RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XX	CASE:  PD1201868
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20130508
SEPARATION DATE:  20020415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCpL/E-3 (5963/Electronics Technician and System Administrator) medically separated for a left lower quadrant (LLQ) pain condition.  The CI had a weight lifting injury in January 2000 resulting in a left inguinal hernia.  The hernia was surgical treated, however, the CI developed a chronic LLQ pain condition that did not respond to conservative or re-exploratory surgery adequately to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The chronic LLQ pain status post (s/p) inguinal hernia repair condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The PEB adjudicated chronic LLQ pain s/p inguinal hernia repair condition as unfitting, existed prior to service (EPTS) reduced by 0%, and rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated with a 10% disability rating.

CI CONTENTION:  “I do not feel that the impact of the injury I received while in the Marines was not fully realized on how it would impact my overall quality of life.  The area of my incision from my hernia surgery (continue) is completely numb to include my left side of my thigh.  I continue to suffer what was deemed to be optical migraines and speech issues which were never fully evaluated in my opinion.  I was treated for this several times during my enlistment but never given the treatment I should have received.  I also suffer from irritable bowel syndrome starting my first year in the service which still continues to this day.  My hearing loss from being on an Air base was never evaluated either.”

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 LLQ pain s/p inguinal hernia repair condition and the contended left side thigh numbness around the surgical incision are addressed below.  The contended migraine headaches, speech issues, irritable bowel syndrome (IBS) and hearing loss conditions are not within the DoDI 6040.44 defined purview of the Board.  These and any condition 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 Naval Records

RATING COMPARISON:  

Service IIPEB – Dated 20020220	VA - (1 Mo. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LLQ Pain s/p Inguinal Hernia Repair	8730	10%	Residuals , Left Inguinal Herniorrhaphy	8730-7338	10%	20020315	
			Scar , Left Inguinal Herniorrhaphy	7804	10%	20020315	
No Additional MEB/PEB Entries	Other x 1	20020315	
Combined:  10%	Combined:  20%	

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continues to burden him, but must emphasize that the Disability Evaluation System (DES) 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 (DVA), operating under a different set of laws.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Chronic LLQ Pain S/P Inguinal Hernia Repair Condition.  The CI underwent a left inguinal herniorrhaphy in March of 2000.  Eighteen months later he was surgically explored for possible nerve entrapment versus a recurrent hernia due to reoccurrence of LLQ that had not responded to conservative treatment.  At the time of surgery there was no recurrence of a hernia and there was a nerve like structure entrapped in the mesh.  Pathology confirmed this nerve entrapment.  The CI was pain free for 2 weeks then his pain returned worse than prior to surgery especially with lifting, prolong sitting or standing.  He was taking the narcotic pain medication, Percocet, for pain relief.  The LIMDU identified the pain condition and documented the following limitations, no heavy lifting greater than 10 pounds; no prolonged standing or sitting greater than 15 minutes; no weapon use; no kneeling; crawling; climbing; and no field duty.  The non-medical assessment (NMA) (commander’s statement) documented the CI was on medication that made him drowsy, that he missed 2-4 hours per week, and that he was unable to perform his PMOS duties.

At the narrative summary (NARSUM) exam, 5 months prior to separation, the CI reported a burning, stabbing, pain sensation in his left groin which radiated along the course of the ilioinguinal nerve.  The pain was exacerbated with activity, in particular lifting any heavy object or any type of physical training (PT) which would last for several hours to several days and would prevent him from sleeping.  The NARSUM physical exam demonstrated a normal gait; soft and non-tender abdomen; well healed left groin incision without erythema or edema; no scrotal abnormalities; no evidence of recurrence of herniation and no significant tenderness at the site of the hernia repair.  The examiner diagnosed chronic LLQ pain s/p inguinal hernia repair.  The MEB physical exam at the time of the NARSUM demonstrated mild to moderate tenderness to palpation of the left exploratory incision, scar on the left abdomen, and a scar on the left hip.

At the VA Compensation and Pension (C&P) exam performed a month prior to separation, the CI reported constant LLQ pain increased with use of his abdominal muscles, and numbness around the scar, but not of the upper thigh or the genitals.  The exam demonstrated a linear, soft, and elevated, pink non -adherent scar, in the LLQ of his abdomen from the hernia repair.  There was tenderness in the lateral half of the scar and a feeling of irregularity of the mesh, which was palpable through the scar.  The examiner opined there were scar disfigurement, keloid formation, and limitation of function.  The abdomen, genital, neurologic reflex exam findings were normal.  There was no hernia.
The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA chose different coding options for the condition, but this did not bear on rating.  The PEB assigned a 10% rating coded 8730 (neuralgia ilioinguinal nerve) for severe to complete pain, which is above the maximum allowable under this code, IAW §4.124a—Schedule of ratings–neurological conditions and convulsive disorders.  However the Board's recommendation may not produce a lower rating than that of the PEB.  The VA assigned a 10% rating coded analogous to 7338 (Hernia, inguinal) IAW §4.114—Schedule of ratings–digestive system analogous to the 8730 code.  The Board notes the evidence does not support the 10% 7338 rating criteria which states “Postoperative recurrent, readily reducible and well supported by truss or belt” as there is no hernia.  The Board considered an additional rating for scar disfigurement as the VA adjudicated as both the MEB and VA examiners documented a tender scar.  By precedent, the Board does not recommend separation rating for scars unless their presence imposes a direct limitation on fitness.  The Board agreed the pain is the underlying functional disability and this could either be related to the likely neurologic pathology or a scar pathology, but agreed IAW VASRD §4.14 (avoidance of pyramiding) the LLQ pain must be rated under either code, not both.  The medical member prefers the neurologic code as it subsumes both the pain and sensory deficits evidenced.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic LLQ pain s/p inguinal hernia repair 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 LLQ pain s/p inguinal hernia repair condition and IAW VASRD §4.124a, 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:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Left Lower Quadrant Pain s/p Inguinal Hernia Repair	8730	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20121028, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	XX
	Director of Operations
	Physical Disability Board of Review
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
                                       BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
          (b) CORB ltr dtd 12 Jun 13

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- x former USMC   
- x former USN  
- x former USMC
- x former USMC
- x former USMC
- x former USMC
- x former USMC
- x former USN 

						  xx
	     				             Assistant General Counsel
						    (Manpower & Reserve Affairs)