdominal condition.  Panel members also agreed there was insufficient evidence of “partial obstruction manifested by delayed motility of barium meal” to warrant the next higher 30% (moderately severe) 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 right flank and abdominal condition.

Contended PEB Condition:  Atypical Depressive Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended 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 right flank and abdominal condition and IAW VASRD §4.114, the panel recommends no change in the PEB adjudication.  In the matter of the contended atypical depressive disorder, the panel agrees it cannot recommend it for additional disability rating.  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.  

	PD-2017-05490

XXXXXXXXXXXXXX 

Dear XXXXXXXXXXX

	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.

	

	PD-2017-05490