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AF | PDBR | CY2012 | PD-2012-01679
Original file (PD-2012-01679.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2012-01679
BRANCH OF SERVICE: Army  BOARD DATE: 20141009
SEPARATION DATE: 20020820


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (91B/Wheeled Vehicle Mechanic) medically separated for groin pain. The groin pain could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent L4 profile and referred for a Medical Evaluation Board (MEB). The groin pain condition, characterized as “ bilateral ilioinguinal nerve entrapment following inguin a l herniorrhaphies causing server pain ” , was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also forwarded two other conditions ( pain disorder associated with psychological factors and general medical condition and panic disorder without agoraphobia) IAW AR 40-501. The Informal PEB adjudicated bilateral groin pain post - hernia nerve entrapment repair as unfitting, rated 20%, referencing the US Army Physical Disability Agency (USAPDA) pain policy. The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “There is no treatment options available anymore. All medications and methods have been tried. Currently, the conditions interferes with my employment. The headaches have also increased and I have missed work. In addition, the short term memory and the restless burning feeling in my legs caused by the Neurotin the Army and VA had me on became much worse. The anxiety attacks continue to increase and treatment of these with medication will cause me to be discharged from my employment or disqualified without pay until I am no longer suffering from this condition.” [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 groin pain condition and not unfitting panic disorder, contended as anxiety, are addressed below. The contended, headaches, memory and leg conditions were not identified by the MEB or PEB, and thus are not 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 Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System 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, 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.


 RATING COMPARISON :

Service IPEB – Dated 20020426
 VA - (12 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Groin Pain… 5099-5003 20% Status-Post Ilioinguinal Nerve Resection, Right 8599-8530 10% 20030807
Status-Post Ilioinguinal Nerve Resection, Left 8599-8530 10% 20030807
Status-Post Bilateral Inguinal Hernia Repair 7338 0% 20030807
Panic Disorder without Agoraphobia Not Unfitting Psychiatric Condition (Panic Attacks) 9400 NSC 20030806
Other x 1 (Not in Scope)
 Other x 3
Rating: 20%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 40313 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Bilateral Groin Pain. The CI underwent surgery for a right inguinal hernia in April 2000 and for a left inguinal hernia in December 2000. He experienced persistent groin pain after both surgeries due to ilioinguinal nerve entrapment. The groin pain did not satisfactorily respond to injections, medications, or bilateral surgical removal of the nerve. The MEB narrative summary (NARSUM) performed on 31 January 2002 reported continued bilateral groin pain aggravated by activity. On examination there was tenderness in both groin areas. The remainder of the physical examination was normal. The Veterans Affairs (VA) Compensation and Pension (C&P) examination performed on 7 August 2003, a year after separation, noted the CI underwent a repeat left inguinal hernia repair in July 2002 prior to separation. The CI reported persistent pain unchanged since discharge from service for which he took medication. On examination there were no hernias detected but there was increased sensitivity to touch in the groin areas.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the bilateral groin pain condition 20% with application of the USAPDA pain policy. The VA rated the right and left groin pain (status post ilioinguinal nerve resection) 10% each coded 8599-8530 (8530 ilioinguinal nerve). All Board members agreed the ilioinguinal nerve code used by the VA best described the condition. The highest rating achievable under the ilioinguinal nerve codes is 10%. Although the VA’s approach to rating was compliant with the VA Schedule for Rating Disabilities (VASRD) while the PEB utilized the USAPDA pain policy, the combined ratings adjudicated by the PEB and the VA for the groin pain condition were the same (20%). 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 bilateral groin pain condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the panic disorder without agoraphobia condition was not unfitting. The Board’s threshold for countering fitness determinations requires a preponderance of evidence which 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. According to a medical document dated 12 March 1999, the CI was diagnosed and treated for generalized anxiety disorder prior to entry into military service (January 2000). At the time of his enlistment examination, the CI listed Celexa as a current medication (Celexa is used to treat anxiety as well as depression). A service treatment record entry dated 7 February 2000, 3 weeks after entry into service, noted the history of generalized anxiety disorder that was treated with Celexa but that the CI was not taking it since starting basic training. As noted above, the CI underwent the first hernia surgery in April 2000 followed by persistent groin pain. The psychiatry MEB NARSUM addendum dated 14 November 2001, reported symptoms of irritability, anger, depressed mood and anxiety with panic episodes. He was treated with medication and psychotherapy. On mental status examination (MSE) the mood was irritable and anxious with normal affect. The remainder of the MSE was normal. The psychiatric diagnoses were pain disorder (groin pain) associated with both psychological factors and a general medical condition; and panic disorder without agoraphobia. The pain disorder was noted to cause occupational impairment. The Global Assessment of Functioning (GAF) was indicated as 75 (transient mild symptoms causing slight impairment). The VA C&P mental health examination performed on 6 August 2003, a year after separation, noted the CI was employed as contractor in security. The examiner noted situational anxiety symptoms that were not pathological. The MSE was normal. No psychiatric diagnosis was rendered and the GAF was indicated as 80 to 90 (absent or minimal symptoms with good functioning). The Board noted the CI was treated for an anxiety disorder prior to entering military service. The symptoms worsened while in service associated with the groin pain disorder, however the post- separation VA C&P examination reflected significant improvement in symptoms indicating the worsening of the pre-existing anxiety condition while in service was not permanent. The severity of the condition indicated by the MEB NARSUM indicated mild symptoms causing mild impairment. The Board concluded there was clear evidence the condition existed prior to service and was not permanently aggravated by service. The Board also concluded there was not a preponderance of evidence that indicated the condition, despite the transient worsening, was separately unfitting. After due deliberation, and 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 panic disorder 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. As discussed above, PEB reliance on the USAPDA pain policy for rating the bilateral groin pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the bilateral groin pain condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended panic disorder without agoraphobia condition, 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, 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 20120901, 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 , AR20150006303 (PD201201679)

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

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