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AF | PDBR | CY2013 | PD-2013-01813
Original file (PD-2013-01813.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-01813
BRANCH OF SERVICE: Army  BOARD DATE: 20141212
SEPARATION DATE: 20040720


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (M1 Armor Crewman) medically separated for right 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 P3/L3 profile and referred for a Medical Evaluation Board (MEB). The right groin condition, characterized as “persistent right groin pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “chronic right groin pain, post herniorrhaphy” as unfitting, rated 10% with presumed application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “I have had Additional surgeys, due to scar tissue, And I have to wear knee brace All the time, And take pain medicines All the time.” [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 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 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 20040528
 VA* - (6 Days Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Groin Pain
 8799-8730 10% Residuals of Right Herniorrhaphy, Scar 7334-7804 10% 20040726
Other x 0 (Not in Scope)
 Other x 4
Combined: 10%
 Combined: 20%
* Derived from VA Rating Decision (VARD) dated 20041122 (most proximate to date of separation ( DOS ) )

ANALYSIS SUMMARY:

Right Groin Pain Condition. The narrative summary (NARSUM) notes the CI to have a history of recurrent right testicular pain and swelling since 2000. No urologic etiology for this was found. An abdominal ultra sound on 12 February 2003, for evaluation of this pain, revealed a small right inguinal hernia which was not incarcerated. Surgical repair of this hernia was undertaken in June 2003. In August 2003, the CI experienced painful swelling in the right groin radiating to the right testicle while lifting. A recurrence of the hernia was found and repaired laparoscopically in October 2003 with mesh material. Post-operatively the CI developed groin pain with radiation to his right scrotum. On a radiographic study (ultrasound) on 17 November 2003, no hernia recurrence was present. On a surgical examination on 22 January 2004, the operative wounds were well-healed and no hernia recurrence was found. The groin pain condition was felt to result from entrapment of a groin nerve (ilio-inguinal nerve) during the operative procedure; this was treated with anti-inflammatory and pain medications. A surgical procedure to “untrap” the nerve was offered to the CI who declined. On a pain clinic evaluation on 27 January 2004, the CI reported groin pain shooting to his scrotum. On examination the surgical scars were well healed without swelling or inflammation. Palpation of the scar reproduced the groin pain. In March 2004, the pain service initiated treatment with a direct nerve improving medication (Neurontin). At the MEB/NARSUM evaluation on 23 March 2004, 4 months prior to separation, the CI described the pain as of dull tooth aching quality and that it would “shoot” to his right testicle. On physical exam no recurrent hernia was present. The surgical scars were well healed without irritation or instability. Palpation of the scar reproduced the groin and testicle pain. Examination of the testicles was normal. At the VA Compensation and Pension exam performed 6 days after separation, the CI reported improvement in the pain with increasing doses of the Neurotic medication. On physical examination, the CI was in no distress; gait and posture were normal. Exam of the abdomen revealed no hernia recurrence. The right groin surgical incision was well healed without irritation or instability. Palpation of the scar produced no discomfort. Examination of the genitalia was normal without masses or tenderness.

The Board directed attention to its rating recommendation based on the above evidence. The PEB and the VA both rated the right groin condition 10%. The VA rated the right groin condition with code 7334-7804 (rectum, prolapse/scar, unstable or painful ) IAW §4.114 , ( digestive system ) and §4.118 , ( skin ) . The PEB utilized analogous code 8799-8730 (neuralgia; incomplete paralysis/ilio-inguinal nerve/severe) IAW §4.124 (neuralgia, cranial or peripheral). The Board notes that IAW §4.124 (neuralgia), no higher rating than 0%, moderate, can be given for incomplete paralysis of the ilio-inguinal nerve under code 8730. The Board unanimously agreed that the right groin pain condition met the criteria for a 10% “severe” rating under code 8630 (neuritis) IAW §4 .123 (neuritis, cranial or peripheral). The Board considered a rating under code 7338 (inguinal hernia), but was unable to recommend this rating as no postoperative recurrence, a requirement for any rating under this code, was confirmed by the record. The Board considered a rating for a painful scar IAW §4.118. The Board unanimously agreed that the scar, described as well healed and stable, was an integral part of the groin pain condition and any pain originating from the scar was included in the 8630 (neuritis) rating. Therefore, it could not be additionally rated IAW §4.14 (avoidance of pyramiding). The Board notes the reports of testicular pain by the CI and considered a rating under §4.115 (nephritis and diseases of the genitourinary system). The Board could not recommend this as no evidence of a primary unfitting genitourinary condition was supported by the record in evidence. The Board found no other appropriate codes for consideration and no pathway to a rating higher 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 disability rating for the chronic right groin pain condition. The Board noted that the CI’s functional impairment most closely approximated the VASRD characterization of a neuritis versus neuralgia and met the criteria for a 10% “severe” rating under code 8630 (neuritis) IAW §4 .123 (neuritis, cranial or peripheral); therefore, the Board unanimously recommends a code change to 8699-8630 (analogous to ilio-inguinal nerve neuritis) for the right groin 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. In the matter of the chronic right groin pain condition the Board unanimously recommends no change in the PEB adjudication, but recommends a VASRD code change to 8699-8630. 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, but does recommend a VASRD code modification as follows:

CONDITION VASRD CODE RATING
Chronic Right Groin Pain 8699-8630 10%
COMBINED 10%



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






XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXX, AR20150007613 (PD201301813)


1. 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 to modify the individual’s disability description without modification of the combined rating or recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                       XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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