RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00779
BRANCH OF SERVICE:  Army 	BOARD DATE:  20141112
SEPARATION DATE:  20070507

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92A/Automated Logistics Specialist) medically separated for endometriosis.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “severe endometriosis and pelvic adhesive disease” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated endometriosis as unfitting rated at 10%, citing Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “My overall rating for the VA increased to 100% individual unemployability.  Over the past seven years my endometriosis has gotten worse requiring me to have three laparoscopic surgeries.  I also have a severe mental disorder that should have been included in my rating.  My ratings included from other illnesses equal 100%.”  [sic]

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 endometriosis is addressed below.  The specifically contended mental disorder was not documented by the PEB; therefore it’s not within the purview of the Board.  There were no other conditions are within the Board’s scope of review.  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 Board for Correction of Military Records.

RATING COMPARISON:  
   
Service IPEB – Dated 20070329	VA - (6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Endometriosis	7629	10%	Endometriosis	7629	10%	20071103	
Other x  0 (Not in Scope)	Other x 3	20071103	
Combined:  10%	Combined:  50%	
Derived from VA Rating Decision (VARD) dated 20080228 (most proximate to date of separation)
VARD 20081130 increased DC 7629 to 30% effective 20080929.  VARD 20110510 inceased DC 7629 to 50% effective 2010608.  

ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but must emphasize that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veteran Affairs (DVA), operating under a different set of laws.  The Board considers VA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-months interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.  

Endometriosis Condition.  The CI presented to the emergency room on 7 March 2006 with complaints of shoulder / back pain and abdominal cramps.  Further diagnostic studies (CT scan and ultrasound of the uterus), revealed fluid in the abdominal cavity (probable fibroids or ruptured ovarian cyst), therefore she was referred to gynecology service for further work up.  Laparoscopy procedure performed on 8 May 2006 revealed adhesions to bilateral [fallopian] tubes, the right ovary (the left was not visualized) and endometriosis; the latter confirmed by pathology.  Surgery was discussed.  However the CI desired to preserve fertility and at that time was currently engaged in an infertility program (for 36 months).  Thus the recommendation for the use of Lupron as an alternative treatment for the endometriosis was given but was found to be a contraindication for conception efforts.

The Board did note that pregnancies does at times control or eliminates endometriosis symptoms.  However, 6 weeks after the gynecology consultation, pregnancy was no longer a treatment option due to the CI separated from her spouse (she was under the care of family advocacy for marital discord).  Therefore the CI elected to proceed with the Lupron treatment plan.  The Lupron did lead to a reduction in endometriosis symptoms.  Nonetheless, the CI’s medication profile documented that it was discontinued in January 2007 (4 months prior to separation) as well as her analgesic / narcotic prescriptions being discontinued prior to the dictation of the MEB narrative summary (NARSUM).

The NARSUM dated 2 March 2007 (2 months prior to separation) the examiner noted that [the CI] reported only mild pelvic pain and no menstrual cycle (not unusual in treatment of endometriosis with Lupron).  The examiner further notes that the CI’s pain was minimal when not actually having her menstrual cycle and she was able to fully perform her duties.  However, during her menstrual cycle her pain was intense and directly impacted her duty performance.  The Action Officer opined that this set of statements, while appearing inconsistent, probably reflects the improvement in symptoms as well as the cessation of her menstrual cycle while taking Lupron, and the recurrence of both when the medication was discontinued.  At the time of the NARSUM dictation the CI was pain free.

During the VA Compensation and Pension (C&P) examination performed on 3 November 2007 (6 months post separation), the CI reported cramping, heavy bleeding and prolong menstrual cycles.  She denied any gastrointestinal or urinary tract symptoms; currently not on any treatment for endometriosis; no [signs of symptoms of] acute distress and abdominal examination was benign.  Her weight was 137 pounds, increase of 15 pounds from the previous year.  The pelvic examination was omitted without an explanation.  The no reports that endometriosis impact activities of daily living. 

VA’s Gynecological C&P examination performed on 28 October 2008 (approximately 17 months post-separation), the CI stated that her symptoms had steadily worsened and were partially controlled with medications.  She noted nausea, weight loss and acne from [taking] the medication, having menstrual cycle approximately every 90 days, constant pelvic pain and frequent abdominal pain.  On examination, the examiner noted tenderness to bilateral lower quadrants of the abdomen.  A CT performed in April 2008 showed fluid in the abdomen of unknown etiology.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the condition at 10% using the code 7629 (endometriosis).  The Board considered the criteria for a 30% rating “pelvic pain or heavy or irregular bleeding not controlled by treatment” and that for a 10% rating “pelvic pain or heavy or irregular bleeding requiring continuous treatment for control”.  In actual fact, the CI does not appear to have been on any medications at the time of separation, which would support only a 0% 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 endometriosis 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 endometriosis 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 recharacterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140115, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXXX AR20150006636 (PD201400779)

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