Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-01062
Original file (PD-2013-01062.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-01062
BRANCH OF SERVICE: Army  BOARD DATE: 20140520
SEPARATION DATE: 20070501


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (68W/Combat Medic) medically separated for rectum and anus impairment. He began having bowel movement issues in 2005 and 2006 and after conservative treatment he was given surgical intervention. His conditions did not adequately respond to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The rectum and anus impairments, characterized as “proctalgia fugax,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated proctalgia fugax condition as unfitting, rated 30%, with application of the VA Schedule for Rating Disabilities (VASRD). The CI did not appeal. The PEB’s 30% rating decision was returned for a VASRD code correction and a Reconsideration IPEB reaffirmed the 30% rating. The CI did not appeal. The PEB’s 30% rating decision was returned due to receipt of new evidence and the Reconsideration PEB changed the rating to 10%. The CI did not concur and requested a Formal PEB (FPEB). The FPEB adjudicated a 10% rating. Following nonconcurrence/rebuttal, the US Army Physical Disability Agency reaffirmed the FPEB’s rating and the CI was medically separated.


CI CONTENTION: “On 21/Nov/06 I signed paperwork stating I was rated at 30% TDRL. Without any further reviews/screening it was changed to 10% 1/18/07.” “My problem has continued since leaving the Army. I am now at 100% at the VA but medical care at the VA hospital is 20 mins away. My main concern is the Tricare medical which will be easier to get to.”


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 ratings for the unfitting rectum and anus impairment conditions are addressed below. Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s assertions that it was an injustice to be separate with a 10% disability rating while he has a 100% total VA disability; but, must emphasize that the Military Disability Evaluation System 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 Veterans Affairs, operating under a different set of laws.


RATING COMPARISON :
Service FPEB – Dated 20070222
 VA* - ( 2.6 Mo. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Rectum and Anus Impairment 7332 10% Proctalgia Fugax, S/P Sphincter Repair 7332 60%** 20070717
Other x 0 (Not in Scope)
 Other x 3 20070717
Combined: 10%
 Combined: 60%
*Derived from VA Rating Decision (VARD) dated 20070914 (most proximate to date of separation ( DOS))
** Rating incre ased to 100% effective 20091208


ANALYSIS SUMMARY:

Rectum and Anus Impairment. The record indicates the CI had complaints of painful bowel movements with diagnoses of hemorrhoids and anal fissure and underwent corrective surgery. He continued to have bowel movement and anal pain symptoms and a diagnosis of proctalgia fugax (a functional anorectal disorder characterized by severe, intermittent episodes of rectal pain) was made. The CI underwent a sphincterotomy in April 2006, but had recurrent bloody/painful bowel movements and incontinence. The narrative summary dated 4 October 2006, approximately 6 months prior to separation, indicated “pain and bleeding came back with every bowel movement. Since that time, he has been in chronic pain, having pain 2-3 times per week. This is very severe, lasting 1-1/2 hours after each bowel movement. He describes it as a tearing pain and pain always when he sits for greater than 2 hours. His pain after sitting is described as a stinging 7/10 pain, lasting 15 minutes after he gets up and starts to walk around.” The FPEB dated 22 February 2007, approximately 2 months prior to separation, described the unfitting condition as “rectum and anus impairment for sphincter control status post surgical repair of anal fissure and sphincterotomy. These Surgical procedures were prompted by proctalgia fugax which has continued to cause severe pain lasting 1 1/2 hours after each bowel movement 2-3 times per week. Due to ongoing sphincter dyscontrol, the soldier continues to experience slow, steady leakage of fluid and soft stools after bowel movements requiring use of 2 or more pads daily to prevent staining. Rated for constant slight with occasional moderate leakage.” The applicant was present at the FPEB and sworn testimony was noted by the FPEB in their rating determination. At the VA Compensation and Pension general exam dated 17 July 2007, approximately 2 months after separation, the CI reported “recurrence of stool leakage. He wears pads on a consistent basis, which he requires to change about 3-4 times a day.” Remote from separation (over 2 years) a VA claim in December 2009 and examination in January 2010 indicated symptom worsening, which was rated at 100% by the VA. However, this worsening was not adjudged to be indicative of the CI’s condition proximate to separation.

The Board directs attention to its rating recommendation based on the above evidence. The FPEB rated the condition at 10% coded 7332 ( Rectum and anus , impairment of sphincter control). The VA rated the condition at 60% using the same disability code of 7332. The Board considered possible analogous ratings under 7319 (Irritable colon syndrome (spastic colitis, mucous colitis, irritable bowel, etc.) and 7333 (Rectum and anus, stricture of), but determined that coding under 7332 was predominate. The focus of the Board was consideration of the rating level IAW VASRD § 4.114 and the c riteria for 7332 listed below:

7332     Rectum and anus, impairment of sphincter control:
                  Complete loss of sphincter control       100
                  Extensive leakage and fairly frequent involuntary bowel movements        60
                  Occasional involuntary bowel movements, necessitating wearing of pad     30
                  Constant slight, or occasional moderate leakage.         10
                  Healed or slight, without leakage        0

The Board deliberated between the 10%, 30%, and 60% rating levels. The record indicated the CI wore pads constantly versus occasionally, and had leakage that caused pad changes more than 2 times per day. The FPEB’s description of “continues to experience slow, steady leakage of fluid and soft stools after bowel movements requiring use of 2 or more pads daily to prevent staining” coupled with the VA description of “recurrence of stool leakage. He wears pads on a consistent basis, which he requires to change about 2- to 3-4 times a day” were not considered sufficient to warrant a 60% rating for extensive leakage and fairly frequent bowel movements. However, the history and descriptions of pain, anal leakage and pad use were substantially similar between the FPEB and the VA exam and did indicate daily/continuous use of pads. Changing pads more than twice a day on days without a bowel movement also appeared to represent a disability picture greater than that envisioned by the 10% rating criteria. The “severe pain lasting 1 1/2 hours after each bowel movement 2-3 times per week” for the pain and disability symptoms of proctalgia fugax versus the anal impairment from sphincterotomy, was considered as potentially analogous to “moderate abdominal distress” under code 7319, but would not support any higher rating. Given the CI’s symptoms necessitating wearing of pad continuously as well as soft stool occurring at other than bowel movements, the CI’s disability picture more nearly approximated that envisioned by the disability picture of the 30% rating level. Considering the totality of the evidence and with consideration of application of VASRD §4.3 (reasonable doubt) the Board recommends a disability rating of 30% for the r ectum and a nus i mpairment with continu ed proctalgia fugax 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 rectum and anus impairment condition, the Board unanimously recommends a disability rating of 30% coded 7332 IAW VASRD § 4.114. In the matter of the rectum and anus impairment 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 recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Rectum and Anus Impairment 7332 30
COMBINED 30



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 201301062, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX, AR20150005956 (PD201301062)


1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.

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:

         a. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

         b. Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

         c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

         d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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

Similar Decisions

  • AF | PDBR | CY2014 | PD-2014-00387

    Original file (PD-2014-00387.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVASRDstandards to the unfitting medical condition at the time of separation. She reported GI symptoms 8 months out of the year. XXXXXXXXXXXXXXXPresidentDoD Physical Disability Board of Review

  • AF | PDBR | CY2013 | PD-2013-02780

    Original file (PD-2013-02780.rtf) Auto-classification: Approved

    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. Post-Separation)ConditionCodeRatingConditionCodeRatingExam Pruritus Ani With Current Fissures Formation73370%Pruritus Ani7337-733610%20070207Other x 0 (Not In Scope)Other x 5 RATING: 0%RATING: 50% *Derived from VA...

  • AF | PDBR | CY2012 | PD2012-01217

    Original file (PD2012-01217.pdf) Auto-classification: Approved

    TDRL RATING COMPARISON: Service USAPDA – Dated 20030124 VA – All Effective Date 20050429* Condition Code Rating Exam Condition Enter TDRL (19981117) Crohn’s Disease Code 7326-7319 Enter TDRL 30% Rating Sep (20030219) 10% No Additional MEB/PEB Entries Crohn’s Disease Lumbar Strain w/ DDD 7323 60%** 5010-5242 Not Service Connected x 8 40% 19990707 20050929 20050929 20050929 Combined: 10% Combined: 80% * VA rating based on exam most proximate to date of permanent separation. Crohn’s Disease...

  • AF | PDBR | CY2012 | PD2012 01571

    Original file (PD2012 01571.rtf) Auto-classification: Denied

    No other conditions were submitted by the MEB.The PEB adjudicated “abdominal pain, status post gunshot wound”as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).The CI requested reconsideration. 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...

  • AF | PDBR | CY2013 | PD-2013-01934

    Original file (PD-2013-01934.rtf) Auto-classification: Denied

    No other conditions were submitted by the MEB.The Informal PEB adjudicated “recurring pilonidal cyst”as unfitting, rated 10%, with likely application of VA Schedule for Rating Disabilities (VASRD).The CI made no appeals and was medically separated. The rating for the unfitting recurring pilonidal cyst condition is addressed below including possible residuals; no additional conditions are within the DoDI 6040.44 defined purview of the Board. Additionally, he also had difficulties with his...

  • AF | PDBR | CY2013 | PD-2013-01703

    Original file (PD-2013-01703.rtf) Auto-classification: Denied

    At the deployed clinic encounter on 30 December 2002, when the CI complained of episodes of testicular pain, the examiner recorded, “denies any other problems.” In the deployed clinic encounters on 2 January 2003 and 5 January 2003, there was no complaint or history of bowel problems recorded. The CI was seen the next day in the clinic and the encounter recorded “states he has seen blood in stools as of late.” The history of ulcerative proctitis was noted and he was referred to...

  • AF | PDBR | CY2012 | PD2012 00696

    Original file (PD2012 00696.rtf) Auto-classification: Approved

    The CI was then medically separated. The Board directs attention to its rating recommendationbased on the above evidence.The PEB’s 10% rating was based on a combined 7319 code (IBS) and analogous 7323 code (ulcerative colitis).The VA assigned a 60% ratingunder an analogous 7323 code for Crohn’s disease deemed to be “severe; with numerous attacks a year and malnutrition, the health only fair during remissions.” However, the VA additionally assigned 10% for separately rated irritable bowel...

  • AF | PDBR | CY2014 | PD-2014-01545

    Original file (PD-2014-01545.rtf) Auto-classification: Denied

    A 10% rating requires the symptoms to be “mild” and a higher rating of 30%, requires the condition to be “severe”.The Board unanimously agreed that well-established medical principles documents that the upper abdominal pain with diarrhea and episodic elevation of liver enzymes is a known consequence of cholecystectomy and that this may occur acutely or at distant interval after surgery unrelated to known stimuli.The Board unanimously agreed that, based on acceptable medical practice, the...

  • AF | BCMR | CY2009 | BC 2009 00790

    Original file (BC 2009 00790.txt) Auto-classification: Approved

    RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2009-00790 COUNSEL: HEARING DESIRED: NO _________________________________________________________________ APPLICANT REQUESTS THAT: His disability rating for his permanent disability retirement be changed from 30 percent to 60 percent. The counsel’s rebuttal is at Exhibit E. ___________________________________________________________________ BCMR MEDICAL CONSULTANT EVALUATION: The...

  • AF | PDBR | CY2012 | PD2012-01029

    Original file (PD2012-01029.pdf) Auto-classification: Denied

    After due deliberation, considering all of the evidence and mindful of VASRD §4.7 (higher of two evaluations), the Board recommends a disability rating of 10% for the IBS with chronic abdominal pain and diarrhea condition. Any abdominal disability from this condition was appropriately considered as a comprehensive abdominal condition under the CI’s unfitting 7319 abdominal condition discussed above. After due deliberation in consideration of the preponderance of the evidence, the Board...