RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY  
SEPARATION DATE:  20031126 

 
NAME:  XXXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200634 
BOARD DATE:  20130201 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty,  SPC/E-4,  (91W/Health  Care  Specialist),  medically 
separated for chronic abdominal and pelvic pain secondary to endometriosis, status post (s/p) a 
total  abdominal  hysterectomy  (TAH).    In  1999  the  CI  had  an  emergency  laparoscopy  for  a 
hemorrhagic  corpus  luteum  cyst.    The  pathology  report  indicated  endometriosis.    Despite 
ongoing treatment, she failed to have any resolution of her symptoms and her pain worsened.  
In February 2003, she had complications during surgery for adhesions requiring a repair to a 
perforated section of her small bowel and a TAH and bilateral salpingo-oopherectomy (BSO).  
She continued to have pain post-operatively.  She was also diagnosed with Grave’s disease in 
November  2002.    The  CI  did  not  improve  adequately  with  treatment  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 chronic pelvic pain secondary to endometriosis s/p TAH and Grave’s disease to 
the  Physical  Evaluation  Board  (PEB)  as  medically  unacceptable.    The  PEB  adjudicated  the 
chronic  abdominal  and  pelvic  pain  secondary  to  endometriosis  as  unfitting,  rated  10%,  with 
application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The Grave’s disease 
was determined to be not unfitting.  The CI made no appeals and was medically separated with 
a 10% disability rating.   
 
 
CI CONTENTION: “My desire to serve my country was cut short due to a surgical mistake.  I had 
7 years of dedicated service to my country when my physical condition that was caused during 
my  military  service  prevented  me  from  continuing  to  retirement.  I  am  still  dedicated  to  the 
military  and  love  all aspects  of  it.  I  miss  the  systematic  missions  and  long  for  that  feeling of 
comradery (sic) that can be found nowhere else.”  The CI elaborated further on her small bowel 
surgery and TAH, but did not contend for the treated Graves Disease.   
 
 
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.  The unfitting chronic abdominal and pelvic 
pain secondary to endometriosis is within the scope.  The TAH does not fail retention standards 
and is not a ratable, unfitting condition.  The not unfitting Grave’s disease was not contended 
and  is,  therefore,  not  within  the  purview  of  the  Board.    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:   
 

20040429 

10% 
50% 

pain 
to 

Not Unfitting 

Code 

7900 
7617 

Rating 

10% 

Code 

7629 

7328-7301 

10%* 

Rating 

Exam 

20040429 
20040429 
20040429 

VA (5 Mos. Post-Separation) – All Effective Date 20031127 
Condition 
Pelvic  pain  s/p  perforation  of 
the  small  bowel  w/repair  and 
re-anastomosis 
Graves Disease 
TAH/BSO w/scar 
0% X 2 / Not Service-Connected x # 
Combined:  60% 

Service IPEB – Dated 20030808 
Condition 
Abdominal/pelvic 
secondary 
endometriosis, s/p TAH 
Graves Disease 
↓No Additional MEB/PEB Entries↓ 
Combined:  10% 
*VA originally coded 7328 and rated at 0%; increased to 10% and changed code to 7328-7301 effective DOS after DRO review.  
 
 
ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit 
and  vital  fighting  force.    While  the  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.  The 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  nor  for 
conditions determined to be service-connected by the Department of Veterans Affairs (DVA) 
but not determined to be unfitting by the PEB.  However the, operating under a different set of 
laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  all  service-connected 
conditions  and  to  periodically  re-evaluate  said  conditions  for  the  purpose  of  adjusting  the 
Veteran’s disability rating should the degree of impairment vary over time.  The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating  determinations,  compared  to  VASRD  standards,  based  on  severity  at  the  time  of 
separation.    The  Board  utilizes  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.  The Board 
has neither the jurisdiction nor authority to scrutinize or render opinions in reference to the CI’s 
statements  in  the  application regarding  suspected  DES  improprieties  in  the processing  of  his 
case.   
 
Chronic  Abdominal  and  Pelvic  Pain  Secondary  to  Endometriosis.    The  CI  presented  with 
abdominal pain while deployed and was found to have a ruptured corpus luteum cyst with a 
large  hemorrhage  into  the  abdomen.    Her  post-operative  recovery  was  uneventful,  but  her 
abdominal/pelvic pain persisted.  On 24 April 2001, she underwent laparoscopy and was noted 
to have endometriosis and adhesions.  She subsequently developed constipation and was noted 
to  have  an  adhesion-induced  tortuous  colon  on  sigmoidoscopy.    She  remained  symptomatic 
despite hormonal medications.  In February 2003, she again had laparoscopy and lysis of the 
adhesions, but developed abdominal pain after the surgery and was found to have a perforated 
segment of small bowel which was surgically resected in a second procedure.  Due to the extent 
of the pelvic pathology, the surgeon also performed a TAH BSO, procedures which had been 
discussed  with  the  CI  prior  to  the  surgery  and  to  which  she  had  consented.    She  was  seen 
multiple  times  in  the  immediate  post-operative  period  with  residual  pain.    At  the  MEB 

examination on 9 June 2003, 4 months after the last surgery and 5 months prior to separation, 
the  CI  reported  persistent  abdominal  pain  and  intestinal  trouble  since  the  surgery.    The 
narrative summary was dictated on 19 July 2003.  The examiner noted that the CI had enjoyed 
some improvement in her pelvic pain, but that she continued to have significant pain and would 
likely have issues with adhesions in the future.  On examination, she was noted to have midline 
incision scars, but otherwise there were no masses noted and the abdomen was nontender.  
Pelvic and rectal examinations were deferred as she had undergone a complete examination at 
the time of the surgery.  She was not on any treatment for the endometriosis or pelvic pain at 
the time of the dictation, but was taking replacement hormones following the TAH BSO.  She 
was  unable  to  do  vigorous  activities.    At  the  VA  Compensation  and  Pension  examination  on 
29 April 2004, 5 months after separation, the CI reported that she still developed pain in the left 
abdomen on occasion and passed a lot of gas.  On examination she was noted to be in no acute 
distress.  She weighed 105 pounds, one pound less than on her accession examination 8 years 
earlier.    The  scars  were  noted  to  be  non-tender  and  well-healed.    The  abdomen  was  soft, 
nontender and without masses.  Normal external female genitalia were present.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The VA 
awarded 50% for the TAH BSO.  As already noted, this is not medically unacceptable, unfitting 
for  service,  or  ratable.    The  VA  determined  that  the  pelvic  pain  was  secondary  to  the 
perforation of the small bowel initially and awarded a 0% rating coded 7328 (resection of the 
small bowel) since she did not have diarrhea, anemia or inability to gain weight.  Upon Decision 
Review Officer (DRO) reevaluation, the VA awarded 10% for pelvic pain secondary to adhesions 
coded 7328-7301 (peritoneal adhesions).  The PEB also awarded 10%, but utilized the coding 
option  7629  (endometriosis).    The  Board  considered  that  the  unfitting  abdominal  and  pelvic 
pain could have been caused by the endometriosis, the adhesions or both.  Under code 7328, 
her condition would not be compensable due to the absence of diarrhea or weight loss.  While 
she  clearly  had  endometriosis,  she  was  not  under  treatment  and  would  also  be  non-
compensable  under  this  coding  option.    The  peritoneal  adhesions  coding  option,  7301,  does 
support a 10% disability rating.  However, this provides no advantage to the CI.  By precedent, 
the Board typically does not change the PEB coding choice unless there is an advantage to the 
CI.    After  due  deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3 
(Resolution  of  reasonable  doubt),  the  Board  concluded  that  there  was  insufficient  cause  to 
recommend  a  change  in  the  PEB  adjudication  for  the  chronic  abdominal  and  pelvic  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  chronic  abdominal  and  pelvic  pain  condition  and  IAW 
VASRD  §4.114  and  §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, as follows:   
 

10% 

UNFITTING CONDITION 
Chronic  Abdominal  and  Pelvic  Pain  Secondary  to  Endometriosis,  7629 

VASRD CODE  RATING 

status post Total Abdominal Hysterectomy 

 
 

 

COMBINED 

10% 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120602, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20130003068 (PD201200634) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)