RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03365
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040422

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Automated Logistics Specialist, medically separated for “right inguinal neuralgia onset following right hernia repair during previous period of active duty,” with a disability rating of 0%. 

CI CONTENTION:  The applicant contends that his disability rating should have been higher.  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 - 20040310	STR	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Inguinal Neuralgia	8799-8730	0%	Right Inguinal Neuralgia	8799-8730	0%	STR	
  Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 	
COMBINED RATING:  0%	COMPLETE COMBINED VA RATING:  0%	

ANALYSIS SUMMARY:  

Right Groin.  The Service treatment record (STR) documented that the CI underwent a surgical repair (herniorrhaphy) of a right inguinal hernia (protrusion of abdominal cavity contents through the inguinal canal) during his first enlistment.  The history and physical (H&P) exam for the CI’s second enlistment noted a history of right inguinal hernia repair with no complications or recurrences.  At an evaluation by physical medicine and rehabilitation (PM&R) the CI complained of 4 weeks of right groin pain.  He reported a history persistent groin pain following a right inguinal herniorrhaphy during his first active duty period.  He rejoined the Army after a 15-month break in service.  The CI denied any problems during the intervening period but was on unemployment and did not work at all.  Intermittent sharp pain resumed with physical activity upon reentry into the Army.  Pain was exacerbated by any activity and valsalva maneuvers (forceful exhalation against a closed airway which increases intra-abdominal and intra-thoracic pressures).  The pain was described as “like my testicular is being pulled.”  The CI denied erectile dysfunction and bowel or bladder incontinence.  The physical exam revealed a normal circumcised phallus with a well healed scar over the right inguinal ligament region.  There was tenderness at the scar and the proximal right vas deferens (coiled duct that connects the testis with the urethra).  There was bulging in the right inguinal canal with valsalva.  Strength, sensation, and deep tendon reflexes were normal.  An electrodiagnostic study of the bilateral lateral femoral cutaneous nerves was interpreted as normal, with the caveat that the inguinal nerve cannot be studied.  An ultrasound or urology evaluation was recommended by PM&R.  At a general surgery evaluation, the CI reported a history of right inguinal pain following an inguinal hernia repair 2 years prior.  He complained of waxing and waning right inguinal pain with associated pain, tightness, and pulling of the right testis.  The CI reported an abdominal wall bulge but denied inguinal swelling, abdominal swelling, periumbilical pain, or radiation.  Pain was exacerbated by abdominal exercises, lifting, strenuous activity, and intercourse and gradually resolved on its own.  The physical exam revealed no abdominal hernia, no inguinal hernia, and a normal scrotum.  The assessment listed neuralgia (sharp and paroxysmal pain along nerve course) with post surgical right groin pain.  The surgeon performed an ilioinguinal nerve block by injecting steroid and local anesthetic.  At the general surgery follow-up, the CI reported no relief from the nerve block.  

The narrative summary (NARSUM) by general surgery, approximately 3 months before separation, recounted the history and interventions.  The NARSUM stated “at the time of his discharge he was having the groin pain, and he was fed up with the Army, and wanted to pursue other avenues.”  After a year of being unemployed, he returned to active duty service. The NARSUM further stated “about two weeks after returning to service, he noted that his right groin pain became so severe, that he was once again unable to work.”  Pain prevented him from wearing load-bearing equipment, wearing body armor, wearing constricting garments, heavy lifting, or participating in group physical training.  The CI was taking no medication, as the Motrin he had previously been taking provided no relief.  The physical exam was unremarkable and showed no evidence of a recurrent hernia.  An ultrasound showed no evidence of a hernia.  The diagnosis listed right groin neuralgia.  The surgeon documented that the right groin neuralgia existed prior to his most recent matriculation into the Army.  The hernia repair in his previous period of service did not relieve the groin pain and it recurred almost immediately upon resuming active duty.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB, a month before separation, rated the right groin condition 0%, coded 8799-8730.  The PEB cited right inguinal neuralgia, onset following right hernia repair during previous period of active duty, reenlisted and developed recurrent right groin pain, pain recurred in a period of weeks, pain due to increased physical activity, and pain not responsive to conservative therapy.  Two weeks after separation, the VA rated the right groin condition at 0%, coded 8799-8730, citing the Service medical records.  In support of this rating, the VA cited right inguinal neuralgia, residuals of right hernia repair, right inguinal hernia surgical repair in first period of service, and discharge from service and reentry for second period of service where the entrance exam noted the CI did not have any problems with right inguinal hernia repair.  The VA additionally cited that all tests revealed no hernia, no evidence of any recurrent hernia by physical exam and that the neuralgia resulted from hernia repair in first period of service.  This evidence resulted in the non-compensable evaluation for mild or moderate incomplete paralysis of the ilioinguinal nerve.  Peripheral neuralgia is usually characterized by dull and intermittent pain, of typical distribution so as to identify the nerve.  The neuralgia codes are rated based on an assessment of functional impairment expressed in terms of severity of paralysis.  The neuralgia code 8730 is limited to a maximum of moderately severe incomplete paralysis (§4.124) which is a 0% rating.  In multiple exams, the neuralgia findings were characterized as pain with no evidence of associated loss of reflexes, motor loss, or muscle atrophy.  Members agreed that findings did not approach severe incomplete paralysis, consistent with a 10% rating under code 8530 (ilioinguinal nerve, paralysis of).  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 right groin condition.

BOARD FINDINGS:  In the matter of the right groin condition and IAW VASRD §4.71a, 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 20140623, 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
(AH RC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160007996 (PD201403365)

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