Upgrade.Vet

AF | PDBR | CY2013 | PD-2013-02561

Original file (PD-2013-02561.rtf) Auto-classification: Approved

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX CASE: PD-2013-02561
BRANCH OF SERVICE: Army BOARD DATE: 20141223

SEPARATION DATE: 20061113

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-3 (Field Artillery Officer) medically separated for pilonidal disease. 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 P2/L3 profile and referred for a Medical Evaluation Board (MEB). The condition, characterized as “recurrent pilonidal disease” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (low back pain) as meeting retention standards. The Informal PEB adjudicated “recurrent pilonidal disease, status post excision x 3, 2x3 cm rated as deep scar” as unfitting, rated 0% with application of the VA Schedule for Rating Disabilities (VASRD). The remaining condition was determined to be not unfitting . The CI made no appeals and was medically separated.

CI CONTENTION : “ Wound is still open. Must be constantly monitored and cleaned. Had follow on surgery after military separation in April of 2007 at UMASS Memorial Hospital in Worcester Mass. Still can not sit flush on the area. This has led to aggravation of other issues with right hip, knee and back.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. 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. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON :

Service IPEB – Dated 20060808	VA* - (2 Mos. Pre-Separation)
Condition	Code	Rating	Condition	Code	Rating	Exam
Recurrent Pilonidal Disease	7899-7820	0%	Scar, S/P Multiple Pilonidal Cyst Removal	7819-7804	10%	20060905
Low Back Pain	Not Unfitting	Degenerative Disk Disease of the Lumbar Spine	5242	10%	20060905
Other x 0 (Not in Scope)	Other x 5
Combined: 0%	Combined: 40%

* Derived from VA Rating Decision (VA RD ) dated 200 61207 (most proximate to date of separation ( DOS ) )

ANALYSIS SUMMARY

Recurrent Pilonidal Disease. The narrative summary (NARSUM) notes the CI developed a pilonidal cyst condition (infected deep hair follicles in the sacral area of the mid lower back). This required surgical excision of the area in February 1999. The surgical site did not completely heal with recurrence of the cysts. Second and third operations for removal of recurrent pilonidal disease were undertaken in March 2004 and June 2005. At this third operative procedure, the diseased tissue extended deep near the coccyx (tail bone) in close proximity to, but not involving, the area of the rectum. The surgical site could not be closed primarily (with sutures) and was left open for healing by secondary intent (natural healing) with wound care and packing of the wound. This was undertaken with frequent clinic visits and daily cleansing of the wound and packing with dressings at home. On wound clinic visits in September and November 2005, the surgical wound was painful but healing. Dimensions of the healing area are in the chart below. At the NARSUM examination performed on 31 January 2006, the sacral wound was reported to be “open with drainage” and “packed with a dressing.” At the MEB NARSUM evaluation on 11 April 2006, 8 months prior to separation, the CI reported being unable to do this duty because of the time required daily dressing changes and wound pain limiting his ability to sit. The MEB physical exam described the scar as “healing” with “moderate and intermittent pain.” The total scar size was not reported but an area of 2 centimeter (cm) wide by 3 cm long was reported “under treatment.” Further details of this exam are summarized in the chart below. In May 2006, the upper end of the scar was reported to have opened with some purulent drainage. An opened area of 2.5 cm long x 1.0 cm wide by 0.5 cm deep was recorded. Pain in the area was moderate. Further details of this examination are in the chart below.

At the VA Compensation and Pension (C&P) exam performed on 5 September 2006, 2 months prior to separation, the CI reported cleaning and packing of the wound every day. He noted pain when pressure is applied to the area such as sitting in a chair, but was taking no major pain medicine. On physical exam the total size of the scar was 8 cm by 2 cm with the lower 25% of the scar area devoid of skin. Details of this evaluation are summarized in the chart below.

The results of clinical evaluations of wound size and condition, which the Board considered in its rating decision, are contained below. All measurements are expressed in centimeters (cm).

SCAR AND WOUND ANALYSIS

DATE S OF EVALUATION	WOUND SIZE (length x width x depth)	DESCRIPTION OF WOUND	WOUND PAIN
19 Sept 2005	--	S maller than last visit; healing	5/10 Moderate when he sits
16 Nov 2005	2.0 x 1.0 x 1.0	M uch improved; healing	Intermittent pain and bleeding
4 April 2006	1.5 x 0.5 x ? ( area without skin )	Healing small am oun t blood/dressing	M oderate
11 April 2006 (NARSUM)	2.0 x 3.0 x ? ( area without skin )	Healing without infection	‘M oderate and intermittent’
17 May 2006	--	Superior part of wound is opening Small am ount purulent drainage	M oderate
22 May 2006	2.5 x 1.0 x 0.5 ( area without skin )	Healing	M oderate
5 Sept 2006 (C&P)	8.0 x 2.0 ( t otal scar) Bottom 2.0 x 2.0 ( area without skin )	Deep scar; not stable, inflammation present	Pain when things touch area and with sitting ; pain when probed on exam

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the pilonidal cyst condition at 0%, analogous to code 7820 (infections of the skin). Under this code the condition is rated under referred codes 7806 (dermatitis) or 7804 (painful scars). Under code 7806 (skin infections), a rating of 0% requires less than 5% involvement of the exposed area affected. A 10% rating requires at least 5% but less than 20% of the exposed area affected. A higher rating of 30% requires involvement of at 20% to 40% of the exposed area affected. Under code 7804 (scars), a 10% rating requires one or two scars that are unstable or painful. A 20% rating requires three to four scars that are unstable or painful. The VASRD defines an unstable scar as one “where, for any reason, there is frequent skin loss or covering of the skin of the scar.” The VA rated the pilonidal cyst condition at 10%, coded 7804 (scars) citing the scar to be painful. The Board considered a rating under code 7806 (skin infections). The Board was able to determine the size of the open surgical wound from the record in evidence, but was unable to determine the area of overall sacral area of potential involvement. Therefore, no percentage of involvement, required for rating under this code, could be calculated. The Board considered a rating under code 7804 (scars). The Board noted that the scar condition was deep had two separate components documented by the record (pain and scar instability) and that each had separate symptoms and impact on function. The Board consensus was that the record in evidence supported a rating of 10% for wound pain given documentation of sacral pain in multiple clinic visits, the location of the scar with recurrent irritation, and pain associated with the frequent required treatments and dressing changes. The Board agreed the wound met the criteria for instability, given the marked delay in healing; the changing size of the scar, both increasing and decreasing during treatment and the continued loss of skin over a portion of the total scar area as documented by the record at the time of separation. The Board concluded, however, that the condition could not be dual rated for both pain and instability IAW VASRD rules in effect at the time of separation. The Board found no other appropriate codes for rating consideration. 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 pilonidal cyst condition.

Contended Back Condition. The Board’s main charge is to assess the fairness of the PEB’s determination that the contended back condition was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The CI sustained an injury to his back during active training in 2003. An MRI of the back in November 2003 revealed lower back degenerative disc disease without disc herniation or spinal nerve root compression. On multiple service treatment exams, the CI had normal ranges-of-motion of the back with some painful motion but normal motor, reflex and sensory examinations.
On the C&P exam, performed 2 months prior to separation, the CI reported no episodes of incapacitation from the back condition for the past 12 months. The back condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards. All were reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended back condition and so no additional disability rating is recommended.

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 pilonidal cyst condition, the Board majority recommends a disability rating of 10%, coded 7804, IAW VASRD §4.118. In the matter of the contended back pain condition, the Board unanimously recommends no change from the PEB determination as not unfitting. 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 his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING
Pilonidal Cyst Disease	7804	10%
COMBINED	10%

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131126, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

invalid font number 31502 SAMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

invalid font number 31502 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
invalid font number 31502 f invalid font number 31502 or invalid font number 31502 XXXXXXXXXXXXXXXXXX invalid font number 31502 , AR20150008343 (PD201302561)

invalid font number 31502
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                                                  invalid font number 31502 XXXXXXXXXXXXXXXXXX invalid font number 31502
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

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 | CY2011 | PD2011-01091

Original file (PD2011-01091.docx) Auto-classification: Denied

The PEB adjudicated the bilateral plantar fasciitis with underlying pes planus condition, and recurrent skin abscesses condition as unfitting, rated 0% and 0% respectively, with application of the Veterans Administration Schedule for Rating Disabilities (VASRD). The left knee osteochondral defect and left ankle sprain conditions requested for consideration and the unfitting plantar fasciitis and recurrent skin abscesses conditions meet the criteria prescribed in DoDI 6040.44 for Board...
AF | PDBR | CY2013 | PD-2013-01798

Original file (PD-2013-01798.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 the VASRD standards to the unfitting medical condition at the time of separation. The General Surgeon noted the shrapnel wounds were healing well and a Physical Medicine Specialist documented right anterolateral thigh numbness, sharp pain, and weakness. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the...
AF | PDBR | CY2014 | PD 2014 01924

Original file (PD 2014 01924.rtf) Auto-classification: Denied

invalid font number 31502 Service IPEB – Dated 20080711VA - based on Service Treatment Records (STR)ConditionCodeRatingConditionCodeRatingExam Lumbar DDD523710%Lumbar DDD with Radiculopathy524220%STROther X 0 (Not in Scope)Other x1 Combined: 10%Combined: 30%Derived from VA Rating Decision (VARD) dated 20090124 (most proximate to date of separation [DOS]) ANALYSIS SUMMARY :IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. A...
AF | PDBR | CY2012 | PD 2012 01539

Original file (PD 2012 01539.rtf) Auto-classification: Denied

Left Shoulder Condition . Treatment records supported findings of instability after surgical repair and an emergency department visit in May 2003 (8 months prior to separation) documented a left shoulder dislocation.The MEB physical exam performed 6 months prior to separation documented shoulder range-of-motion (ROM) of 160 degrees of flexion (180 degrees normal) and 160 degrees abduction (180 degrees normal) which was equal on the left and right shoulders. At the VA Compensation and...
AF | PDBR | CY2014 | PD-2014-01693

Original file (PD-2014-01693.rtf) Auto-classification: Denied

invalid font number 31502 Service IPEB – Dated 20060316VA - (3 Mos. Chronic Upper Back Pain Condition . The CI was seen in pain managementprior to deploying for pain medications due to the chronic clavicle and shoulder pain.
AF | PDBR | CY2014 | PD-2014-02503

Original file (PD-2014-02503.rtf) Auto-classification: Approved

Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Post-Separation) ConditionCodeRatingConditionCodeRatingExam Lumbago5299-52370%Lumbago523710%20070130Other x 0 (Not In Scope)Other x 2 RATING: 0%RATING: 30% *Derived from VA Rating Decision (VARD)dated 20070319(most proximate to date of separation (DOS)). Motor, sensory and reflexes...
AF | PDBR | CY2013 | PD-2013-02791

Original file (PD-2013-02791.rtf) Auto-classification: Denied

The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separationand, to review those fitness determinations within its scope consistent with performance-based criteria in evidence at separation. tenderness to palpation; Decreased movement of toes of right foot; Repetitive motion increased ROM; No temperature change; No skin or vascular changes; Normal reflexes...
AF | PDBR | CY2013 | PD-2013-01784

Original file (PD-2013-01784.rtf) Auto-classification: Approved

Scars Condition . The Board directed its attention to its rating recommendationbased on the above evidence.The PEB assigned a 10% rating under the 7801 code (scars that are deep and nonlinear) for the right leg scar while the VA also rated the scar at 10%, but used the 7804 code (scars, unstable or painful).While the VA also assigned a 0% rating for multiple other scars, the PEB’s rating addressed only the unfitting right leg scar. At the MEB exam 4 months prior to separation the CI...
AF | PDBR | CY2013 | PD-2013-02188

Original file (PD-2013-02188.rtf) Auto-classification: Denied

Left Knee Condition . Post-SepFlexion (140 Normal)13014095Extension (0 Normal)00-10CommentMild effusion; left thigh atrophy; neg lachman and posterior drawer; no valgus or varus instability; crepitus notedOccasional use of an assistive device.Painful motion noted; Four months post-operative from post separation surgery.§4.71a Rating10%10%10%The Board directed attention to its rating recommendationbased on the above evidence.The VA and PEB both rated the knee at 10% based on examinations...

Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02561

Similar Decisions