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AF | PDBR | CY2014 | PD-2014-00989
Original file (PD-2014-00989.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-00989
BRANCH OF SERVICE: Army  BOARD DATE: 20150212
SEPARATION DATE: 20080214


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Traffic Management Coordinator) medically separated for chronic right groin pain. 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 condition, characterized as “chronic right groin pain secondary to post-surgical neuralgia (right ilioinguinal) with myofascial component,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated his right groin pain as unfitting and rated it at 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “I believe my rating should be changed because the rating that [I] have is [solely] based [on] not combat-related. All paper work [I] sent to [the] board and sent back to me with rating stated this fact. But in 2009 I received a DD 215 correction that states combat-related. I believe it should have been considered and would have [changed] my rating. Also to be considered my unit never reintegrated me because I was medavaced [sic] held by the med unit in Germany and returned to my unit during my Med-Board process. Since being part of the VA I am being seen for PTSD which was never considered because of never being reintegrated. PTSD is my biggest rating from the VA, also sleep apnea.”


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/Naval 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 Admin IPEB – Dated 20090226
 VA - (3 Months Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Groin Pain… 8799-8730 10% Status Post Right Inguinal Herniorrhaphy 7804 0% 20080519
Right Inguinal Nerve Transection... 8530 0% 20080519
Other x 0 (Not In Scope)
 Other x 3
Combined: 10%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 80627 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Right Groin Pain. The service treatment record indicated that the CI had a surgical repair of a right inguinal hernia in 1999 and a revision of the same with mesh support in 2000. He remained without subjective complaints until 2006 when he developed right groin pain after a physical training run. His pain was directly over the prior surgical incision with extension into the lower abdomen and upper thigh. The CI underwent extensive conservative treatment to include pain medications, oral steroids, incisional injections, electro-stimulation and or chemical ablation therapy. Secondary to persistent pain, he underwent a complete transection of the ilioinguinal nerve on 2 February 2007. Post-operatively, he had short-term relief of his symptoms, but eventually his pain returned. He was issued a permanent profile in June 2007 listing chronic right groin pain as the sole diagnosis. The commander’s statement specifically noted that the CI’s pain condition was the primary cause of his inability to perform the duties and tasks required of his MOS.

At the MEB narrative summary examination on 29 August 2007, the CI endorsed a constant right groin pain described as stabbing and sharp with extension into his upper thigh. Symptom aggravators included prolonged sitting or standing, and ascending stairs. Relief was obtained with medications. The physical examination was brief and revealed tenderness over the pubic bone extending into the right groin and directly over the surgical incision. There was no hernia or mass present. The diagnosis remained post-surgical neuralgia.

At the VA Compensation and Pension examination on 19 May 2008, the CI reported a constant 7/10 pain with “some” numbness into his right upper thigh with the inability to walk during “flare-ups” which occur 3 times per month lasting up to 2 days each episode. “He [the CI] cannot describe any precipitating or aggravating factors, and there are no alleviating factors or medications.”

The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA chose different coding options for the condition, but this did not bear on rating and both were consistent with §4.124a (Schedule of Ratings, Neurologic Conditions). The PEB adjudicated the right groin condition at 10% analogously coded as 8799-8730 (neuralgia; ilioinguinal nerve) whereas the VA coded 8530 (paralysis of ilioinguinal nerve) at 0%. Absent any actual inguinal herniation, code 7338 was non-applicable in this case and Board members agreed that a neurological coding approach was appropriate.

The pathology, symptomatology, and nerve identification in this case is specifically supported by VASRD code 8730. The VASRD §4.124a descriptive rating criteria for “neuralgia” is excerpted below:       
Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis.

Board members acknowledged that the maximum rating level available for this specific code is 10% “complete paralysis.” In light of the CI’s final surgery in which the identified nerve was actually transected with partial removal was wholly supported under 8530 (severe to complete) paralysis of the ilioinguinal nerve. Therefore, the maximum available rating under this code is of no additional benefit to the CI’s current PEB rating. 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’s 10% adjudication for the right groin pain.


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 groin 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 20140224, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150011026 (PD201400989)


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              XXXXXXXXXXXXXXX
                  Deputy Assistant Secretary of the Army
                  (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA                   

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