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AF | PDBR | CY2013 | PD2013 00289
Original file (PD2013 00289.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX          CASE: PD1 3 00 289
BRANCH OF SERVICE: Army   BOARD DATE: 201 4 0107
Separation Date : 20050711


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B10/Infantryman) medically separated for chronic right groin and testicular pain. He had a bilateral hernia repair in June 2003, followed by increasing testicular pain. In October 2003 he was diagnosed with orchalgia and ilioinguinal neuritis. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The chronic right groin and testicular pain condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 and no other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated testicular pain condition as unfitting, rated 0% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI submitted a rebuttal to the IPEB. The IPEB reviewed the rebuttal and forwarded the rebuttal to the US Army Physical Disability Agency (USAPDA) for final processing. The USAPDA affirmed the IPEB’s decision. The CI was medically separated.


CI CONTENTION : “I am currently rated at 100% through SS and VA. I have had this rating since discharge. I feel that even though I am and have undergone a lot of counseling that my condition physically and mentally has not improved.”


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 testicular pain condition is addressed below. As a mental health (MH) review case, the MH conditions in the medical records will also be considered, regardless of any MH condition being mentioned in the MEB or PEB. 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.


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Service IPEB – Dated 20050510
 VA - (1 Mo. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Groin and Testicular Pain 8799-8730 0% S/P Transection of Ilioinguinal Nerve 8530 10% 20050912
No Corresponding Condition
 PTSD 9411 70% 20050831
No Additional MEB/PEB Entries
 Other x 5 20050912
Combined: 0%
 Combined: 80%
Derived from VA Rating Decision (VARD) dated 20051217 ( most proximate to date of separation [DOS]).


ANALYSIS SUMMARY: 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 (DVA), operating under a different set of laws. The Board also acknowledges the CI’s implied contention for ratings of his posttraumatic stress disorder (PTSD) condition which was diagnosed and rated by the DVA, but not addressed by the PEB. Disability compensation may only be offered for those conditions that cut short the member’s career. Should the Board judge that any contested MH condition was most likely incompatible with military service, a disability rating IAW the VASRD, based on the degree of disability evidenced at separation, will be recommended.

Chronic Right Groin and Testicular Pain Condition. According to a “Patient Movement Request” in June 2003, the CI reported a 1-year history of right groin pain that was progressively worsening. Two days after undergoing an uncomplicated bilateral inguinal hernia repair on 16 June 2003, the CI experienced testicular swelling, bruising and pain. During a surgical follow-up visit in August 2003 for persistent right scrotal pain, the CI stated that he first experienced pain in May (preoperatively) when he was struck in the groin with a metal object. The pain had reportedly disappeared for a short time, but recurred with the hernias. Ongoing post-operative right testicular pain was treated with a nerve block, which was minimally helpful and pain medication, which was partially helpful. An attempt was made to alleviate the pain with a right groin surgical exploration and transection of the ilioinguinal and general femoral nerves on 9 June 2004. Although this resulted in some pain improvement, it was insufficient to allow performance of unrestricted duties. The MEB narrative summary (NARSUM) exam on 9 March 2005 (4 months prior to separation) indicated that the CI still had constant numbness in the area and chronic right groin pain, was only able to walk for approximately 20 minutes and was unable to perform any exercises involving abdominal exercises or strenuous exercises. Neurontin, a medication used for neurogenic pain, was helpful but caused drowsiness. The pain was described as a 4-5/10 in severity. The physical examination noted no testicular masses or tenderness. The examiner diagnosed chronic right groin pain and right testicular pain and stated that there was no clear explanation for the pain. Removal of the right testicle was discussed as a “last ditch effort.” The CI was given an L3 profile for chronic right groin and testicular pain with specific restrictions towards limiting physical activities. The commander’s statement indicated that the CI’s testicular condition rendered him physically incapable of performing his MOS duties. The VA Compensation and Pension(C&P) exam on 12 September 2005 (2 months after separation) noted that the CI had residual numbness distal to the scar on the right side and chronic right groin pain with right testicular pain that was constant and aggravated by slight touch. The physical exam findings demonstrated that the superior lateral portion of the scrotum was a very tender area of soft tissue with swelling, but there was not a specific cyst or tumor formation. The examiner opined that the diagnosis was right groin neuralgia and neuropathy following inguinal herniorraphy.

The Board directs attention to its rating recommendation based on the above evidence. The PEB coded chronic right groin and testicular pain analogously to 8730 (neuralgia of ilioinguinal nerve) and rated at 0% for mild or moderate paralysis. The VA also used an ilioinguinal nerve coding approach, but under the 8530 code a 10% rating was assigned for “severe to complete paralysis.” VASRD §4.123 stipulates that neuritis, 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. In the absence of organic changes, the maximum rating will be for moderate, incomplete paralysis. VASRD §4.124a specifies that when peripheral nerve involvement is wholly sensory, the mild, or at most moderate, rating is applicable. In this case, the PEB rating was for chronic right groin pain; and the MEB NARSUM indicated that the right groin pain was chronic, worse with strenuous exercises or ambulation more than 20 minutes and with performing any abdominal exercises. The VA C&P exam noted residual numbness distal to the scar on the right side and chronic right groin pain with right testicular pain that was constant and aggravated by slight touch. The evidence supports a neurologic etiology for this condition since pain is the overriding pathology, and the Board agreed with the PEB and the VA that the ilioinguinal nerve code closely reflected the anatomical localization and symptomatology of the CI’s condition. The Board carefully considered the provisions of §4.123 and §4.124; the Board majority concluded that the evidence was most accurately depicted by the 0% rating criteria. 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 chronic right groin and testicular pain condition.

Contended PEB Conditions. The Board considered the appropriateness of changes in the MH diagnoses, PEB fitness determination; and if unfitting, whether the provisions of VASRD §4.129 were applicable, and a disability rating recommendation in accordance with VASRD §4.130. The Board noted that there were no MH conditions listed on the MEB or PEB documents. However, a note was written by a psychiatrist on 12 November 2004 specifically “for input for the MEB;” and the note listed a MH diagnosis. Board members agreed that the MH diagnosis was inappropriately omitted from the MEB form, and therefore the applicant did meet the inclusion criteria in the Terms of Reference of the MH Review Project.

The Board’s first charge with respect to these conditions is an assessment of the fitness based on a preponderance of evidence. There were notes in the service treatment record that discussed episodes of depressive symptoms that began at some point after returning from deployment. He was on two psychotropic medications in February 2004 that reportedly decreased or stopped his nightmares and increased his appetite. A possible diagnosis of PTSD was considered by a primary care doctor on 2 March 2004 in a consult to psychiatry. On 27 July 2004 the CI requested to be reclassified instead of going through a medical board. At a clinic visit on 17 September 2004, a physician stated: “Patient describes history of anxiety disorder…at this time patient has no complaints.” A week later, in the context of being informed he did not have a heart ailment; the CI became very upset and expressed suicidal ideations.

In the psychiatry note for the MEB on 12 November 2004, the examiner stated that the CI “filed a complaint against me after our last appointment. He felt that I did not act on his suicidal statement…He expressed a desire to have a second opinion (this was in Mar 04).” The CI acknowledged that he did not follow-up at the redeployment sessions as recommended. He still expressed anger about his pain condition. Notes from the MH department reportedly indicated he had an adjustment disorder and the psychiatrist confirmed a diagnosis of adjustment disorder with disturbance of emotions. The CI was released without limitations. At a follow-up appointment with a social worker on 8 December 2004, the CI “expressed concern with board and if making progress would hinder being viewed as PTSD.” In his rebuttal to the PEB on 13 May 2005, the CI requested a reconsideration of the statement that his hernia-related injuries were not combat related, but made no mention of a MH condition. A review of the medication profile shows that a prescription for a psychotropic medication (previously reported to be helpful) was last filled in March 2004, with authorized refills sufficient to last for a year. Although other medications for pain and hypertension were filled during the time leading up to separation, the psychotropic medication was not refilled after March 2004.

The final permanent profile did not specify a MH condition (profiled S1 for no duty restrictions), and no MH condition was implicated in the commander’s statement, or was judged to fail retention standards. The Board agreed that, prior to separation, there was insufficient evidence to support any diagnosis other than adjustment disorder rendered by the service psychiatrist. Regardless of any diagnostic debate however, the Board determined that there was no indication from the record that any mental health condition significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a determination of unfit for a contended MH condition; and, therefore, no additional disability rating can be recommended. Two months after separation, a VA examiner reported that the CI had been admitted to a hospital after separation for a diagnosis of PTSD. The Board noted the CI’s problems and diagnoses following separation; however, by law, the Services can only rate and compensate for those conditions that were found unfitting for continued military service based on the severity of the condition at the time of separation and not based on possible future changes. The VA can rate and compensate all service-connected conditions without regard to their impact on performance of military duties, including conditions developing after separation that are direct complications of a service-connected condition. The VA can also increase or decrease ratings based on the changing severity of each condition over time.


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 groin and testicular pain condition and IAW VASRD §4.124a, the Board by a vote of 2:1, recommends no change in the PEB adjudication. The single voter for dissent (who recommended a 10% rating, coded 8530) did not elect to submit a minority opinion. In the matter of any contended MH condition, the Board unanimously agrees that no additional disability can be recommended. 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:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Right Groin and Testicular Pain 8799-8730 0%
COMBINED
 0%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130509, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




        
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review







SFMR-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 XXXXXXXXXXXXXXXXXX, AR20140006897 (PD201300289)

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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

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