RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01393
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080409

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Infantryman) medically separated for “inguinal pain, left, after repair of inguinal hernia,” rated 0 

CI CONTENTION:  He was given a higher rating by the VA for his left inguinal hernia condition and he was not evaluated for his PTSD, left knee, and tinnitus conditions.  His 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 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 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 20040409	VA* - ~10 Mos. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Inguinal Pain, Left, after Repair of Inguinal Hernia	8799-8730	0%	Residuals, LIH Repair with Ilio-Inguinal Nerve Neuralgia	8730-7338	10%	20081219	
			Left Hip Pain	NSC		
Other MEB/PEB Conditions x 1 (Not In Scope)	Other x 8	
RATING:  0%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20090130 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Inguinal Pain, Left, after Repair of Inguinal Hernia.  The CI was found to have a LIH while deployed and referred to general surgery for evaluation and treatment after redeployment.  It was surgically repaired in January 2007 and healed well except for persistent post-operative numbness and pain at the site of the incision.  He was diagnosed with a nerve injury secondary to the surgery.  Despite a profile and pain medications and over 8 months of rehabilitation, he was not able to return to full duty and MEB was recommended.  At the MEB examination on 13 November 2007, 5 months prior to separation, the CI reported chronic pain.  On the MEB physical examination, the left side of the scrotum and left inguinal area were very sensitive.  The narrative summary (NARSUM) was dated 6 December 2007, 4 months prior to separation.  It noted that the discomfort began approximately a month after the surgery and was aggravated by coughing and activity.  The hernia was well repaired.  Some pain in the left hip was also present.  X-rays of the hips showed some abnormalities, but these were thought to be unrelated to the inguinal pain.  He was noted to be tender on the left side of the scrotum and left inguinal area and movement of the left leg aggravated his pain.  However, his gait and stance were normal.  At the VA Compensation and Pension (C&P) examination performed on 19 December 2008, 10 months after separation, the CI reported ongoing pain aggravated by straining.  He had temporary relief from a nerve block and later a nerve ablation.  On examination, the scar was well healed, but tender.  No evidence of a recurrent herniation was present.  His gait was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the inguinal pain condition at 0% using the code 8730 (neuralgia of the ilio-inguinal nerve) at the mild to moderate.  The VA rated the CI at 10% for residuals of the hernia repair and ilio-inguinal nerve neuralgia using the dual code 7338 (inguinal hernia) and 8730.  The 10% rating was assigned for recurrent pain from the hernia repair.  The Board considered these codes.  While the CI reported ongoing pain and also pain with movement of the left leg, his gait was consistently recorded as normal after recovery from the hernia repair.  This is consistent with pain at the mild to moderate level which supports a 0% rating.  The VA also used the 7338 code.  The use of this code is not supported by the evidence.  The Board also considered if a separate rating for the scar was warranted.  The scar was tender, but no limitation in the wear of military gear or uniforms was noted on the profile.  No examiner severed the symptoms from the scar and the inguinal nerve injury.  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 left inguinal 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 left inguinal pain 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.  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 20140318, with attachments
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 XXXXXXXXXX, AR20160004002 (PD201401393)

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