RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03526
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Combat Engineer, medically separated for chronic right groin pain, with a disability rating of 0%.

CI CONTENTION:  “Request VA Records please all my medical history has been documented through them from my medical board till July 2014.”   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 based upon a 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 –20051129	VARD - 20060406	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Groin Pain…	8799-8730	0%	Scars (Status Post Appendectomy, Status Post Inguinal and Status Post Umbilical Herniorrhaphy)	7805	05	20060215	
Mild Post-Traumatic Stress Disorder with Associated Insomnia	Not Unfitting	PTSD (Post Traumatic Stress Disorder)	9411	30%	20060215	
History of Elevated Blood Pressure	Not Unfitting	Hypertension	7101	NSC	20060215	
Pes Planus-Moderate/Asymptomatic	Not Unfitting	Pes Planus (Bilateral)	5276	0%	20060228	
Combined RATING:  0%	Combined RATING Of All Va Conditions:  40%	

ANALYSIS SUMMARY:  

Chronic Right Groin Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right groin condition began in February 2004 after heavy lifting ammo cases.  The CI was diagnosed with an inguinal hernia.  He underwent surgical repair in May 2004, but had persistent pain after surgery.  He underwent right ilioinguinal nerve resection in June 2004 without significant relief of the groin pain.  In December 2004, following return from deployment the CI was evaluated for persistent groin pain and underwent a diagnostic laparascopy in January 2005.  At that time it was noted that the mesh used to repair the hernia had eroded through the peritoneum and created peritoneal adhesions.  The appendix was scarred down and the appendix was red and distended.  There was no evidence of any new or recurrent hernia and the appendix was removed.  After the appendectomy, the CI continued to report constant burning groin pain despite further non-operative treatment.  The MEB forwarded “chronic right groin pain” for PEB adjudication.  

At the MEB examination dated 14 November 2005, 2 months prior to separation, the CI reported constant dull ache in the right groin aggravated by pressure, certain sitting positions, and prolonged walking or standing.  Physical exam showed a well-healed surgical scar.  There was tenderness to palpation in the right groin and mild testicular pain on exam. At the MEB NARSUM examination, also performed on 14 November 2005, the CI reported chronic baseline pain graded 6/10, increased by any activity to 10/10.  The MEB NARSUM cited an examination performed on 6 July 2005 which noted the same findings as the MEB examination.  In October 2005, the CI reported 2 weeks increased groin pain and ultrasound was performed but showed no evidence of a hernia.

At the 15 February 2006  VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported he was doing fine and had no symptoms related to his right groin condition.  Physical exam showed normal abdominal and genital examinations.  Under a separate VA C&P Scars examination, the VA examiner noted that all the right groin surgical scars had healed well and there were no symptoms related to the scars.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right groin pain condition 0%, coded analogous to 8730 (ilioinguinal nerve) citing a moderate condition.  The VA also rated the groin condition 0% coded 7805 (other scars), based on the VA C&P examination 2 months after separation, citing no disfigurement or limitation of function.  The Board agreed that coded IAW VASRD §4.124a (neurological disorders), no higher than a 10% rating was supported under code 8730 for complete paralysis of the ilioinguinal nerve, which was resected in the second surgery.  The CI’s chronic pain after the hernia repair was likely related to the mesh perforating the peritoneum and causing adhesions.  However, utilizing the code for peritoneal adhesions (7301) IAW VASRD §4.14 (digestive system) results in no higher than a 10% rating for “moderate; pulling pain on attempting work or aggravated by movements of the body.”  The next higher rating with this code requires evidence of partial bowel obstruction not present in this case.  The inguinal hernia code (7338) requires evidence of a recurrent hernia for a 10% rating.  Moreover, shortly after separation at the C&P examination, the CI reported all pain symptoms related to the groin condition had resolved and no functional limitations were noted related to the scars.  There was therefore no higher rating than 10% available for the complete paralysis of the ilioinguinal nerve.  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 condition, coded 8799-8730.  

Contended PEB Conditions:  Mild Post-traumatic Stress Disorder, History of Elevated Blood Pressure and Pes Planus Moderate/Asymptomatic.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic right groin pain condition, the Board unanimously recommends a disability rating of 10%, coded 8799-8730 IAW VASRD §4.124a.  In the matters of the contended mild post-traumatic stress disorder, history of elevated blood pressure and pes planus moderate/asymptomatic conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Groin Pain 	8799-8730	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, undated, w/atchs
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 
XXXXXXXXXXXXXXXXXX, AR20160017502 (PD201403526)

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 rating to 10% without 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.

CF: 
(  ) DoD PDBR
(  ) DVA