RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

                              SEPARATION DATE:  20021218 

 
NAME:  XXXXXXXXX                                                                               BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1101139  
BOARD DATE:  20121002   
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SPC/E-4 (Military Occupational Specialty [MOS] Not 
Obtained/Student  in  AIT),  medically  separated  for  chronic  abdominal  pain  following  total 
vaginal hysterectomy for uterine prolapsed.  The CI had symptomatic uterine prolapsed halfway 
through AIT and underwent a vaginal hysterectomy.  Although she returned to training, she was 
unable to train due to residual pelvic pain.  She did not respond adequately to treatment and 
was unable to perform within the military, or meet physical fitness standards.  She was issued a 
permanent P3 profile and underwent a Medical Evaluation Board (MEB).  Chronic abdominal 
pain following total vaginal hysterectomy for uterine prolapsed was forwarded to the Physical 
Evaluation  Board  (PEB)  as  medically  unacceptable  IAW  AR  40-501.    No  other  conditions 
appeared on the MEB’s submission.  The PEB adjudicated the chronic abdominal pain condition 
as unfitting rated 0% with application of the US Army Physical Disability Agency (USAPDA) pain 
policy.  The CI made no appeals, and was medically separated with a 0% combined disability 
rating.   
 
 
CI CONTENTION:  “Lost of reproductive organs and tacked bladder.”   
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
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  condition(s)  “identified  but  not 
determined to be unfitting by the PEB.”  The ratings for unfitting conditions will be reviewed in 
all cases.  The “lost of reproductive organs and tacked bladder” as requested for consideration 
meet the  criteria prescribed  in  DoDI  6040.44  for  Board  purview  as  they are  elements of the 
total vaginal hysterectomy which is part of the unfitting “chronic abdominal pain following total 
vaginal  hysterectomy  for  uterine  prolapse”  condition.    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:   
 

*Original VA rating based on service treatment records (STR) and continued after VA exam 

Combined:  0% 

Service IPEB – Dated 20021209 
Condition 
Code 

Rating 

Chronic Abdominal Pain s/p 
TVH for Uterine Prolapse 

5099-5003 

0% 

↓No Additional MEB/PEB Entries↓ 

VA (STR & ~1 Mo. Post-Separation) – All Effective 20021219 
Exam 
STR 

Condition 

Rating 

Code 

7617 

50%* 

Total Vaginal Hysterectomy with 
Continued Abdominal Pain to 
Include Claim for Tacked Bladder 
Major Depressive Disorder 

9434 

30% 

20040202 

20040202 
20040202 

Not Service Connected x 0 

Combined:  70% 

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding the gravity of her condition and the significant impairment with which her service-
connected  condition  continues  to  burden  her.    The  Board  further  notes  with  respect  to  her 
contended loss of reproductive organs and tacked bladder, that the presence of a diagnosis, in 
and of itself, is not sufficient to render a condition unfitting and ratable.  While the Disability 
Evaluation System (DES) considers all of the member's medical conditions, compensation can 
only be offered for those medical conditions that cut short a member's career, and then only to 
the degree of severity present at the time of final disposition.  It is a fact, however, that the DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or potential complications of conditions resulting in medical separation.  The Board utilizes the 
Department  of  Veterans’  Affairs  (DVA)  evidence  proximal  to  separation  in  arriving  at  its 
recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to 
post-separation evidence.  The Board’s authority as defined in DoDI 6044.40, however, resides 
in evaluating the fairness of DES fitness determinations and rating decisions for disability at the 
time of separation.  Post-separation evidence therefore is probative only to the extent that it 
reasonably reflects the disability and fitness implications at the time of separation.  However, 
the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to 
consider  all  service-connected  conditions  and  to  periodically  re-evaluate  Veteran’s  for  the 
purpose of adjusting the disability rating should the degree of impairment vary over time.   
 
Chronic  Abdominal  Pain  Following  Total  Vaginal  Hysterectomy  for  Uterine  Prolapse.    Service 
treatment records (STRs) indicated that lower abdominal pain persisted after her total vaginal 
hysterectomy 4 months prior to separation.  The total vaginal hysterectomy included removal 
of the reproductive organs and tacking of the bladder.  Following convalescent leave, the CI had 
continued lower abdominal pain with “increased pain with running, prolonged standing, sit-ups 
and marching.”  The CI was unable to perform physical demands of training due to pain and 
apprehension.    The  narrative  summary  (NARSUM),  dictated  2  months  prior  to  separation 
indicated  an  assessment  of  pelvic  pain  status  post  total  vaginal  hysterectomy  secondary  to 
uterine  prolapse.    The  CI  was  taking  medication  of  Motrin  and  occasional  narcotic  pain 
medication  (Percocet)  in  the  evening.    Exams  showed  a  soft  and  non-tender  abdomen  with 
vaginal exam indicating a well healed cuff with no adnexal masses.  The MEB’s DD Form 2808 
indicated lower abdominal tenderness with deep palpation.   
 
At the VA Compensation and Pension (C&P) exam 14 months after separation, the CI reported 
frequent  left  lower  abdomen/pelvic  region pain  along  with  intermittent  urinary  incontinence 
and urinary hesitancy (with use of pads).  There was “pain associated with lifting, picking up and 
carrying the children.  She has frequent bathroom visits due to her urinary problem.”  The CI 
was  using  non-narcotic  pain  medication  (Tylenol-PM).    The  C&P  examination  revealed  mild 
tenderness in the left lower abdomen, and a vaginal exam with no abnormalities.  PAP smear 
from 2004 was reported as normal.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB disability description was “chronic abdominal pain following total vaginal hysterectomy for 
uterine prolapse, physical profile excludes the Army Physical Fitness Test (APFT) and common 
soldier tasks.  Rated for pain, moderate/intermittent.”  Her medical condition was rated at 0% 
analogously to 5003 (Arthritis, degenerative) which was IAW the USAPDA pain policy.  The VA, 
used the STR when rating the CI for “total vaginal hysterectomy with continued abdominal pain 
to include claim for tacked bladder” at 50% coded 7617 (uterus and both ovaries, removal of, 
complete).  It was clear from the record that the disqualifying condition was abdominal pain 
and  not  due  to  loss  of  reproductive  organs  or  any  symptoms  related  to  the  urinary  system.  
Although  the  VA  rates  for  7617,  the  military  only  rates  the  unfitting  condition.    Absence  of 
reproductive  organs  was  not  unfitting.    There  was  no  significant  urinary  system  symptoms 
proximate to separation and “tacking of the bladder did not rise to the level of being unfitting.  
The  CI’s  abdominal  pain,  absent  a  distinct  diagnosis  must  be  coded  analogously  IAW  VASRD 

   2                                                           PD1101139 
 

§4.20 (Analogous ratings) to a closely related disease or injury in which not only the functions 
affected, but the anatomical localization and symptomatology are closely analogous.  Records 
did not indicate that following recovery from surgery there was any prolonged infection; heavy 
vaginal bleeding; abdominal bloating or bowel obstruction symptoms; substantial pelvic pain; 
or muscle injury diagnoses.   
 
The  Board  concluded  therefore  that  absence  of  reproductive  organs  and  the  tacked  bladder 
conditions  could  not  be  recommended  for  additional  disability  rating.    Since  this  unfitting 
abdominal pain condition followed abdominal surgery, the Board considered alternate coding 
analogously to 7629 (Endometriosis) or 7301 (Peritoneum, adhesions of) although neither was a 
laproscopically  proven  diagnosis.    The  CI’s  predominate  unfitting  symptoms  were  abdominal 
pain  on  attempting  work  and  aggravated  by  movement,  which  best  aligned  with  the  7301 
criteria.  The Board considered if the CI’s rating level was closer to the Mild (0%) or moderate 
(10%) criteria as the 30% and higher criteria were not approached.  The Board adjudged that 
the  CI’s  disability  picture  proximate  to  separation  was  closer  to  the  moderate  (10%)  criteria 
IAW VASRD §4.114.   
 
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt),  the  Board  recommends  a  disability  rating  of  10%  for  the  chronic  abdominal  pain 
condition, coded 7399-7301.   
 
 
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.  As discussed above, PEB 
reliance on the USAPDA pain policy for rating the chronic abdominal pain was operant in this 
case  and  the  condition  was  adjudicated  independently  of  that  policy  by  the  Board.    In  the 
matter  of  the  chronic  abdominal  pain  condition,  the  Board  unanimously  recommends  a 
disability rating of 10%, coded 7399-7301 IAW VASRD §4.114, with the absence of reproductive 
organs and the tacked bladder conditions as not unfitting or separately compensable.  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:   
 

VASRD CODE 
7399-7301 
COMBINED 

RATING 

10% 
10% 

Chronic Abdominal Pain, Post-surgical  

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111216, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans Affairs Treatment Record. 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

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SFMR-RB 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXXXX, AR20120019259 (PD201101139) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

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