RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-00159
BRANCH OF SERVICE:  NAVY	Date of SEPARATION:  20070315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Advanced Equipment Operator, medically separated for “lumbar, with groin neuralgia,” rated at 0%. 

CI CONTENTION:  “Chronic Neuropathy in Lower Back, PTSD, Hemangioma, T.B.I.” The applicants 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 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 PEB–20061221	VARD - 20070627	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar, with Groin Neuralgia	5237	0%	Lumbar Strain	5237	10%	20070115	
Right SIJ Discomfort	Category  II	Sciatica, Right Lower Extremity	5252-8620	10%	20040115	
Hx of orchitis with epididymitis 	Category III	Orchitis, also claimed as Right Epididymitis	7599-7525	0%	20040115	
RATING:  0%	COMBINED RATING OF ALL VACONDITIONS:  30%	

ANALYSIS SUMMARY:  

Lumbar, with Groin Neuralgia Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in 2002 after falling from a tractor.  From 2003 to the time of separation, the CI underwent multiple medication trials for neuropathic groin pain. A pain management entry dated 15 December 2005 noted a history of right groin pain and a diagnosis of epididymitis.  The examiner noted that the source of the groin pain was either secondary to his chronic epididymitis or a primary back pain disorder.   The CI was treated twice with genitofemoral nerve blocks without pain resolution.  Radiographic studies (X-ray and MRI) done in January and March 2006 respectively were normal.  A right testicle ultrasound done in November 2005 was normal.  At the MEB examination in October 2006, approximately 5 months prior to separation, the CI reported low back pain centered at the L-5 region radiating to paraspinal area bilaterally and occasional radiation to the right groin and right testicular region.  He denied any weakness down the lower extremities or any further radicular symptoms.  The physical exam findings are summarized in the chart below.  At the VA Compensation and Pension (C&P) examination on 15 January 2007, performed 2 months before separation, the CI reported back stiffness and pain that radiated to the right side of his groin and down his right leg.  He further reported right leg numbness with a loss of function in his toes on his right foot.  The pain was aggravated by walking, driving, sitting, standing, and running for any amount of time.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain and groin neuralgia (nerve pain) condition at 0% coded 5237 (lumbosacral strain).  The VA rated the lumbar strain condition 10% coded 5237, based on the VA examination 2 months before separation, citing objective evidence of painful motion.  The VA rated the sciatica, right lower extremity condition 10% coded 5252-8620 (Thigh, limitation of flexion of-sciatic nerve neuritis), citing objective evidence of sensory dysfunction with findings of pain in the right hip and lower extremity.  The Board agreed that the VA examination was closer to the time of separation and most closely approximated the CI’s functional impairment at separation.  The Board agreed that a 10% rating for the lower back pain condition was justified for localized tenderness not resulting in abnormal gait or abnormal spinal contour.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities.  There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 lower back pain with groin neuralgia condition.  

BOARD FINDINGS:  In the matter of the lumbar pain with groin neuralgia condition, the Board unanimously recommends a disability rating of 10%, coded 5237, IAW VASRD §4.71a.  In the matter of the In the matter of the right SIJ discomfort condition, the Board unanimously recommends no change from the PEB determination as a Category II condition.  There were no other conditions within the Board’s scope of review for consideration.  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	
Lumbar with Groin Neuralgia	5237	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140102, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 2 Mar 16 ICO XXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 2 Mar 16 ICO XXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 22 Feb 16 ICO XXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 29 Feb 16 ICO XXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (e) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.
     
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.