RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX CASE: PD1100970 BRANCH OF SERVICE: ARMY BOARD DATE: 20130313 SEPARATION DATE: 20050606 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (19K10/M1A1 Armor Crewman) medically separated for chronic abdominal pain. The CI went in for a laparascopic appendectomy in early 2004 and experienced a small bowel perforation. Multiple surgeries, a medical coma for 19 days and an incisional hernia repair followed. In December 2004, a surgical consult revealed no surgical pathology only chronic pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The abdominal pain condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated chronic abdominal pain, rated 10%. The CI made no appeals and was medically separated with a 10% disability rating. CI CONTENTION: “I have since been found to have PTSD as a result of the coma which was a result of the abdominal condition for which I was discharged, and the reason given for my discharge was: pain. I had one ventral hernia repair will on active duty, and have had two more since.” SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting chronic abdominal pain condition is addressed below and no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20050331 VA - 4 Mos. Pre –Separation Condition Code Rating Condition Code Rating Exam Chronic Abdominal Pain 7399-7301 10% Abdominal Pain & Digestive Problems s/p Small Bowel Perforation & Peritonitis 7399-7301 10% 20050215 No Additional MEB/PEB Entries Other x 7 20050215 Combined: 10% Combined: 20% Derived from VA Rating Decision (VARD) dated 20050726 (most proximate to date of separation [DOS]). ANALYSIS SUMMARY: Chronic Abdominal Pain. The MEB narrative summary (NARSUM) dated 12 January 2005 noted the CI had a history of multiple abdominal surgical procedures starting with laparoscopic appendectomy performed on 30 January 2004. The CI developed postoperative complications including a small bowel tear, peritonitis and subphrenic abscess which required additional procedures including medically induced coma and exploratory laparotomies. The CI was released from the hospital on 5 March 2004 and returned to active duty on 1 May 2004. On 21 July 2004 the CI had surgery for an uncomplicated incisional hernia repair. However, the CI continued to complain of abdominal pain and was seen on several occasions in the emergency department though no surgical pathology for the pain was identified. Computer tomography (CT) scan performed 15 December 2004 disclosed post-surgical changes but no evidence of obstruction or abnormality requiring treatment or explaining the pain. The CI reported persistent severe pain when bending or lifting heavy loads preventing performance of duties and he was referred for MEB. At the VA Compensation and Pension (C&P) exam performed on 15 February 2005, 4 months prior to separation and 3 weeks prior to the MEB, the CI reported frequent abdominal pain episodes located in the left lower quadrant associated with abdominal distension, nausea, constipation alternating with diarrhea. The examiner considered the functional impairment secondary to small bowel perforation, peritonitis and incisional hernia separately. Subsequently, the difficulties bending and lifting were noted as a consequence of the incisional hernia only. The physical exam indicated a well developed, well nourished male in no acute distress. Height was 75 inches and weight was 225 pounds. Examination of the abdomen noted surgical scars without tenderness, disfigurement, ulceration, adherence, instability, tissue loss, keloid formation, hyperpigmentation, abnormal texture or limitation of motion. Laboratory work did not evidence anemia. At the MEB exam performed on 5 March 2005, 3 months prior to separation, the CI reported continuous pain that started on 14 January 2005 and persisted to the evaluation time. He described the pain as sharp, radiating into the back and kidney area and rated it 4/10 (10 being the maximum level of pain experienced). The CI stated the pain increased to 8/10 before and during bowel movements. The general physical exam was normal, and noted the presence of healed surgical scars. The focal exam of the abdomen elicited severe lower quadrant and pelvic brim tenderness. Laboratory testing was normal (no anemia or results reflecting any gastrointestinal abnormality). The Board directs attention to its rating recommendation based on the above evidence. Both the PEB and VA rated the CI condition 10% analogously to code 7301 (adhesions of peritoneum) based on evidence of residual pulling pain during movements of the body, occasional episodes of colic, nausea, constipation alternating with diarrhea and abdominal distension. The Board could not assign a higher evaluation as there was not demonstrated partial bowel obstruction required for a 30% rating. There was no identified weight loss or anemia which would also warrant an increase in the rating. The Board also considered additional rating warranted by the presence of multiple abdominal scars secondary to surgeries however there was no direct functional limitation related to the scars that rendered the CI unfit. The Board concluded therefore that the scarring could not be recommended for additional disability rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic abdominal pain condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the chronic abdominal pain condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Chronic Abdominal Pain 7399-7301 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20111019, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxx, AR20130006205 (PD201100970) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)