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AF | PDBR | CY2013 | PD-2013-02812
Original file (PD-2013-02812.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02812
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150812
SEPARATION DATE: 20071002


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Security Forces Craftsman) medically separated for a right hip condition. The right hip condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty. He was issued an L4 profile and referred for a Medical Evaluation Board (MEB). The “Iatrogenic chronic right ilioinguinal neuropathy” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB adjudicated “chronic right hip neuropathic pain status post bilateral inguinal hernia repair and right ilioinguinal neurectomy” as unfitting, rated 10%, c iting application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: The CI requests the Board consider all conditions. His complete submission is at Exhibit A.


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 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 :

IPEB - Dated 20070814
 VA* - (~6 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Hip Neuropathic Pain S/P Bilateral Inguinal Hernia Repair and Right Ilioinguinal Neurectomy 8730 10% Chronic Right Hip Neuropathic Pain, S/P Bilateral Inguinal Hernia Repair and Right Ilioinguinal
Neurectomy		 8599-8726 10% 20070420
Residual Abdominal Scars, S/P Bilateral Inguinal Hernia Repairs And Right Retroperitoneal
Neurectomy		 7338-7802 0% 20070420
Other MEB/PEB Conditions x 0 (Not In Scope)
 Other x 6
RATING: 10%
 COMBINED RATING: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 7 1023 (most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Right Hip. Treatment records evidence that the CI had three surgeries (right hernia repair 1996, bilateral hernia repair 1997, and right cutaneous sensory neurectomy 1998) with residual chronic right groin and hip pain. Despite post-surgical physical therapy, pain management and nerve blocks, the CI continued to report right hip pain. A magnetic resonance imaging study of both hips performed 5 June 2006 was normal. During a neurologic consultation dated 4 January 2007, the CI reported constant, sharp, right hip pain radiating to the right inguinal region and both testicles. He reported no pain relief with multiple medication trials. On physical examination he had normal gait, muscle strength, neurologic and hip examinations. A diagnosis of peripheral neuropathy was rendered. The narrative summary noted a diagnosis of iatrogenic chronic right ilioinguinal neuropathy. The physical examination derived from the neurology consultation was normal.

At the VA Compensation and Pension (C&P) examination performed 6 months prior to separation; the CI reported occasional right hip pain and continued use of neurogenic pain medication. The hip examination was normal except for decreased adduction. The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Hip (Thigh) ROM
(Degrees)		 VA C&P ~6 Mo. Pre-Sep
 PT ~3 Mo. Pre-Sep
Flexion (125 Normal) 125 109 , 110 , 110
Extension (20) 30 0 , 0 , 0
External Rotation (45) 60 -
Abduction (0-45) 45 40 , 40 , 40
Adduction (45) 25 Prevents ability to cross legs
Comment Normal examination pain initially 3/10 then 7/10 after ROM measurements
§4.71a Rating 10 % 10 %

The Board directed attention to its rating recommendation based on the above evidence. Both the PEB and VA rated the right hip neuropathy 10%, utilizing codes 8730 (ilioinguinal neuralgia) and 8599-8726 (analogous to anterior crural nerve neuralgia, mild). The Board considered whether the evidence supported a higher than 10% rating. The Board noted that the highest rating under VASRD code 8730 was 10%. There was no evidence of moderate neuralgia for a higher rating analogous to VASRD code 8599-8726. 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 right hip 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 right hip 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131219, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762
Dear XXXXXXXXXXXXXXXXXXXX :

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-02812 .

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.


Sincerely,







XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings
cc:
SAF/MRBR

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