RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX	CASE:  PD-2014-00171
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20141107
SEPARATION DATE:  20070717

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty AM2/E-5 (8842/FA-18 A/B/C/D Systems Organizational Initial Maintenance Technician) medically separated for chronic left ilioinguinal pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards.  He was placed on limited duty twice and referred for a Medical Evaluation Board (MEB).  The left ilioinguinal pain condition, characterized as “abdominal pain, other specified site/multiple sites and other chronic postoperative pain,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic left ilioinguinal pain status post repeat left inguinal hernia repair, bilateral orchidopexy and bilateral hydrocelectomy” as unfitting, rated at 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was discharge from the Navy because of permanent physical disability rated by the Navy at 10%. I was rated by the Veteran Affairs at 80%.”

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 left ilioinguinal pain condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 Naval Records.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20070424	VA - (*1 Mos. Pre -Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ilioinguinal Pain s/p Repeat Left Inguinal Hernia Repair, Bilateral Orchidopexy and Bilateral Hydrocelectomy”	8630	10%	Status Post-Bilateral Inguinal Herniorrhaphy	7338	20%	*20070424	
Other x 0 (In Scope)	Combined:  80%	
Combined:  10%		
Derived from VA Rating Decision (VARD) dated 20071023 (most proximate to date of separation) *C&P Not in Evidence.

ANALYSIS SUMMARY:  The VA Compensation and Pension (C&P) exam was not available in evidence before the Board and could not be located after appropriate inquiries.  Further attempts at obtaining the relevant documentation would likely be futile and introduce additional delay in processing the case. However, the Board noted that the VARD referenced in detail the findings of this exam in the explanation of its rating decision.  Members deliberated if the absence of the original document would negatively impact their ability to render a fair assessment.  The Board unanimously agreed that the evidence referenced in the available VARD was sufficiently probative such that the missing document would not materially affect the Board’s final recommendation.

Left Groin Pain.  The narrative summary notes the CI to have a past history of surgical repair of a left inguinal (groin) hernia using artificial mesh material in 1998 and surgical repair of a right groin hernia without mesh material in 2003.  Both of these healed without sequellae.  The CI began having episodes of recurrent torsion of his left testicle in 2004.  In July 2006, the CI underwent surgical securing of the testicle in the scrotum to prevent torsion through a left groin incision.  At this time a recurrent left inguinal hernia in the area of prior mesh repair was discovered.  The mesh was removed and the hernia re-repaired.  Following this surgery, the incisions healed without hernia recurrence, but with appearance of left groin pain poorly responsive to medical treatment.  This was felt secondary to an injury to a nerve (ilio-inguinal nerve) in the surgical site providing sensory innervation the groin area.  Further surgical treatment was not recommended.  

At the MEB exam performed on 14 March 2007 (performed 3 months prior to separation), the CI reported continued left groin pain with activity.  The MEB physical exam noted the abdomen to be soft, nondistended and without signs of internal pathology.  The small surgical area of the left groin was severely tender to palpation.  There was no evidence of hernia recurrence and testicles were normal.  The examiner referenced a consultation with the chief of surgery at the San Diego Medical Center, (omitted from records), who reported the same findings.  

The VA C&P exam (performed a month prior to separation) was not in record as noted above.  Data from this exam were quoted in the VARD of 23 October 2007.  Data quoted were: 1) well healed 9 x 2 cm scar in the left inguinal area, tender to palpation; 2) well healed 5x1 cm scar in right inguinal area tender to palpation and 3) no evidence of recurrent groin hernias.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the left groin condition 10%, code 8630 (neuritis ilioinguinal nerve/severe) IAW §4.123.  No higher rating is achievable under this code.  The VA combined the left and right groin conditions and rated at 20%, code 7338 (inguinal hernia) recurrent at 10% for each.  The Board agreed that the condition was ratable no higher than 10% under codes 8630 as noted above.  The Board also agreed that the condition could be rated no higher than 0% with code 7338, as no post-operative recurrence, a requirement for 10%, was confirmed by the record.  

The Board considered a rating for painful scars IAW §4.114, but was unable to do so without violation of §4.14 (Avoidance of pyramiding).  The Board considered ratings under §4.114 (diseases of the digestive system; gut involvement in hernia), §4.73 (muscle injury; from surgery) and §4.115 (diseases of the genitourinary; injury from surgery), but could recommend none as these were not supported by the record in evidence.  The Board found no other appropriate codes for consideration and no pathway to a rating higher than 10%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the right groin 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 groin pain condition and IAW VASRD §4.123, 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 20140102, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 22 Apr 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXX
	     				  Assistant General Counsel
		  (Manpower & Reserve Affairs)