RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05738
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070903

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

CI CONTENTION:  The VA rated the condition higher.  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 - 20070810	VARD - 20080306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Abdominal Pain	7399-7319	0%	Hiatal Hernia 	7346	0%	20071115 	
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 April 2006 when he noticed blood in the toilet after a bowel movement.  Abdominal cramping and pain with diarrhea developed.  An upper endoscopy (EGD) and colonoscopy were both negative aside from external hemorrhoids and a small hiatal hernia, which were not considered causative for the abdominal pain.  Gastroenterology indicated that evaluation was negative for irritable bowel disease, microscopic colitis or other organic causes.  Additional evaluations by surgery and neurology found no clear etiology of the abdominal pain.  Psychiatry evaluation for somatic symptoms of gastrointestinal pain found no Axis I mental health diagnosis.  

During the 16 May 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported stomach pain, indigestion, hiatal hernia and occasional blood in the stool.  Physical examination revealed a diffusely tender abdomen, worse in the right upper quadrant, with no masses or other abnormal findings.  Hemoccult test was negative for blood in the stool.  The 25 July 2007 MEB NARSUM examination, 1 months prior to separation, noted complaints of constant low-level abdominal pain with frequent exacerbations.  Physical examination showed the abdomen was diffusely tender, worse in the right upper quadrant, with mild guarding.  There were normal bowel sounds and liver margins with no palpable masses or rebound.  

At the 15 November 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported progressively worse abdominal pain, but denied nausea, vomiting, diarrhea, constipation, indigestion, heartburn or periods of incapacitation.  The physical examination was normal with normal bowel sounds, no tenderness or rebound and no masses or guarding.  There was no palpable hernia present.  The liver and spleen were normal.  No hemorrhoids were present.  The diagnosis was hiatal hernia.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the abdominal pain 0%, analogously coded 7399-7319 (irritable colon syndrome), citing no significant findings.  The VA also rated the abdominal pain 0%, coded 7346 (hernia hiatal), based on the C&P examination, citing a lack of two or more of the following symptoms associated with epigastric distress: dysphagia, pyrosis, regurgitation, or substernal or arm or shoulder pain.  The panel agreed the CI had insufficient symptoms under code 7346 (hiatal hernia) criteria to meet the 10% rating.  The panel considered if the CI’s symptoms more nearly approximated the next higher 10% criteria under code 7319 (irritable colon syndrome) for “moderate; frequent episodes of bowel disturbance with abdominal distress” rather than the 0% criteria of “mild, disturbances of bowel function with occasional episodes of abdominal distress.”  There was no evidence of continuing diarrhea or constipation, and the frequency of abdominal distress was adjudged as between occasional and frequent.  The panel determined there was no objective evidence of bowel disturbance and the evidence did not more nearly approximate the disability picture of the next higher rating 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 pain.  

BOARD FINDINGS:  In the matter of the abdominal pain 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170806, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008229, 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. 

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure