RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03087
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20090530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Water Support Technician, medically separated for “chronic post-operative pain, status post (S/P) left inguinal hernia repair,” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions:  intense anger and anxiety issues, ringing in the ears, possibly sterile, inable to keep memory of things, sleeping issues.”  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 - 20090305	VARD - 20090902	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Postoperative Pain, S/P Left Inguinal Hernia	8630	10%	Pain Disorder	9422	30%	20081205	
			Scar, S/P Left Inguinal Herniorrhaphy and Left Varicicelectomy	7804	10%	20081114	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Postoperative Pain, S/P Left Inguinal Hernia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left groin pain condition began in November 2005 with left testicular pain due to a varicocele.  There was mixed evidence of a possible hernia.  Diagnostic imaging and the surgery consultant did not find a hernia.  In May 2006 the CI underwent surgery to repair the left varicocele and an inguinal exploration with placement of an inguinal patch.  Following surgery, the CI developed a chronic pain syndrome in the left groin that was not responsive to treatment.  

At the MEB NARSUM examination dated 26 September 2008, 8 months prior to separation, the CI reported chronic pain in the left groin.  Limited duty (LIMDU) included no prolonged standing, marching, push-ups, pull-ups, or lifting over 50 pounds.  Physical examination showed tenderness to palpation below the inguinal ligament with no evidence of hernia.  Pain was reproduced on straight leg raising.  The non-medical assessment (NMA) dated 7 October 2008 indicated that performance of duties was satisfactory, however, that due to the CI’s medical injuries and treatment required, the CI was not worldwide assignable.  

At the MEB examination (recorded on DD Forms 2807, 2808, and 2697) dated 8 October 2008, 8 months prior to separation, the CI reported chronic nerve pain in the lower abdomen and left (as well as right) groin.  He also reported frequent urination diagnosed as overactive bladder, and diagnosis of depression with and excessive worry.  The CI was taking narcotic pain medication and anti-inflammatory medications.  The DD Form 2808 noted diagnoses of “MDD, GAD, EtOH dependence” [major depressive disorder, generalized anxiety disorder, alcohol dependence].  Genitourinary examination was deferred.  

At the VA Compensation and Pension (C&P) internal medicine examination on 14 November 2008, performed 7 months before separation, the CI reported a chronic left groin condition, groin nerve damage, varicocele, overactive bladder, and status post hernia surgery.  Examination showed a normal gait.  There was a 7 cm disfiguring tender scar in the left inguinal area.  Genitourinary examination was normal with no evidence of hernia.  Lower extremity strength, reflexes and sensation were normal.  Diagnoses were status post left inguinal herniorrhaphy and left varicocelectomy with residual disfiguring, tender scar; overactive bladder, on Ditropan, controlled; and, no evidence of nerve damage in the left inguinal area.  

At the VA C&P psychological examination on 5 December 2008, performed 6 months before separation, the CI reported depression and chronic left groin and leg pain.  Substance abuse history was positive for alcohol abuse.  Mental status examination noted affect and mood were congruent and somewhat flattened and suspicious, and was otherwise negative.  The Axis I diagnoses were chronic pain disorder associated with both psychological factors and general medical condition, and Alcohol abuse.  Global Assessment of Functioning was 51 (moderate symptoms 51-60).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 8630 code (Ilio-inguinal nerve neuritis).  The VA assigned a 10% rating using the 7804 code (Scar(s), unstable or painful), citing tenderness.  The VA also assigned a 30% rating using the 9422 code (Pain disorder) based on the VA C&P examination 6 months before separation, citing occasional occupational and social impairment.  

There was no indication from the LIMDUs, MEB, NMA, or PEB that the CI had any mental health disorder adversely impacting duty performance, and the Board focused deliberation on the rating of the groin pain condition.  The 10% awarded by the PEB is the highest rating available under disability code 8630.  There was no evidence of chronic epididymo-orchitis (code 725) for alternative rating.  Potential alternative rating under code 7804 would be no higher than that awarded by the PEB.  

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 chronic postoperative pain, s/p left inguinal hernia condition.  

BOARD FINDINGS:  In the matter of the chronic postoperative pain, s/p left inguinal hernia repair 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 20140624, 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 11 Aug 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:

		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)