RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03092
BRANCH OF SERVICE:  Army	Separation Date:  20050329 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Food Service Specialist) medically separated for chronic bilateral groin pain, rated 20%.  

CI CONTENTION:  The CI makes no contention.  The applicant’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 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:  

IPEB - Dated 20041220	VA* - (~6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Chronic Groin Pain	5099-5003	20%	Systemic Adenopathy	7399-7301	10%	20050913	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
RATING:  20%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20051118 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Bilateral Chronic Groin Pain.  The CI had sudden onset of left groin pain with enlarged lymph nodes in February 2003.  He underwent surgery for a resection of the lymph nodes and an evaluation for lymphoma (due to an enlarged spleen) was negative.  In April 2003 he underwent a right groin lymph node resection and biopsy which was negative.  After additional testing he was positive for mononucleosis and Epstein Barr virus (infection as potentially causing the enlarged lymph nodes).  In August 2003 the specialist indicated the groin pain syndrome was not an infection and no further evaluation for infection was needed.  As a result of the surgeries, the CI developed increased pain from post-operative nerve damage.  Nerve blocks offered temporary relief.  Trials of non-steroidal anti-inflammatory, narcotic and neurogenic pain medication; bilateral ilioinguinal nerve blocks (including pulsed radiofrequency denervation, cryoneurablation, and medication catheters); TENS unit; pool therapy; Pain Management, Rehabilitation Medicine and Physical therapy consults did not provide lasting pain relief.  

The MEB Narrative Summary (NARSUM) exam approximately 7 months prior to separation, documented that the CI continued to have constant bilateral groin pain which interfered with his ability to perform his MOS duties.  There were physical exam findings of exquisite tenderness to palpation in the bilateral groin regions.  Strength at the knees and ankles was normal with limited hip evaluation due to the groin pain.  Reflexes were normal.  The examiner rated the pain in accordance with the American Medical Association (AMA) as “moderate to severe and constant.”  

The VA Compensation and Pension (C&P) exam approximately 6 months post-separation documented that the CI had constant bilateral groin pain which worsened with walking or heavy lifting.  He also reported intermittent bilateral groin swelling dependent on the amount of exertion and that his pain was partially relieved by methadone.  There were physical exam findings of “tender matted adenopathy” of the bilateral groin area.  The CI was ambulating without assistance and strength was normal and bilaterally symmetric.  The examiner’s impression was “systemic adenopathy of unclear etiology, question possibly infectious” with conclusions indicating “…mild non limiting symptoms from his adenopathy….”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the bilateral groin pain condition as analogous to 5003 (arthritis, degenerative [hypertrophic or osteoarthritis]) and rated at 20% with application of the USAPDA pain policy.  The VA coded the systemic adenopathy condition as 7399 analogous to 7301 (peritoneum, adhesions of) and rated at 10%.  The Board first considered if the left groin pain and right groin pain, having been de-coupled from the combined PEB adjudication, each remained independently unfitting.  The CI was on a permanent profile with significant limitations.  All members agreed that the left and right groin condition would have rendered the CI incapable of continued service for his MOS and accordingly merited consideration for separate ratings.  

The Board considered the closest analogous coding would be analogous to neuritis of the ilioinguinal nerve (8630) under VASRD §4.124a.  The Board adjudged that with residuals of surgery and adenopathy there was sufficient evidence to consider there were organic changes in the region of the ilioinguinal nerve.  IAW VASRD §4.123 (neuritis), the maximum rating for each side would be 10% (the VASRD maximum for this nerve).  Alternative coding under 7301 would not achieve higher than a 10% combined rating as there was no intra-abdominal pathology or symptoms (bowel obstruction or delayed intestinal motility).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left chronic groin pain condition and 10% for the right chronic groin 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the bilateral chronic groin pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the bilateral chronic groin pain, the Board unanimously recommends a disability rating of 10% for the left chronic groin pain and 10% for the right chronic groin pain, each coded 8699-8630 IAW VASRD §4.124a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
Left Chronic Groin Pain	8699-8630	10%	
Right Chronic Groin Pain	8699-8630	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140625 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160005021 (PD201403092)

1. 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,
accept the Board's recommendation to modify the individual's disability description
without modification of the combined rating or re-characterization of the individual's
separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA