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AF | PDBR | CY2012 | PD-2012-00129
Original file (PD-2012-00129.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       BRANCH OF SERVICE: AIR FORCE
CASE NUMBER: PD-2012-00129 SEPARATION DATE: 20080215
BOARD DATE: 20120711


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (2A634, Aircraft Fuel Systems Apprentice), medically separated for an abdominal pain condition. Left upper quadrant abdominal pain developed in 2006 and was not caused by an injury or associated with a surgical indication. Extensive evaluation failed to identify a clear cause. The CI did not improve adequately with treatment to meet the physical requirements of her Air Force Specialty (AFS) or satisfy physical fitness standards. She was issued a P4 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded chronic abdominal pain for Physical Evaluation Board (PEB) adjudication. No other conditions appeared on the MEB’s submission. The PEB adjudicated left upper quadrant pain of unknown etiology as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD); and tobacco abuse as Category III: conditions that are not separately unfitting and not compensable or ratable. A Formal PEB (FPEB) upheld the 10% rating for left upper quadrant pain of unknown etiology; tobacco abuse was not included in the adjudication. On appeal to the Secretary of the Air Force Personnel Council (SAFPC), the abdominal pain adjudication was upheld. The CI was medically separated with a 10% disability rating.
CI CONTENTION: ““Left upper quadrant pain of unknown etiology” is not a definitive diagnosis and using “analogized code for gastritis” to describe an undiagnosed physical problem to justify discharge from military service has left me without abdominal relief to date. My main focus is to find a definitive diagnosis for my chronic abdominal pain. It has been years and although the DVA is helping with pain management in other parts of my body which have been diagnosed, I’ve not been treated for my abdomen and it still prevents me from living a normal life and performing daily work duties. More than anything, I need peace of mind.”


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in 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. 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 Air Force Board of Correction of Military Records (BCMR).










RATING COMPARISON:

Service FPEB – Dated 20070815
 VA (1 Mo. Post-Separation) – All Effective Date 20080216
Condition
 Code Rating Condition Code Rating Exam
Abdominal Pain 7399-7307 10% Chronic Gastritis 7307 0%* 20080324
↓No Additional MEB/PEB Entries↓
 Nasal Septal Deformity / Rhinitis 6502 10% 20080324
Thoracolumbar Deg. Joint Disease 5242 10% 20080324
0% X 1 / Not Service-Connected x 4 20080630
Combined: 10%
 Combined: 20%
*Rating decision 20100119 increased gastritis to 10% effective 20090824 (combined 30%) based on new exam


ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which her service-incurred condition continues to burden her. It is a fact, however, that the Disablility Evaluation System (DES) has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation. This role and authority is granted by Congress to the Department of Veterans’ Affairs (DVA).

Abdominal Pain Condition. Left upper quadrant (LUQ) abdominal pain began a few months prior to the first clinical encounter on 27 August 2006. An ensuing extensive laboratory and radiologic evaluation was negative, except for minimal gastritis found on upper endoscopy. Several outpatient notes documented exacerbation of pain with activity and certain movements. Response to antacid and pain medication was variable, but mostly minimal. The MEB narrative summary (NARSUM) examiner (24 April 2007, 10 months prior to separation) reported a steady, dull, non-radiating LUQ ache without nausea, vomiting, constipation or diarrhea. Examination revealed exquisite tenderness to palpation of the LUQ, but the abdomen was soft. Gait was normal and the CI was noted to sit comfortably. A psychiatric NARSUM examination performed on 7 November 2007, 3 months prior to separation, performed at the direction of SAFPC, determined that there was no evidence of a psychiatric disorder as the cause of her pain, and further noted that her pain had improved significantly in response to an abdominal muscle strengthening program. The examiner stated: “she claims to be rapidly improving at this point.” Reference was also made to the fact that her symptoms originally began during vigorous PT training. The axis III assessment was “LUQ pain resolving.” A Department of Veterans’ Affairs (DVA) Compensation and Pension (C&P) exam performed on 24 March 2008, a month after separation, reported that the pain originally developed after extensive physical training exercise. The pain was noted to always be present, and was worsened by twisting, turning, stretching or strenuous exercise. She was able to “easily walk 2 miles.” Exam revealed her to be comfortable and in no acute distress. Her gait was normal. Her abdomen was slightly tender on the left side of the xiphoid process on deep palpation. The assessment was musculoskeletal abdominal pain.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA used the 7307 code for gastritis, an understandable choice given the fact that there was objective evidence of gastritis, although minimal. The use of an analogous code by the PEB underscores the fact that the cause of the pain was not determined with certainty. Under this code, a 10% rating is justified if the condition is “chronic; with small nodular lesions, and symptoms.” The VA rated the minimal gastritis at 0%, and considered the left upper quadrant abdominal pain was due either to a musculoskeletal problem (but with no diagnosed disability of the musculoskeletal system), or to somatoform disorder (which is not considered a disabling condition). In either case, the left upper quadrant pain condition was considered not service-connected. In debating the appropriate coding and rating for the abdominal pain condition, the Board acknowledged that no code ideally described the condition and associated disability, and debated other potential coding pathways. Under the 7301 code (adhesions of peritoneum), the CI’s condition was best described as “moderate; pulling pain on attempting work or aggravated by movements of the body”, consistent with a 10% rating. Board members agreed that the 30% rating described by “ m oderately severe; partial obstruction manifested by delayed motility barium meal” was not supported. Under the 5319 code (muscle injury, g roup XIX), the 30% rating requir ing “moderately severe” symptoms as described under § 4.56 was also not supported. The Board agreed that the clinical picture was most accurately described by “moderate” symptoms via this pathway, also justifying a 10% 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 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 left upper quadrant of unknown etiology 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
Left Upper Quadrant Pain of Unknown Etiology 7399-7307 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20111105, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         XXXXXXXXXXXXXXXXXXXX
         President
         Physical Disability Board of Review


 SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews MD 20762
Dear XXXXXXXXXXXXXXXXXXXX :

          Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2012-00129
         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation with severance pay.
         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.
                                                               Sincerely,





 XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

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