RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00214
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070517

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Automated Logistics Specialist, medically separated for “left inguinal pain,” with a disability rating of 0%.

CI CONTENTION:  The CI requests consideration of all conditions.  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 – 20070214	VARD - 20070910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Inguinal Pain	8799-8730	0%	Residuals, Left Inguinal Herniorrhaphy	7338	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Inguinal Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI discovered a bulge in his left groin while in advanced individual training (AIT).  There was no pain associated with this self-reducing hernia (protrusion of organ or tissue through opening in surrounding walls).  A 5 November 2005 general surgery physical examination noted a left inguinal hernia (protrusion of abdominal cavity contents through inguinal canal).  On 12 December 2005, the CI underwent an open left inguinal hernia repair with mesh.  A postsurgical encounter by general surgery documented the CI “Is able to do all activities.  Still some mild soreness with situps but wants to take PT test this week to graduate AIT.”  The physical examination revealed a well healing left lower quadrant surgical/traumatic scar, no evidence of infection, and no inguinal hernia.  The surgeon opined “Doing well s/p LIH repair.  May return to activities as tolerated.  Still on PT at own pace profile but a PT test is the definition of PT at own pace so he may participate if he desires.”  The CI reported completing a physical readiness test (PRT) approximately 3-4 weeks postoperatively.  He complained that he began to experience pain in his left groin following the PRT.  A 27 June 2006 abdominal diagnostic imaging (ultrasound [US]) study showed no evidence of an inguinal hernia.  A 10 August 2006 abdominal X-ray was normal.  At a 31 October 2006 pain management encounter, the CI complained of chronic (>11 months) left inguinal/scrotal pain status post left inguinal herniorrhaphy (surgical hernia repair).  The examiner documented “Given symptomatology and chronicity of pain, could be entrapped nerve in scar tissue resulting in persistent irritation of nerve.  Multiple treatment modalities can be offered from Gabapentin (for neuropathic pain) to a spinal cord stimulator, and all treatments in between.  At this time, pt refuses treatment and desires to be medically separated from the Army.”  A 3 November 2006 general surgery follow-up documented “The patient reports that he is not interested in the treatments offered by the pain service and is also not interested in any further surgical procedures.”  The surgeon opined “This patient is exhibiting chronic pain of the left groin which can be attributed to nerve entrapment and scar tissue formation.”  In the 30 November 2006 general surgery MEB addendum, the CI complained of chronic, dull to stabbing, groin pain.  He reported associated radiation down his left thigh.  Pain was exacerbated by prolonged sitting, prolonged standing, minimal activity, and lifting.  “The patient was subsequently evaluated approximately 11 times by various health care providers for the same complaint of left groin pain.  In the General Surgery Clinic, the patient was evaluated by two separate general surgeons and there was no evidence of an inguinal hernia upon examination.”  The physical examination revealed a well-healed left groin scar, normal testicles, and tenderness to palpation throughout the groin region.  There was no evidence of inguinal hernia on Valsalva (forceful expiration with a closed glottis to increase intraabdominal and intrathoracic pressures).  The examiner recounted the findings of the abdominal US.  The diagnosis listed chronic left groin pain status post surgical repair of a left inguinal hernia.  The 20 January 2007 NARSUM, 4 months before separation, reported the CI had had left inguinal pain since an open left inguinal hernia repair.  The NARSUM incorporated the findings from a variety of sources and no physical examination was performed.  The author documented “Please refer to General Surgery addendum for full details of this condition. … REVIEW OF SYSTEMS Please see DD form 2807-1. … PHYSICAL EXAMINATION For full details see DD form 2808. … For more focused examination, please see the General Surgery addendum.”  The author recounted the findings of the abdominal X-ray and US.  The diagnosis listed left inguinal pain.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 8730 code (ilioinguinal nerve neuralgia) citing slight left inguinal pain following herniorrhaphy.  The VA assigned a 0% rating under the 7338 code (hernia, inguinal) based on STR and noted the CI did not report for two scheduled VA C&P examinations.  The VA cited history of left inguinal herniorrhaphy, slight left inguinal pain, chronic pain syndrome due to hernia and scrotal pain, and rated as a remediable hernia, or one which is small, reducible, or without true hernia protrusion.  Serial physical exams, and diagnostic imaging studies (US and X-ray), did not demonstrate a postoperative recurrence of the inguinal hernia.  Board members agreed that findings were concordant with small, reducible, or without true hernia protrusion, consistent with a 0% rating under 7388.  Findings were not concordant with postoperative recurrent, readily reducible and well supported by truss or belt, consistent with a 10% rating under 7388.  Peripheral neuralgia is usually characterized by dull and intermittent pain, of typical distribution so as to identify the nerve.  The neuralgia codes rate based on an assessment of functional impairment of the nerve involved expressed in terms of severity of paralysis.  The neuralgia code (8730) is limited to a maximum of moderate incomplete paralysis (§4.124) which is a 0% rating.  The Board majority agreed that findings were concordant with mild or moderate incomplete paralysis, consistent with a 0% rating under 8730.  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 left inguinal condition.  

BOARD FINDINGS:  In the matter of the left inguinal condition and IAW VASRD §4.124, the Board majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification of the assigned rating without re-characterization of the separation and did not elect to submit a minority opinion.  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 , 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 XXXXXXXXXXXXXXXXXXXXX, AR20160018539 (PD201500214)

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