RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00753
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  20040617	DATE REMOVED FROM TDRL:  20060306

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E8, Infantry, medically separated from the Temporary Disability Retired List (TDRL) for “bilateral recurrent groin abscesses with residual pain and scarring,” with a disability rating of 0%.

CI CONTENTION:  The applicant makes no specific contention in his application.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 – 20040308/20060216	VARD – 20041014/20060724	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Chronic Recurrent Infections of Right Groin Area	7820-7806	30%	-	Residuals of Actinomycosis Septicemia, including:  Major Depression; Skin Grafts to Bilateral Thighs; Neuropathy of Bilateral Lateral Cutaneous Nerves; Lumbar Strain; Mixed Headache Disorder; Vertigo; Tinnitus; Bilateral Hearing Loss 	9434	100%	-	
Residual Pain and Scarring from Incision and Drainage of
Numerous Bilateral Recurrent Groin Abscesses	7820-8730	-	0%	Neuropathy, lateral cutaneous nerve, left thigh, as a
residual of Actinomycosis septicemia	8529	-	10%	
				Neuropathy, lateral cutaneous nerve, right thigh, as a
residual of Actinomycosis septicemia	8529	-	10%	
COMBINED RATING:  30% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Groin Abscesses.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s recurrent abscesses and bilateral groin involvement began in 2001 after oral surgery.  The CI had multiple antibiotic trials, surgical debridement procedures, and bilateral thigh wound grafting prior to TDRL placement.  Despite treatment the CI continued to present with recurrent right greater than left thigh infection and pain. 

An admission note dictated 19 March 2003 documented a prior successful surgical excision of the left thigh abscess which was well-healed and a non-healing right thigh wound.  The discharge summary noted a diagnosis of chronic pain in his right femoral nerve secondary to multiple surgical procedures.  At the VA Compensation and Pension (C&P) examination in August 2005, performed 6 months before TDRL removal, the CI reported pain in the right hip.  The pain was worse with ambulation and tight clothing.  The physical examination demonstrated pain in the quadriceps region with hip flexion and knee extension, trouble weight being on the right leg, and an abnormal gait.  At a TDRL evaluation dated January 2006, the CI reported pain in both of his thighs and bilateral leg weakness causing difficulty climbing stairs, walking, and poor coordination.  He also reported burning and tingling in both legs.  At the TDRL removal NARSUM examination in February 2006, a month before TDRL removal, the CI reported continued chronic right greater than left leg pain, difficulty walking long distances, and bilateral weakness which resulted in difficulty climbing stairs, easy fatigability, and poor coordination.  The CI also reported tingling and burning sensations in both of his legs and feet.  The physical examination demonstrated abnormal lower extremity movement and a “pronounced” limp favoring the left leg.  The examiner opined that the CI’s pain was neuropathic (nerve pain).  A diagnosis of chronic pain syndrome, neuropathic in nature secondary to multiple surgical interventions and multiple groin infections was rendered.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right groin recurrent infection and pain condition at 30% at TDRL placement, coded 7820-7806 (infections of the skin-dermatitis) citing chronic severe dermatitis.  The Board noted that at TDRL placement there was no evidence of constant or near constant systemic therapy for a higher rating.  The Board also considered rating the neuropathic pain; however there was no pathway to a higher than 30% 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 adjudication for the right groin condition.  

At TDRL removal, the PEB noted that the CI was “placed on TDRL 17 Jun 04, because of residual pain and scarring from incision and drainage of numerous bilateral recurrent groin abscesses” and assigned a 0% rating under an analogous 7820-8730 code (infections of the skin-ilioinguinal nerve neuralgia moderate incomplete paralysis) for a bilateral condition, citing residual pain and scarring from incision and drainage of numerous bilateral recurrent groin abscesses.  The VA assigned each lower extremity a 10% rating under the 8529 code (lateral cutaneous nerve) citing gait impairment and pain.  The PEB rated the right lower extremity on TDRL placement and a bilateral condition was rated at TDRL removal.  IAW DoDI 6040.44 if the PEB combined adjudication is not VASRD compliant, each condition subsumed under the single disability rating must be reasonably justified as separately unfitting in order to remain eligible for rating.  Board members agreed that the right lower extremity residual neuropathic pain condition could be reasonably justified as separately unfitting.  Board members also agreed that the left lower extremity neuropathic pain was evaluated at the TDRL removal examination, could be reasonably justified as separately unfitting, and met, DoDI 1332.38 E3.P6.2.4.2, criteria for compensability as a residual of the unfitting bilateral groin abscess resulting in multiple surgical interventions.  The Board then directed its attention to its rating recommendations.  Multiple service clinical notes and VA records documented subjective and objective evidence of right greater than left persistent groin/thigh neuropathic pain resulting in gait impairment, poor coordination, and difficulty maneuvering stairs.  In considering nerve codes that most closely approximated the CI’s functional impairment, the Board noted the PEB rated the condition under the ilioinguinal nerve and VA rated the condition under the lateral cutaneous nerve.  Both of these nerves account for the sensory pain component; however, the femoral nerve referenced in the STR most closely approximated the functional impairments resulting from neuropathic pain, muscle weakness, and incoordination.  Board members noted that the STR evidenced right greater than left neuropathic pain.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the right groin pain condition and 10% for the left groin pain condition, coded 8526 at TDRL removal.  

Contended PEB Conditions.  In 2003 the CI was treated with amikacin (an antibiotic which is known to be ototoxic toxic to the organs of hearing) for his non-healing groin wounds and developed moderate to severe sensorineural hearing loss, tinnitus, and vestibulopathy (imbalance).  The NARSUM audiology examiner opined that the CI’s hearing loss was attributable to both his military career and the ototoxicity of amikacin.  Board members agreed that the hearing loss condition was related to treatment of the unfitting condition and therefore, within the scope of review of the Board.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The hearing loss condition was not profiled nor implicated in the commander’s statement.  The Board further noted that the CI’s pure tone audiogram results dated 31 December 2003 (6 months before TDRL placement) met retention standards.  The hearing loss condition was reviewed and considered by the Board.  There was no performance based evidence from the record that the hearing loss 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 the bilateral sensorineural high frequency hearing loss condition as an additionally unfitting condition. 

BOARD FINDINGS:  In the matter of the right groin condition and IAW VASRD §4.118, at the time of TDRL placement, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right groin condition at the time of TDRL removal, the Board determined that it was separately unfitting and unanimously recommends a disability rating of 20%, coded 8726 IAW VASRD §4.124a.  In the matter of the left groin condition at the time of TDRL removal, the Board determined that it was separately unfitting and unanimously recommends a disability rating of 10%, coded 8726 IAW VASRD §4.124a.  In the matter of the contended hearing loss condition, the Board unanimously agrees that it was not unfitting and cannot recommend it for additional disability rating.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Right Groin Pain	7820-7806	30%	-	
Right Groin Pain with Femoral Nerve Neuralgia	8526	-	20%	
Left Groin	8526	-	10%	
RATING	30%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140211, 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 XXXXXXXXXXXXXXXXXX, AR20160005591 (PD201400753)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

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:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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:
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA