RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	 	CASE:  PD-2013-01793
BRANCH OF SERVICE:  ARMY		BOARD DATE:  20140919
SEPARATION DATE:  20040915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve SSG/E-6 (42A/Human Resource Specialist) medically separated for a left groin condition.  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 U2/L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB also identified and forwarded one other condition (left wrist stiffness) for PEB adjudication.  The Informal PEB adjudicated the left groin condition, characterized as “left ilio-Inguinal neuropraxis and groin pain,” as unfitting and rated at 10%.  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “The initial rating was rushed through without regard for the detailed records provided.  The injuries have all been aggravated upon my return to service and continue to worsen.  I have included detailed statements, medical records and other documents.  I cannot afford a civilian Doctor and can only go to the VA Emergency room for pain medications.  Paralysis has spread from L hip, down to back of knee, over to testicles, and up L side ½ way; eye now droops by end of day, tears constantly, and is sensitive to almost all light; foot peels daily, now on top of foot and up ankle.” [sic]

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 left groin condition is addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 purview.  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 Board for Correction of Military Records.

RATING COMPARISON:  
   
Service IPEB – Dated 20051121	VA - (Exam ~ 9 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ilio-Inguinal Neuropraxis and Groin Pain	8730	10%	Status Post Left Inguinal Herniorraphy w/Residual Unresolved Paresthesia and Pain from Surgical Procedure	7338-8530	10%	20050616	
Other x 0 (Not in Scope)	Other x 2 (Not in Scope)	20050616 	
Combined:  10%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20051109 (most proximate to date of separation)

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.  It is a fact, however, that the Disability Evaluation System (DES) has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation.  This role and authority is granted by Congress to the Department of Veteran Affairs (DVA).  The DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate service connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time.  Additionally, the Board utilizes VA evidence proximal to separation in arriving at its recommendations and DoDI 6040.44 defines a 12 months interval for special consideration to post-separation evidence.  The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation.  Post-separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation.

Left Ilio-Inguinal Neuropraxis and Groin Pain Condition.  The Service treatment record (STR) was missing clinical treatment notes between the years 1989 and 2004.  Subsequent to a left inguinal hernia repair performed in May 1989, the CI reported pain and numbness in his upper left thigh, prior to having surgery, in 2004; pain increased with activities and running.  The condition was initially thought to be a “thigh strain”, but was later diagnosed as neuropraxis (the mildest form of peripheral nerve injury) of the ilio-Iinguinal nerve.  The condition was considered a residual outcome from the original surgery.  Despite physical therapy (PT), medications, electro-stimulation and pain management injections, the CI continued to complain of pain and numbness in his upper thigh but described it as “reasonably well controlled with [medications]” in January 2005.

At the VA Compensation and Pension (C&P) examination preformed on 16 June 2005; (9 months after separation), the CI reported left inguinal pain and numbness extending down into the thigh.   A detailed physical examination (PE) was normal.  The diagnosis remained unchanged.  His occupation was a police officer.  At the MEB narrative summary (NARSUM) examination dated 4 November 2005 (14 months after separation), the CI endorsed left inguinal pain and numbness extending down into the thigh aggravated by “walking greater than two miles, sitting greater than 4 or 5 hours without moving around, to include sitting in or driving a vehicle, or performing sit-ups.”  He reported no worsening of symptoms with swimming, standing, performing push- ups, wearing a rucksack, or doing abdominal crunches.  The PE was brief and revealed inguinal tenderness.  There was no hernia or mass present.  The diagnosis remained the same and his pain was listed as “slight” and “occasional”.

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 and both were consistent with §4.124a Schedule of Ratings, Neurologic Conditions.  The PEB adjudicated the left groin condition at 10% coded 8730 (neuralgia; ilio-Inguinal nerve) whereas the VA dual coded (inguinal hernia-paralysis of ilio-Inguinal nerve) at 10%.  Absent actual herniation, coded 7338 were not non-applicable in this case and Board members agreed that a neurological coding approach was appropriate.  The pathology, symptomatology and nerve identification in this case is specifically supported by VASRD code 8730.  The VASRD §4.124a descriptive rating criteria for “neuralgia” is excerpted below:
		
Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis.

Board members acknowledged that the maximum rating level available for this specific code is 10% “complete paralysis”.  Based upon the above, a logical deduction could be made that if measured in context of “incomplete paralysis” such impairment would be less than a 10%, or at least not greater than 10%.    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’s 10% adjudication for the left groin pain.

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 left groin pain 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131023, 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, AR20150003602 (PD201301793)

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