RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00973
BRANCH OF SERVICE:  Army	BOARD DATE:  20150320
SEPARATION DATE:  20081022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (AH-64 Attack Helicopter Repairer) medically separated for left thigh 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 P3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “meralgia paresthetica” as medically unacceptable to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “left meralgia paresthetica”as unfitting, rated 20% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI submitted two applications.  The first application contended: “The new research dealing with chronic pain steming from the injury.  The severe nerve damage caused chronic pain then depression”.  The CI’s second application contended:  “Major Depression with Generalized Anxiety Disorder 50% Neuralgia Paresthetica, left Thigh 20%”.

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:

IPEB – Dated 20080709	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Meralgia Paresthetica	8799-8726	20%	Neuralgia Paresthetica, Left Thigh	8526	20%	20080826	
			Scar, Status Post Left Inguinal Hernia Repair	7804	10%	20080826	
Other x0	Other x6	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20090207 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  The Board acknowledges the presence of anxiety disorder as a service-connected condition by the VA, but notes that the scope of its recommendations does not extend to conditions which were not diagnosed or in evidence at the time of medical separation.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using VASRD standards, based on ratable severity at the time of separation.

Left Meralgia Paresthetica.  The evidence supports that the CI developed left groin pain in February 2007.  After an ultra sound exam confirmed the hernia, the CI underwent a left inguinal hernia repair.  Immediately after surgery, the CI complained of severe left groin pain with radiation to his left knee and weakness below the knee.  The weakness resolved that same day while he recovered in the Same Day Surgery unit.  The CI experience persistent burning pain in his left thigh and used a cane for walking.  He was treated conservatively yet continued to express pain in his groin with radiation to his left leg.  He was referred to the pain clinic where injection of the nerve failed to relieve his pain, and a lumber spine magnetic resonance imaging study was normal, so he was referred to physical therapy which did little to relieve his pain.  He underwent extensive therapy to include rehabilitation and pain management and still had persistent left groin pain with radiation into his left leg and knee.  He was evaluated by neurology and physical medicine where nerve conduction studies demonstrated a marked delay of femoral nerve latency without suggestion of a generalized neuropathic process; therefore, was consistent with left femoral nerve injury at the surgical site.  There was no documented weakness of the left leg.  The MEB physical exam performed 9 months prior to separation noted, “Decreased sensation to light touch – left upper inner thigh.”  The lower extremity exam was marked “normal.”  The narrative summary prepared 7 months prior to separation confirmed the above historical events.  The exam noted there was no recurrence of the hernia.  At the VA Compensation and Pension (C&P) exam performed 2 months prior to separation, the CI reported that he “…is able to run through jumping and squatting with discomfort.”  He “…has been taking Motrin and Valium as needed on a daily basis with good relief without significant side effects.”  There was no physical examination documented in that C&P document.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB applied the analogous VASRD code of 8799-8726 (paralysis of the anterior crural (femoral) nerve) and rated it 20% citing, “IAW VASRD 4.124, this can be rated no higher than moderate incomplete paralysis.”  The VA also applied code 8726 and also rated it 20% citing, “An evaluation of 20 percent is assigned for pain and numbness and delay in left femoral nerve.  An evaluation of 20 percent is assigned for incomplete paralysis of the thigh muscle which is moderate.”  The rating criteria for peripheral nerve codes include the following note which is pertinent to this case, as there was no motor/strength disability documented:

“The term ‘‘incomplete paralysis,’’ with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration.  When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree.”

The 20% rating for the incomplete paralysis of the femoral nerve is the highest rating available under VASRD guidelines.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 20% for the left meralgia paresthetica condition was appropriately adjudicated in this case.

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 left meralgia paresthetica 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 20140525, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB									

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation or XXXXXXXXXXXXXXX, AR20150013329 (PD201400973)

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			     
						         
CF: 
(  ) DoD PDBR
(  ) DVA