Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-01714
Original file (PD-2014-01714.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-01714
BRANCH OF SERVICE: navy  BOARD DATE: 20141217
SEPARATION DATE: 20081106


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Infantry, Gun Crews and Seamanship Specialist) separated for female pelvic pain. The condition could not be adequately rehabilitated to meet the physical requirements of her Rating or satisfy physical fitness standards. She was placed on limited duty and referred for a Medical Evaluation Board (MEB). The pelvic condition, characterized as “unspecified symptoms associated with female genital organs” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB also identified and forwarded six other conditions (see rating chart below) for PEB adjudication. The Informal PEB adjudicated “female pelvic pain,” rated 10% and reduced to 0% for noncompliance using the VA Schedule for Rating Disabilities (VASRD). The dysmenorrhea and dyspareunia conditions were determined to be related C ategory I I diagnoses, those that contribute to the unfitting condition. The remaining conditions, sleep disorder, high grade squamous intraepithelial lesion status post (s/p) cone, adjustment disorder with depressed mood, depression and irritable bowel syndrome (IBS), were determined to be Category III conditions, not separately unfitting and not contributing to the unfitting condition. The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions”


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 20080827
 VA - based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Female Pelvic Pain 7699-7629 0% Female Pelvic D/O Voc Rehab <20%
Dysmenorrhea Cat 2 No VA Entry
Dyspareunia Cat 2 No VA Entry
High Grade Squamous Intraepithelial Lesion status post Cone Cat 3 No VA Entry
Sleep Disorder Cat 3 No VA Entry
Irritable Bowel Syndrome Cat 3 IBS 7319 NSC STR
Adjustment Disorder with Depressed Mood Cat 3 Anxiety 9413 NSC STR
Depression Cat 3 Major Depression 9434 NSC STR
Other x 0 (Not in Scope)
 Other x 1 STR
Combined: 0% (noncompliance)
 Combined: NSC
Derived from VA Rating Decision (VA RD ) dated 200 90122 ( most proximate to date of separation [ DOS ] ). *NOTE: The VA also granted Voc Rehab Purposes <20% for LBP, MD, Anxiety and IBS.


ANALYSIS SUMMARY:

Female Pelvic Pain. The narrative summary (NARSUM) noted the CI’s history of bilateral pelvic pain began in September 2007. Upon initial presentation to the clinic the pain was described as sharp, stabbing and throbbing, worse with physical activities such as running, walking and performing sit-ups. She was diagnosed with endometriosis and provided appropriate treatment. The CI was also diagnosed with dysmenorrhea (painful menses), IBS based on bowel habits and sleep disorder. The treatment approach for these conditions included behavioral interventions and hormones to suppress the menstrual cycle (thought to have been the mechanism triggering the pelvic pain). The CI underwent evaluations with gynecology to rule out reproductive system pathology and was referred to physical therapy to help with pelvic floor dysfunction with the goal of improving painful menses and painful sexual intercourse. Sonogram of the pelvis in September 2007 showed no evidence of pelvic pathology. Cervical cytology in December 2007 demonstrated Grade II cervical intraepithelial neoplasia (non-cancerous cells commonly secondary to HPV virus). A cone biopsy was performed to remove or destroy abnormal tissue. There were no pathological findings related to the CI’s complaint of pelvic pain. At the NARSUM on 12 May 2008, approximately 6 months prior to separation, the examiner noted that CI had not been compliant with the prescribed physical therapy and medication to address her functional pain (dysmenorrhea, and dyspareunia [painful intercourse]). She was absent for several physical therapy visits and had not taken her medications. The physician noted the CI had other treatment goals to improve sleep, reduce stress, and dietary plan to address IBS. It was noted the CI had prior history of depression and had discontinued participation in August 2007. She had indicated an unwillingness to return to mental health. Examination of the abdomen noted mild tenderness to palpation of the bilateral lower quadrants and pelvic structures and findings consistent with pelvic floor dysfunction (weakness of pelvic muscles that supports bladder, bowel and reproductive muscles to allow for appropriate relaxation and contraction). The physician opined her prognosis relied on her ability to comply with care and her participation in treatment, specifically taking medication prescribed to suppress the menstrual cycle and participating in physical therapy to address pelvic floor dysfunction (exercises to strengthen pelvic floor muscles). The CI did not appear to her scheduled VA Compensation and Pension (C&P) examination.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated 10%, coded analogously 7699-7629 (endometriosis) and reduced the rating to 0% for “non-compliance.” The Board adjudged that the record sufficiently documented pelvic pain for a 10% rating under this code. A higher rating of 30% requires demonstration of medication treatment failure, not supported by the evidence and incapacitating episodes of pain, not supported by the record in evidence. The Board agreed there were no other codes to rate the condition. The Board next examined whether the 10% reduction in the rating was warranted. The PEB subtracted 10% from the adjudicated 10% disability rating based on the contributing and aggravating factors of medication non-compliance. The Board acknowledged the PEB’s application of DoDI 1332.39 in this case of medication non-compliance; however, the Board is obliged to comply with DoDI 6040.44 and the VASRD. The VA does not make deductions based on compliance/non-compliance; hence the Board recommends the 10% rating. The Board opined that the dysmenorrhea and dyspareunia conditions were integral components of the pelvic pain pathology and could not be recommended for additional rating IAW VASRD 4.14 (avoidance of pyramiding). 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 female pelvic pain condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the high grade squamous intraepithelial lesion s/p cone biopsy, sleep disorder, IBS, adjustment disorder with depressed mood and depression conditions were 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 Board reviewed the available treatment records and determined there was no performance based evidence from the record that any of these conditions independent of themselves had significantly interfered with satisfactory duty performance. None of the above conditions were implicated in the commander’s statement and were not judged to fail retention standards. All were reviewed by the action officer and considered by the Board. 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 any of the contended conditions and so no additional disability ratings are 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 female pelvic pain condition, the Board unanimously recommends a disability rating of 10%, coded 7699-7629 IAW VASRD §4.117. In the matter of the contended high grade squamous intraepithelial lesion s/p cone, sleep disorder, IBS, adjustment disorder with depressed mood, and depression conditions, the Board unanimously recommends no change from the PEB determinations 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 her prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Female Pelvic Pain 7699-7629 10%
COMBINED
 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140416, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoD I 6040.44

(b) PDBR ltr dtd 1 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(c) PDBR ltr dtd 1 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(d) PDBR ltr dtd 8 Jun 15 ICO XXXXXXXXXXXXXXXXXX
(e) PDBR ltr dtd 19 May 15 ICO XXXXXXXXXXXXXXXXXX

1. Pursuant to reference (a} I approve the recommendations of the Physical
Disability Board of Review set forth in references (b) through (d).

2. The official records of the following individuals are to be corrected to
reflect the stated disposition:

a. XXXXXXXXXXXXXXXXXX former USN: Entitlement to disability
severance pay with a disability rating of 10 percent (increased from 0 (zero)
percent) effective date of discharge.

b. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability
severance pay with a disability rating of 20 percent (increased from 10
percent) effective date of discharge.

c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability
severance pay with a disability rating of 20 percent (increased from 0 (zero)
percent) effective date of discharge.

d. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent
Disability Retired List with a 50 percent disability rating (increased from
20 percent) effective date of discharge.

3. Please ensure all necessary actions are taken to implement these
decisions, including the recoupment of disability severance pay, if
warranted, and notification to the subject members once those actions are
completed.



XXXXXXXXXXXXXXXXXX
Assistant General Counsel
(Manpower & Reserve Affairs)




Similar Decisions

  • AF | PDBR | CY2013 | PD 2013 01123

    Original file (PD 2013 01123.rtf) Auto-classification: Approved

    SEPARATION DATE: 20020920 The Board noted endometriosis was not diagnosed while on active duty (or subsequently) and not seen at the time of the cesarean section and later hysterectomy. The Board then considered the appropriate code and rating for the chronic pelvic pain.

  • AF | PDBR | CY2011 | PD2011-01072

    Original file (PD2011-01072.docx) Auto-classification: Denied

    At her first TDRL periodic evaluation, the CI’s endometriosis not controlled by treatment condition was found not sufficiently stabilized to permit final adjudication, while her back and knee pain were changed to not unfitting at that time. The CI was continued on the TDRL with a 30% rating for endometriosis. After her subsequent and final TDRL periodic evaluation, the IPEB determined the CI’s status post TAH/BSO in treatment of endometriosis, with intermittent cramping, pelvic pain...

  • AF | PDBR | CY2012 | PD2012-01186

    Original file (PD2012-01186.pdf) Auto-classification: Denied

    Endometriosis. 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 her prior medical separation: UNFITTING CONDITION VASRD CODE RATING Endometriosis, Stage II 7629 COMBINED 30% 30% 3 PD1201186 The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120611, w/atchs Exhibit B. Service...

  • AF | PDBR | CY2013 | PD-2013-01789

    Original file (PD-2013-01789.rtf) Auto-classification: Approved

    The MEB examiner described the CI’s current functional status as “required to miss fairly frequent work duties due to the migraine headaches.”The MEB examiner provided a pain rating of slight/intermittent.The commander’s statement noted that “at various times” the CI had to “leave work due to migraines or abdominal pains that incapacitates her to work.”The VA C&P exam on 25 February 2005, performed 2 monthsafter separation, did not address the migraine condition, but listed 12 conditions...

  • AF | PDBR | CY2011 | PD2011-00758

    Original file (PD2011-00758.docx) Auto-classification: Denied

    The Board evaluates DVA evidence proximal to separation in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness decisions and rating determinations for disability at the time of separation. The VA reduced the rating for this condition to 0% effective 9 October 2009, 4 years after separation. Service Treatment Record

  • AF | PDBR | CY2013 | PD 2013 00954

    Original file (PD 2013 00954.rtf) Auto-classification: Approved

    The PEB adjudicated “chronic pelvic pain syndrome associated with chronic interstitial cystitis and pain disorder as unfitting, rated 30% with application of the VA Schedule for Rating Disabilities (VASRD) and placed the CI on the Temporary Disability Retired List (TDRL).The PEB also adjudicated the migraine headaches as a Category II condition (one that can be unfitting but is not currently compensable or ratable). The Board then reviewed the medical records in evidence. BOARD FINDINGS :...

  • AF | PDBR | CY2012 | PD2012 00067

    Original file (PD2012 00067.rtf) Auto-classification: Approved

    The earliest documentation in the service treatment records (STR)of a left shoulder problem is a radiology report of the left shoulder dated 7 September 2007 that was normal; the X-ray had been requested for a history of severe pain in the left anterior shoulder after an apparent anterior subluxation on the previous day.Examination by physical therapy in October noted left shoulder abduction limited to 160 degrees and flexion limited to 170 degrees, both by pain. A week later, the CI had...

  • AF | PDBR | CY2014 | PD-2014-00779

    Original file (PD-2014-00779.rtf) Auto-classification: Denied

    Endometriosis Condition . The Board directed its attention to its rating recommendationbased on the above evidence.The PEB and VA both rated the condition at 10% using the code 7629 (endometriosis). Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record

  • AF | PDBR | CY2011 | PD2011-01139

    Original file (PD2011-01139.pdf) Auto-classification: Approved

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW SEPARATION DATE: 20021218 NAME: XXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1101139 BOARD DATE: 20121002 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (Military Occupational Specialty [MOS] Not Obtained/Student in AIT), medically separated for chronic abdominal pain following total vaginal hysterectomy for uterine prolapsed. In...

  • AF | PDBR | CY2012 | PD2012-00634

    Original file (PD2012-00634.pdf) Auto-classification: Denied

    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). (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...