RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02057
BRANCH OF SERVICE:  Army	BOARD DATE:  20150204
SEPARATION DATE:  20050811

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Human Resources Specialist) medically separated for pelvic adhesive disease.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The conditions characterized as “chronic pelvic pain” and “pelvic adhesive disease (moderate to severe),” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) found the CI fit for duty.  The CI appealed the IPEB and a subsequent Reconsideration PEB adjudicated pelvic adhesive disease as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition, chronic pelvic pain, was included with the pelvic adhesive disease as a single unfitting condition.  The CI made no further appeals and was medically separated.

CI CONTENTION:  “I was rated for pelvic adhesive disease and not the total unfitting conditions.  The issues were not considered in the rating; however, they were a result of military service (1) hysterectomy, (2) low back strain, (3) patellofemoral pain syndrome (left knee), (4) hypertension, (5) seasonal allergic rhinitis and (6) Cesarean section scar.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Recon PEB – Dated 20050621	VA* - (11 Days. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pelvic Adhesive Disease…	7699-7613	10%	Pelvic Adhesive Disease	7613	10%	20050822	
Other x 0 (Not In Scope)	Other x 8 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20060330 (most proximate to date of separation (DOS)).  Note:  The VARD, dated 20050917, most proximate to the date of separation was for Vocational Rehabilitation; therefore, the 20060330 Original VARD was used in the Rating Comparison.

ANALYSIS SUMMARY:  

Pelvic Adhesive Disease Condition.  The CI had a history of pelvic pain for several years when she underwent a caesarian section on 29 September 2001 to deliver her third child.  At the same time, she had a hysterectomy (removal of the uterus) secondary to painful fibroids (benign growths of uterine muscle) and lysis (cutting) of pelvic adhesions.  Her pelvic pain recurred after the surgery and on 29 October 2002 she had removal of the tubes, ovaries, and cervix as well as lysis of pelvic adhesions.  Her pelvic pain persisted.  A CT on 2 September 2003 showed no intra-abdominal or pelvic inflammatory process or mass.  Due to persistent pain, she had lysis of the pelvic adhesions again on 21 December 2004.  At a follow-up on 26 January 2005, her pelvic pain was improved, but she reported abdominal pain which was thought to be secondary to gastro-esophageal reflux disease for which she was treated.  The Report of Medical Assessment dated 10 March 2005 recorded that the CI took (replacement) estrogen.  On 26 April 2005, she reported that she was free of pelvic pain, but continued to have abdominal pain which was worsened with food.  Excessive intake of non-steroidal anti-inflammatory drugs was noted and she was evaluated for an ulcer.  This is the last clinical record prior to separation 3 months later.  The narrative summary was dated 16 May 2005, less than 3 months prior to separation.  The examiner noted persistent pelvic pain which was attributed to pelvic adhesive disease.  On examination, manipulation of the vaginal cuff (the vaginal wall where the cervix had been) had reproduced her pain, but was improved following the surgery in December 2004.  However, it was still sufficient to limit the performance of full duty.  At the VA Compensation and Pension (C&P) gynecology examination performed on 3 August 2005, 8 days prior to separation, the CI reported that she had done fairly well since her surgery in December 2004 but still had some pain around the time she would have expected her menses.  Intercourse, which had been painful, was described as “fairly good …without any severe pain.”  Her pelvic examination was normal other than the surgical changes.

The Board directed its attention to its rating recommendation based on the above evidence.  The reconsideration PEB and VA both rated the condition at 10% and used the code 7613 (injury or adhesions of the uterus) although the PEB did so analogously.  On the C&P examination, tenderness was not recorded.  The CI was noted as being on hormonal therapy (estrogen) prior to separation.  The Board considered the coding options and found no route to a rating higher than the 10% adjudicated by both the PEB and VA.  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 pelvic adhesive disease 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 pelvic adhesive disease condition and IAW VASRD §4.116 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131030, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150010569 (PD201302057)

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		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA