RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	    CASE:  PD-2014-01856
BRANCH OF SERVICE:  MARINE CORPS                                           Date of sepAration:  20090429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Motor Vehicle Operator) medically separated for post-operative pain neuropathy s/p (status post) parotid tumor excision.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The conditions of “other acute postoperative pain” and “mononeuritis of unspecified site,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “post-operative pain neuropathy S/P parotid tumor excision” as unfitting, rated 10%.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant requests consideration of all conditions in his application.  His complete submission is at Exhibit A.  

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 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:  
IPEB - Dated 20090305	VA* - (2 Weeks. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Operative Pain Neuropathy S/P Parotid Tumor Excision	8307	10%	Regional Pain Syndrome…	5237	10%	20090921	
			Residual Scar from Tumor Removal Left Side of Face	7800	30%	20090511	
Other Conditions x 0	Other x 8	
RATING:  10%	RATING: 40%	
*Derived from VA Rating Decision (VARD) dated 20090511 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Post-Operative Pain Neuropathy s/p Parotid Tumor Excision Condition.  The CI was found to have a mass of the left parotid gland (a salivary gland located in front of the ear and beneath the mouth) which was excised in July 2008.  The tumor was a benign (not cancerous) adenoma on pathology.  The CI was placed on LIMDU effective 25 September 2008 for post-operative pain.  None of the above records was in evidence.  The first record in evidence is an otolaryngology evaluation on 12 November 2008, less than 6 months prior to separation.  It noted that the CI had been seen in the pain clinic and placed on a medication for chronic pain (Lyrica).  The surgical scar was noted to be well healed and without infection or inflammation.  Separation due to the chronic pain was recommended for consideration.  The narrative summary was dictated by the attending otolaryngologist.  The CI had presented with a 2-month history of a slowly enlarging left upper neck mass which was excised on 9 July 2008.  The examiner noted that the facial nerve function was preserved before and after surgery (motor function for the face).  The CI reported post-operative pain and subjective hearing loss at his follow-up visit on 27 August 2008.  An audiogram showed normal function despite “questionable hearing loss.”  Despite medications, he reported pain on the left side of his face near the surgical incision (scar) precluding the wear of headgear or Kevlar.  He was diagnosed with a neuropathy.  He was noted to have good nutrition.  At the MEB examination on 7 January 2009, 4 months prior to separation, the CI reported continued severe pain “around my previous surgery.”  The MEB examiner noted a scar from the procedure, but a normal neurological examination.  The hearing test showed no significant change from his accession physical with some frequencies improved and others worse, but all within acceptable variation.  

At the VA Compensation and Pension (C&P) examination performed on 11 May 2009, a month after separation, the CI reported pain in the left neck and behind the left ear since the surgery.  He also endorsed a painful scar, but noted no limitation in function.  On examination, the scar was noted to be mildly tender to palpation with “some adherence to underlying tissue.”  Disfigurement was present.  The neurological examination, including the cranial nerves, was intact.  The CI had a second C&P on 21 September 2009 which addressed the neck.  The CI reported that his pain radiated from the left ear to his neck.  He was noted to have abnormal sensation in the area of the scar, but the cranial nerve function remained normal.  He was thought to have a regional pain syndrome and chronic cervical strain.  The Board observed that the CI maintained a stable weight with 173 pounds noted at accession, 185 at a periodic physical on 21 March 2008 (prior to surgery), 185 at the MEB examination (6 months after surgery), and 181 at the initial VA examination.  This supports no significant impairment in eating.  No speech impairment was recorded in the record.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated “post-operative pain neuropathy s/p parotid tumor excision” at 10%, coded 8307 (neuritis of the VIIth [facial] nerve).  This is a motor nerve.  The Board observed that the code 8407 (neuralgia of the VIIth) would have been more accurate, but provided no rating difference at the moderate level of impairment.  It is limited to the moderate level though which the 8307 code is not.  The VA rated the scar at 30%, coded 7800, noting both adherence to the underlying tissue and also the disfigurement.  The regional pain syndrome was also rated at 10%, but coded 5237 (cervical strain).  The Board considered the findings.  The scar was noted to be well healed by the treating surgeon and the pain was in the region of the scar, but not the scar itself.  Neither the MEB nor the PEB specifically addressed the scar as a separate condition.  The evidence does not support the addition of the scar as separately unfitting condition at separation.  The post-operative pain condition was rated 10% by both the PEB and VA, although different codes were used.  While this limited the use of head gear, no impact on speech or eating was recorded.  

The Board determined that the pain did not rise to a severe level of impairment and no route to a higher rating was found.  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 post-operative 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 post-operative pain neuropathy s/p parotid tumor excision 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 20140429, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	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 6 Jan 16

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

				XXXXXXXXXXXXXXX
	     			Assistant General Counsel
				(Manpower & Reserve Affairs)