RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01706
BRANCH OF SERVICE:  Army	BOARD DATE: 20150414
SEPARATION DATE:  20040313

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Bradley Fighting Vehicle System Maintainer) medically separated for left inguinal pain.  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 L3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “neuralgia of the left inguinal region due to neuroma secondary to left inguinal hernia repair” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic left inguinal pain following hernia repair” as unfitting, rated 0% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I am in constant pain 24 hours a day and have seen numerous doctors and specialists for the pain. I take many medications to help try and clam it down. I have also been advised it is now irreversible and going in could cause more damage.”

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 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 20040205	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Inguinal Pain following Hernia Repair	8799-8730	0%	Left Ilioinguinal Nerve Entrapment….Hernia Repair	7338-8530	10%	20040525	
Other x 0 (Not in Scope)	Other x 3	
Combined:  0%	Combined:  40%	
*Derived from VA Rating Decision (VARD) dated 2004721 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Chronic Left Inguinal Pain Following Hernia Repair Condition.  The CI underwent surgery for a left inguinal hernia in October 2002.  He experienced persistent groin pain after surgery due to ilioinguinal nerve entrapment due to scar tissue.  The groin pain did not satisfactorily respond to medications or injections (scar injection to soften the scar and nerve blocks for neuralgia) and he was unable to perform all duties of a soldier or mechanic.

The MEB narrative summary (NARSUM) dated 25 November 2003, approximately 3 months prior to separation, reported continued left groin pain radiating to the left hip and thigh aggravated by activity.  On examination there was tenderness in the left groin area.  The examiner diagnosed neuralgia left inguinal region due to neuroma secondary left inguinal hernia repair.

At the VA Compensation and Pension examination on 25 May 2004, approximately 2 months after separation, the CI reported continued left groin pain radiating to the leg aggravated by activity including lifting heavy weights, bending over or reaching things.  On examination there was no evidence of recurrent hernia but findings consistent with left ilioinguinal nerve entrapment status post left inguinal hernia repair.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left inguinal pain following hernia repair 0% for moderate neuralgia of the ilioinguinal nerve (code 8799-8730, neuralgia ilioinguinal nerve).  The VA rated the left ilioinguinal nerve entrapment status post left hernia repair 10% for severe involvement of the ilioinguinal nerve (coded 7338-8530; inguinal hernia -  ilioinguinal nerve).  The Board agreed that the ilioinguinal nerve code was the most appropriate VASRD diagnostic code for rating the CI’s ilioinguinal nerve condition.  The Board discussed whether the impairment due to neuralgia of the ilioinguinal nerve more nearly approximated the mild or moderate impairment (0%) versus the severe or complete impairment (10%) under the diagnostic codes for the ilioinguinal nerve (8530 paralysis, 8630 neuritis, 8730 neuralgia).  The highest rating achievable under the ilioinguinal nerve codes is 10%.  Based on the pain and limitations described in the MEB NARSUM and the commander’s statement, the Board concluded that the 10% rating better described the impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left inguinal pain following hernia repair condition (8799-8730).

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 left inguinal pain following hernia repair condition, and IAW VASRD §4.124a, the Board unanimously recommends a disability rating of 10% (coded 8799-8730).  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Left Inguinal Pain following Hernia Repair 	8799-8730	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131013, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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, AR20150011079 (PD201301706)

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 rating to 10% without 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						

CF: 
(  ) DoD PDBR
(  ) DVA