Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02182
Original file (PD-2013-02182.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02182
BRANCH OF SERVICE: Army  BOARD DATE: 20140912
SEPARATION DATE: 20040905


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (92G20/Food Service Sergeant) medically separated for reflux disease with atypical chest pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent P3/H2 profile and referred for a Medical Evaluation Board (MEB). The MEB identified “esophageal spasms; atypical chest pain and reflux disease” as not meeting retention standards and forwarded these conditions to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “reflux disease with atypical chest pain, suspected esophageal spasm” as unfitting, rated at 10% citing the US Army Physical Disability policy memorandum, table of analogous codes. The CI submitted a request for reconsideration of the PEB findings, after which, the US Army Physical Disability Agency found that no change to the original findings was warranted. The CI made no further appeals and was medically separated.


CI CONTENTION: “hyatal hernia (GERD) esophageal spasms”


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 reflux disease with atypical chest pain is addressed below and no additional conditions are within the DoDI 6040.44 defined 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 respective Service Board for Correction of Military Records.


 RATING COMPARISON :

USAPDA Reconsideration – Dated 20040811
 VA - (~3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Reflux Disease With Atypical Chest Pain, Suspected Esophageal Spasm 7399-7346 10% Esophageal Spasms. Hiatal Hernia. Chronic and Severe
Gastroesophageal, Reflux Disease		 7399-7346 30% 20041124
Other x 0 (Not in Scope)
 Other x 10 20041124
Combined: 10%
 Combined: 80%
Derived from VA Rating Decision (VA RD ) dated 200 50106 ( most proximate to date of separation )
VARD 20050331 increased DC 7399-7346 to 60% effective 20040906. VARD 20060518 decreased DC 7399-7346 to 30% effective 20060501.


ANALYSIS SUMMARY:

Reflux Disease with Atypical Chest Pain. The CI had past medical history of atypical chest pain diagnosed as gastritis, Barrett’s esophagitis, gastroesophageal reflux disease (GERD), hiatal hernia and esophageal spasms. He also has a history of smoking, high blood pressure, high cholesterol and consumed alcohol daily; and family history that included coronary artery disease. The initial entry in the CI’s service treatment records for chest pain was dated
 11 September 2002. For his complaint of chest pain, the CI was given a complete cardiac and pulmonary diagnostic work-up, which included a stress test, cardiac catherization and pulmonary function tests; all results were within normal limits. Additionally, his esophageal pressures and acid probes showed only minimal level of reflux.

The CI was deployed to Iraq in April 2003 and medically evacuated CONUS in August 2003 due to increase nausea and vomiting, believed to be related to his GERD condition. The CI continued to experience difficulty, such as pain with swallowing and heartburn, despite his proton pump inhibitor medication.

The CI underwent a laparoscopic Nissen’s fundoplication on 29 December 2003 without significant improvement of his symptoms. A cardiology note dated 1 April 2004 (5 month prior to separation) documented the CI was undergoing an MEB for atypical chest pain. The CI stated that his chest pain was located left anterior upper chest, the lower chest and of the left axilla chest region. The CI was having more than 10 [chest pain] episodes per day lasting a duration of 4 to 10 minutes that was relieved by taking sublingual nitroglycerin. He occasional complained of shortness of breath, having sensation of food being stuck in lower chest and regurgitation. The CI stated that his pain increased with physical or emotional stress. His [restricted] diet or antacid medication provided no relief.

The narrative summary (NARSUM) dated 21 April 2004 notes the CI had recurrent chest pain with occasional radiation to neck and left arm with associated shortness of breath and lightheadedness occurring several times per day. He was evaluated for recurrent substernal chest pain and demonstrated no clinical improvement. The final diagnoses were esophageal spasms/atypical chest pain and GERD. The MEB’s gastroenterology consultation dated 24 June 2004 (3 months prior to separation) noted a post Nissen fundoplication surgery; normal upper GI series X-ray images and much improved GERD symptoms. The note also stated that the CI was prescribed nifedipine calcium channel blocker for suspected esophageal spasms.

At the VA Compensation and Pension (C&P) exam performed on 24 November 2004 (3 months post separation), the CI reported taking both Protonix and Tums antacids without relief. He stated that he has spasms sensation on a daily basis and his pain radiates into the left [side of his] neck and shoulder when it does occurred. The CI stated that his pain was exaggerated by stress and tension but taking [sublingual] nitroglycerin did relieve his pain. He also had dysphagia (difficulty swallowing) and the sensation of food “sticking” which cause severe epigastric pain that’s relieved by gentle sipping of water. His weight was 183 pounds at the C&P examination (181 pounds at entry physical May 2000). Physical examination revealed normal heart and lungs, no abdominal organomegaly or masses and three 1 cm scars from laparoscopic Nissen fundoplication.

The Board directs attention to its rating recommendation based on the above evidence. The Board considered VASRD diagnostic codes 7399 (rated analogously to), 7346 (hiatal hernia) used by both the PEB for a 10% rating and the VA for a 30% rating. The Board did not find evidence of vomiting, material weight loss, hematemesis, or melena with moderate anemia; or other symptom combinations productive of severe impairment of health for a 60% rating proximal to the time of separation. The applicant did not lose any weight since entry physical in 2000 and laboratory testing was negative for anemia, or blood in stool. The Board deliberations centered on whether the episodic chest pain of esophageal spasms could be considered to reach a level of considerable impairment of health. There was evidence that deployment caused considerable temporary distress and worsening of the condition that necessitated a medical evacuation from theater due to nausea, vomiting and dehydration. That GERD exacerbation condition resolved after medical and surgical treatment. The Board did not find evidence of after-treatment weight loss, or anemia. There was no reported worsening of the condition after surgery and one report of improvement of the GERD symptoms. The esophageal spasm pain resolved after 2 minutes with sublingual nitroglycerin medication (esophageal smooth muscle relaxant).

Prolonged deliberations and review of the evidence ensued, including the effects of alcohol damage to the esophageal and stomach lining and smoking on the production of acid in the stomach. The Board also noted that the VA rating decision also included irritable bowel syndrome, which was undiagnosed and asymptomatic while on active duty. After extensive review and discussion, the Board did not see evidence to support the reflux disease with atypical chest pain, suspected esophageal spasm condition approached a permanent considerable impairment of health for a higher rating of 30%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.7 (higher of two ratings), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the reflux disease with atypical chest pain, suspected esophageal spasm 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. As discussed above, PEB reliance on the USAPDA policy/guidance memorandum #12 table of analogous codes (since withdrawn) for rating reflux disease with atypical chest pain, suspected esophageal spasm condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the reflux disease with atypical chest pain, suspected esophageal spasm 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.
















The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130916, 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, AR20150003241 (PD201302182)

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 of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2012 | PD2012-00495

    Original file (PD2012-00495.pdf) Auto-classification: Denied

    The Board also considered the residual effects of gastroesophageal surgery claimed as memory loss and any mental condition for which the VA assigned a 10% rating based on an evaluation in 2011, and which the CI contends warrants additional disability rating. In the matter of the residual effects of gastroesophageal surgery claimed as memory loss and any mental condition, the Board unanimously agrees that it cannot recommend a finding of unfit for additional rating at separation. Service...

  • AF | PDBR | CY2011 | PD2011-00637

    Original file (PD2011-00637.docx) Auto-classification: Denied

    The Formal PEB (FPEB) adjudicated the non-cardiac chest pain condition as unfitting, rated 10%; additionally, history of trauma to sternum with arthritic changes condition was considered category II, related but not separately unfitting. Cardiac causes for the chest pain were ruled out and although some significant gastroenterological conditions were noted, none contributed to the CI’s chest pain. While the initial and reconsideration PEBs determined the CI was fit for duty, an FPEB...

  • AF | PDBR | CY2009 | PD2009-00459

    Original file (PD2009-00459.docx) Auto-classification: Denied

    After the surgery she gradually improved but still had persistent recurrent flare-ups of severe spasm and pain of the left upper back, left posterior neck that radiated to her left occiput and down her left arm. The Board considered the following conditions and unanimously concluded that none should be considered unfitting: Left Upper Extremity Radiculopathy; Lumbosacral Spine, Degenerative Joint and Disc Disease; S/P Hysterectomy; S/P Cholecystectomy; Postoperative Scar, Anterior Cervical...

  • AF | PDBR | CY2011 | PD2011-00537

    Original file (PD2011-00537.docx) Auto-classification: Denied

    SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (25L/Cable Systems Installer), medically separated for chronic nausea and vomiting of unknown etiology, with normal nutritional state. The PEB awarded 0% disability for the chronic nausea and vomiting condition and determined the GERD condition to be not unfitting. It notes the normal laboratory findings, other than the evidence for mononucleosis, and...

  • AF | PDBR | CY2014 | PD-2014-01788

    Original file (PD-2014-01788.rtf) Auto-classification: Approved

    The bowel and hip conditions, characterized as “irritable bowel syndrome [IBS] with chronic pain and bloating” and “snapping hip syndrome,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. Snapping Hip Syndrome . The DA Form 2173( Statement of Medical Examination and Duty Status ),dated 14 December 2005, noted complaints of bilateral hip pain during mobilization training in August 2004, with increasing hip pain due to the weight of gear and weight loss.

  • AF | PDBR | CY2012 | PD 2012 01311

    Original file (PD 2012 01311.rtf) Auto-classification: Denied

    The VA continued the 10% rating on its review in 2007. 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 back pain condition and IAW VASRD...

  • AF | PDBR | CY2013 | PD-2013-01609

    Original file (PD-2013-01609.rtf) Auto-classification: Denied

    The Informal PEB adjudicated “chronic abdominal pain, status post a cholecystectomy” and “schizoaffective disorder with PTSD, requiring psychotropic medications” as unfitting, rated 10% and ---% respectively, citing application of the US Army Physical Disability Agency (USAPDA) pain policy for the abdominal pain and EPTS without permanent service aggravation to the schizoaffective disorder. The Board’s assessment of the PEB rating determinations is confined to review of medical records and...

  • AF | PDBR | CY2014 | PD 2014 00038

    Original file (PD 2014 00038.rtf) Auto-classification: Denied

    The Informal PEB adjudicated bradycardia and sick sinus syndrome, transient light headedness, chest pain, mild distal esophageal stricture currently asymptomatic, dyspnea on exertion, and gastroesophageal reflux (GERD) currently controlledas unfitting, rated at 0%.The remaining conditions, migraines, chronic lower back pain and obesity conditions were determined to be Category III and not unfitting.The CI made no appeals and was medically separated. The NARSUM examiner noted that the CI was...

  • AF | PDBR | CY2009 | PD2009-00709

    Original file (PD2009-00709.docx) Auto-classification: Denied

    Right Ankle Condition . All evidence considered proximate to the CI’s date of separation, there is not reasonable doubt in the CI’s favor supporting the addition of the lower back condition as an unfitting condition for separation rating. The CI’s contended depression was not in evidence at the time of separation and the worsening of his ankle and lower back conditions cannot be adjudicated by the Board.

  • AF | PDBR | CY2013 | PD-2013-02233

    Original file (PD-2013-02233.rtf) Auto-classification: Denied

    Post-Separation) ConditionCodeRatingConditionCodeRatingExam Abdominal Pain, Status Post Laparoscopic Cholecystectomy731810%Gastroesophageal Reflux Disease with Cholecystectomy7318-734610%20050802Scars, Residual of Cholecystectomy780410% 20050802Other MEB/PEB Conditions x 0 (Not In Scope)Other x 7 (Not in Scope) RATING: 10%RATING: 30%*Derived from VA Rating Decision (VARD)dated 20060118 invalid font number 31502 ( most proximate to date of separation [DOS]). The Board reviewed the VA...