RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXX CASE: PD1201366 BRANCH OF SERVICE: ARMY BOARD DATE: 20130312 SEPARATION DATE: 20060203 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SFC/E-7 (96D/Imagery Analyst), medically separated for chronic right lower quadrant (RLQ) pain and weakness. She experienced an onset of abdominal pain in 2005 while performing sit-ups for the Army Physical Fitness Test (APFT) and a later civilian orthopedic evaluation demonstrated a RLQ muscle tear that was confirmed by magnetic resonance imaging (MRI). The CI could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The MEB also identified and forwarded asthma, allergies and bilateral ovarian cysts as conditions meeting retention standards. The Physical Evaluation Board (PEB) adjudicated chronic RLQ pain and weakness as unfitting, rated 0%. The remaining conditions were determined to meet retention standards and not determined to be unfitting and therefore not ratable. The CI made no appeals and was separated with a 0% disability rating. CI CONTENTION: “My rating from the Army was 0% and my overall rating from the Veteran's Administration is 40%.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in Department of Defense Instruction (DoDI) 6040.44 (Enclosure 3, paragraph 5.e.2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those conditions “identified but not determined to be unfitting by the PEB.” The rating for the unfitting RLQ condition is addressed below. The requested conditions asthma and allergies, which were determined to be not unfitting by the PEB, are likewise addressed below. 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 of Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20051201 VA - (4 Mos. Post-Separation) Condition Code Rating Condition Code Rating Exam Chronic Right Lower Quadrant Pain and Weakness 5319 0% Residuals of Tear of Right Rectus Abdominus 7399-7339 20% 20060614 Allergies Not Unfitting Allergic Rhinitis 6522 0% 20060614 Asthma Not Unfitting Asthma 6602 0%* 20060614 Bilateral Ovarian Cysts Not Unfitting Left Ovarian Cyst 7615 NSC No Additional MEB/PEB Entries Other x 8 20060614 Combined: 0% Combined: 40% VARD 20061011 (most proximate to Date of Separation) * VARD 20090520 increased Asthma from 0% to 10% based on clear and unmistakable error, effective 20060204. ANALYSIS SUMMARY: Chronic Right Lower Quadrant (RLQ) Pain and Weakness. The narrative summary (NARSUM) stated the CI experienced abdominal pain during an APFT 12 June 2005 and orthopedic evaluation with MRI documented a tear of the rectus abdominus. Her symptoms did not improve with conservative treatment and there was no recommendation for surgery. At the MEB exam the CI reported a daily constant abdominal pain that she rated as 3/10 and increased to 7/10 with activity such as twisting or driving. She reported being unable to run, do situps or pushups and noted increasing difficulty performing any physical activity since the acute injury. An orthopedic consult said it could take up to a year to heal. The MEB physical exam noted “Normal walk, jog, heel-toe and low jump.” The abdomen was tender in the right lower area. Sit-ups increased the tenderness; muscles were firm with good tone but with a palpable defect without hernia in the right lower abdomen on forward flexion. The orthopedic evaluation of 31 August 2005 stated that with abdominal exercise the pain was well localized and increased at the torn muscle site. MRI 20 September 2005 showed a partial tear of the rectus abdominus muscles, more pronounced on the right. At the VA Compensation and Pension (C&P) exam performed on 14 June 2006, approximately 4 months after separation, the CI reported constant pain, worse with activity. She was unable to run long distances or do any heavy lifting. She was on multiple medications, including pain medication which reduced the pain. The CI reported that she was able to do her current job without limitations. The Board directs attention to its rating recommendation based on the above evidence. The PEB rated 5319 (Muscle Group XIX) at 0%, rated as slight. The VA rated 7399-7339 (as analogous to a postoperative ventral hernia) at 20%. The Board opined that coding under §4.73—schedule of ratings muscle injuries appeared predominant to coding under §4.114- schedule of ratings digestive system; there was no evidence in the record of an abdominal hernia associated with the CI’s muscle tear or use or recommendation for a support belt or garment due to abdominal weakness as described in the rating criteria of 7339. The Board deliberated whether the CI’s muscle injury disability rose to the next higher rating under 5319. There was documentation that this simple wound of the muscle caused consistent complaints of one or more cardinal signs and symptoms of muscle disability of pain with use and was associated with a palpable defect indicating tissue loss. The Board reviewed the tenants of §4.56 (evaluation of muscle disabilities). Although the muscle injury was simple, the Board concluded that functional loss from pain with use resultant from the abdominal muscle tear met the criteria for rating under group XIX function, at the moderate level. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), and IAW §4.40 (functional loss), the Board recommends a disability rating of 10% for the chronic right lower quadrant pain and weakness condition. Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that asthma and allergies were not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. 1) Asthma: The NARSUM noted a history of asthma with inhaler use. The DD 2807 form indicated the CI had a bronchodilator inhaler. The MEB respiratory exam, chest x-ray and PFTs were normal. At the VA C&P exam the CI reported a history of exercise induced asthma and asthma related to environmental allergens with symptoms once per month. She reported medications were effective and denied any functional impairment; 2) Allergies: The NARSUM stated that the CI had multiple evaluations for allergies and treatment with appropriate medications. At the C&P exam the CI reported use of medications for allergies and they were effective. She reported year round symptoms of runny nose and sneezing. She denied any functional impairment or incapacitating episodes and had lost no work time due to allergies. The exam showed normal evaluation of the eyes, ears, nose and throat. The asthma and allergy conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards. Both conditions were reviewed and considered by the Board. There was no performance based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the either of the contended conditions and so no additional disability ratings are recommended. 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 RLQ pain and weakness condition, the Board unanimously recommends a disability rating of 10%, coded 5319 IAW VASRD §4.73. In the matter of the contended asthma and allergy conditions, the Board unanimously recommends no change from the PEB determinations of not unfitting. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation: UNFITTING CONDITION VASRD CODE RATING Chronic Right Lower Quadrant Pain and Weakness 5319 10% RATING 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120810, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxx, AR20130006285 (PD201201366) 1. 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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)