RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-00986
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E3, Basic Trainee, medically separated for “persistent left groin pain,” with a disability rating of 0%.

CI CONTENTION:  “Veteran has had a continued issue with hematuria.  He has it documented with the VA.  His blood pressure was on his initial review before I got out yet the file was not made.  This issue with hematuria is more present because it has begun to affect his marriage.  Due to continuing issue and progressive problems.”  The CI’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 – 20081106	VARD - 20090105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Left Groin Pain	8799-8730	0%	Scars, Abdomen, Status Post Laparoscopic Left Inguinal
Hernia Repair	8730-7805	0%	20081202	
Painless Hematuria	Not Unfitting	Hematuria	7599-7502	0%	20081202	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Persistent Left Groin Pain.  According to the service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI underwent left inguinal hernia repair on 27 February 2008.  In April 2008, he began to experience left groin pain and blood was noted in his urine (further discussed below).  The CI did not have a recurrent hernia on examination.  Despite treatment, the persistent left groin pain could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “persistent left groin pain status post inguinal hernia repair for PEB adjudication.

At the MEB NARSUM examination on 14 October 2008, 2 months before separation, the CI reported left groin pain.  The physical examination noted tenderness to palpation of the left inguinal region.  There were no signs indicative of an acute surgical condition (no rebound tenderness or guarding).  There was no evidence of a recurrent hernia or testicular tenderness or mass.

At the VA Compensation and Pension (C&P) examination on 2 December 2008 performed 1 day before separation, the CI reported persistent left inguinal pain.  Physical examination of the abdomen, genitals, and rectum were all normal, without tenderness to palpation and no recurrent hernia was noted.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the groin pain condition 0%, coded 8799-8730 (analogous to neuralgia of the ilioinguinal nerve) for mild or moderate neuralgia.  The VA provided a 0% rating, coded 8730-7805 (scar and neuralgia of the ilioinguinal nerve).  The Board agreed that evidence supports a 0% rating for the left inguinal pain as adjudicated by the PEB IAW VASRD §4.124a (neurological conditions) and the groin pain could not be characterized as severe for the next higher rating of 10%, coded as 8799-8730.  There was no evidence of a recurrent hernia to support a rating greater than 0% coded as 7338 (inguinal hernia) IAW VASRD §4.114 (digestive system).  There was no evidence that the laparoscopic scars were unstable, painful, or caused limitation of function of the affected part or comprised a large enough total area to support a higher rating with a scar code IAW §4.118 (skin).  There was therefore no higher rating available than 0% with any applicable VASRD code.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the left groin condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the hematuria condition was not unfitting.  As noted above, the STR and the NARSUM indicated that following hernia repair surgery in February 2008, the CI developed blood in his urine (hematuria).  The hematuria was thought to be unrelated to the hernia surgery.  The CI underwent a full urologic evaluation and no cause for the hematuria was identified except for a blood vessel abnormality in the bladder.  Removal was attempted (fulgurated); however, the hematuria continued.  The MEB urology addendum 29 October 2008 indicated that the hematuria was not attributed to a malignant cause and “given the low likelihood of any significant diagnosis being made, further anatomic evaluations should be conducted after separation.”  The urologist recommended that the hematuria condition was “not a boardable condition under Chapter 3 of AR 40-501” and was medically acceptable at the time.

The hematuria condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance based evidence from the record that this 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 a change in the PEB fitness determination for the hematuria condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the “persistent left groin pain” condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the “painless hematuria” condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  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 20140219, 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, AR20160008277 (PD201400986)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA