RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  MARINE CORPS 
SEPARATION DATE:  20031215 

 
NAME:  XXXXXXX                                                 
CASE NUMBER:  PD1200539                                                    
BOARD DATE:  20121219 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty,  SGT/E-5  (0311/Rifleman),  medically  separated  for 
chronic right inguinal neuropathic pain.  The CI’s history of chronic right inguinal pain began in 
October 2000 when he presented complaining of a painful mass in the right inguinal area.  He 
subsequently underwent two surgical procedures and three different selective nerve-blocking 
procedures.  He was then prescribed chronic narcotic medications when the above mentioned 
procedures did not resolve his pain.  The CI did not improve adequately with treatment to meet 
the  physical  requirements  of  his  Military  Occupational  Specialty  or  satisfy  physical  fitness 
standards  and  he  was  referred  for  a  Medical  Evaluation  Board  (MEB).    The  MEB  forwarded 
chronic right inguinal neuropathic pain as the only condition for Physical Evaluation Board (PEB) 
adjudication.  The PEB adjudicated the right inguinal neuropathic pain condition as unfitting and 
rated it 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:  “Do (sic) to my injury (femoral nerve entrapment) I have been dealing with 
severe chronic pain, the pain is so intense that I take large amounts of medications daily.  The 
injury combined with the meds (MS Contin 150 mg 3xday) make finding work impossible and 
everyday life is a constant struggle.  I have tried every option presented to me to try and fix the 
problem.  Nerve transaction, spine injections, acupuncture even surgical implants not only did 
all these things not work but caused more damage and pain.  As evidence, I include 18 pages 
from my military record while on active duty.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e.(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  cases.    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 Naval Records. 
 
 
RATING COMPARISON: 
 

 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding  the  significant  impact  that  his  service-incurred  condition  has  had  on  his  current 
earning ability and quality of life.  It is a fact, however, that the Disability Evaluation System 

Service IPEB – Dated 20030925 
Code 
Condition 
Right    Inguinal  neuropathic 
8726 
pain 
↓No Additional MEB/PEB Entries↓ 
Combined:  10% 

Rating 
10% 

VA (1 Month Post-Separation) – All Effective Date 20031216 
Condition 
Right nerve resection w/residual 
ilioinguinal nerve neuropathy 
0% x2 
Combined:  30% 

Code 
8699-8626 

Rating 
30% 

Exam 
20040122 

(DES)  has  neither  the  role  nor  the  authority  to  compensate  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  Veterans  Affairs  (DVA).    The  Board 
utilizes  DVA  evidence  proximal  to  separation  in  arriving  at  its  recommendations;  and,  DoDI 
6040.44 defines a 12-month interval for special consideration to post-separation evidence.  The 
Board’s authority as defined in DoDI 6040.44, 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. 
 
Right  Inguinal  Neuropathic  Condition.    The  undated  narrative  summary  prepared  between 
23 May  and  30  June  2003  noted  the  CI  had  a  history  of  chronic  right  inguinal  pain  despite 
maximal medical therapy.  His symptoms began in November 2000, when he noticed a right 
inguinal mass.  The mass became painful and after evaluation with ultrasound and CT scanning 
was consistent with a right inguinal hernia, he underwent an open right inguinal hernia repair.  
His surgery was successful; it did not detail any complications and his post-operative course was 
uneventful.    Within  2  months  of  the  initial  surgical  procedure,  the  CI  presented  for  re-
evaluation of his  right  groin following  a  sudden  increase  in  groin pain while  shooting  on  the 
range.  The evaluating physician was unable to identify a recurrent inguinal hernia; however, 
the severity of symptoms prompted a referral to a general surgeon.  After further evaluation, 
the CI underwent a laparoscopic right inguinal hernia revision and again, no complications were 
detailed  during  the  surgery,  and  the  patient  was  discharged.    Despite  post-operative 
convalescence leave and extensive light duty; the CI continued to experience right inguinal pain 
with any physical exertion.  He then underwent a right inguinal nerve transection, followed by a 
right  ilioinguinal  nerve  block  by  a  pain  management  specialist,  and  finally  underwent  a 
diagnostic right L1-L2 paravertebral blockade which resulted in no resolution of his symptoms.  
The CI had been placed on a long-term narcotic program, including oxycontin IR and oxycontin 
SR with close follow-up care by the pain management clinic.  Despite dosing with oxycontin SR 
and oxycontin IR; he continued to be unable to run, jump, or march prolonged distances.  He 
was  not  worldwide  deployable.    Physical  exam  revealed  multiple  scars  in  the  right  lower 
quadrant, full range-of-motion, and normal strength throughout the musculoskeletal system. 
 
At the MEB exam performed approximately 7 months prior to separation, the CI reported “after 
nerve  trans-section  needed  to  get  pain  medications,  Hernia  repair  and  laparoscopic  hernia 
repair, femoral nerve entrapment nerve transection.”  The MEB physical exam noted “multiple 
scars right lower quadrant all well healed no hernia and chronic right inguinal pain.”  
 
At the VA Compensation and Pension exam performed 5 weeks after separation, the CI relayed 
a  similar  history  to  that  outlined  above  with  the  following  pertinent  additions:    He  reported 
suffering  from  tingling,  numbness  and  chronic  pain  in  the  right  groin  in  the  area  of  surgery 
which radiates to the right buttock.  He reported that he could not stand for prolonged periods 
of time longer than 30 minutes.  He had trouble climbing stairs and could not walk any long 
distances.  The pain also interfered with his sleep.  The pain was constant.  He had been treated 
with Oxycontin 40 mg three times a day and Oxycodone 5 mg two times a day.  He also had 
been  prescribed  non-steroidal  anti-inflammatory,  tri-cyclic  anti-depressant  and  other 
medications  used  for  control  of  chronic  pain.    He  had  functional  impairment  of  being 
debilitated by the pain.  He was unable to function.  He was currently not employed and was 
having  difficulty  finding  employment  as  he  could  not  sit  or  stand  for  any  length  of  time.  
Physical  examination  revealed  a  scar  in  the  right  groin  consistent  with  right  inguinal  hernia 
repair which measures 4 cm x 0.4 cm.  It was non-tender to light touch.  It had no ulceration or 
adherence.  There was no tissue loss, keloid, hypo or hyper pigmentation.  There was no burn 
scar.  By history, the ilioinguinal nerve on the right side was the nerve involved in this pain.  It 
radiated  from  the  groin  to  the  right  buttock.    It  is  increased  with  walking,  standing  or 
movement.    Lower  extremity  motor  function  was  normal.    Sensory  examination  revealed  an 

   2                                                           PD1200539 
 

area of decreased sensitivity to light touch surrounding the scar from the right inguinal surgery.  
Reflexes, knee was 3+ on the right and 3+ on the left.  Ankle was 1+ on the right and 1+ on the 
left. 
 
Detailed review  of the CI’s  service  treatment records  revealed  that  his  pain  was  consistently 
described as a constant, dull throbbing pain mainly localized in the right groin area with some 
radiation around to the buttock.  There was no evidence of muscle weakness or atrophy, no 
documentation of abnormal reflexes and a limited decrease in sensation was documented. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB coded the CI’s chronic right inguinal neuropathic pain as 8726, neuralgia of the anterior 
crural (femoral) nerve, and rated it 10% signifying their adjudication of a mild partial paralysis 
of that nerve.  The VA applied the analogous code of 8699-8626 and rated it 30% indicating a 
severe  neuritis  of  the  femoral  nerve.    This  30%  evaluation  was  based  on  VA  examination 
findings of symptoms which included pain which radiated from the groin to the right buttock, 
was aggravated by walking, standing, and movement and was considered to be severe.  There 
was a decrease in sensitivity to light touch in the scar area.  Treatment included the use of high-
dose narcotics.  In order to proceed with the proper coding and rating recommendation for this 
case, the Board must identify which nerve is causing the CI’s disability.  The two possibilities are 
the right femoral or the right ilioinguinal nerves.  All documentation present indicates that the 
CI’s chronic pain involved the right groin and the surgical procedures performed in that area.  
Anatomically, of the two nerves potentially involved in this disability, only the ilioinguinal nerve 
resides in the location where the surgical procedures were performed and therefore, the nerve 
responsible for the disability in this case is the ilioinguinal nerve.  This conclusion also matches 
the documentation present for review.  Characterization of nerve pain as a neuritis or neuralgia 
is critical to the proper coding and rating of this peripheral nerve disability.  The Board utilizes 
the  following  definitions  and  applicable  rating  guidelines  present  in  the  VASRD  for  neuritis.  
Neuritis, §4.123, “is characterized by loss of reflexes, muscle atrophy, sensory disturbances, and 
constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve 
involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which 
may be assigned for neuritis not characterized by organic changes referred to in this section will 
be that for moderate....”  The severity and constant throbbing nature of the CI’s pain along with 
the  lack  of  muscle  atrophy,  normal  reflexes  and  very  limited  local  sensory  disturbance  fits  a 
pattern  most  consistent  with  a  neuritis  not  characterized  by  organic  changes.    Rating  this 
neuritis of the ilioinguinal nerve IAW § 4.123 would require assigning a 0% rating.  However, 
IAW with DoDI 6040.44, the Board may not recommend a rating lower than that received prior 
to  the  application  for  review.    After  due  deliberation,  considering  all  of  the  evidence  and 
mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was 
insufficient cause to recommend a change in the PEB adjudication for the chronic right inguinal 
neuropathic pain 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 right inguinal neuropathic 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 recharacterization of 
the CI’s disability and separation determination, as follows: 

   3                                                           PD1200539 
 

UNFITTING CONDITION 
Chronic Right Inguinal Neuropathic Pain  

VASRD CODE  RATING 
8726 
COMBINED 

10% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120601, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           xxxxxxxxxxxxxxx 
           Director 
           Physical Disability Board of Review 

   4                                                           PD1200539 
 

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 08 Feb 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: 
 
 

 

 

 

     

 
 
 
 

-  xx former USMC 
-  xx former USMC 
-  xx former USN  
-  xx former USMC 
-  xx former USMC 
-  xx former USN  
  

 

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

xxxxx 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

   5                                                           PD1200539