RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00349
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic right inguinal pain,” with a disability rating of 0%.

CI CONTENTION:  “Review 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 - 20070615	VARD - 20080530	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Inguinal Pain	8799-8730	0%	Condition to Account for Groin Pain	7399-7338	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Right Inguinal Pain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic right inguinal pain condition began in August 2006 after carrying a fellow soldier in a fireman’s carry during Basic Training.  A large right inguinal hernia that was reducible was diagnosed, and the CI underwent surgical repair using mesh and a patch on 20 September 2006.  After physical therapy and rehabilitation, the CI returned to training and noted a sudden onset of right groin pain during a fireman’s carry around 4 days prior to a visit on 23 January 2007; however, no mass or lump was noted by examination or ultrasound. Treatment consisted of naproxen (a nonsteroidal anti-inflammatory drug) and rest.  On 13 March 2007, a trial injection of a steroid/anesthetic combination in the area of the right ilioinguinal nerve provided no relief.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right inguinal pain residual neuralgia [from] a right inguinal hernia repair with mesh and patch” for PEB adjudication.  

At the MEB examination on 28 March 2007, 3 months prior to separation, the CI reported he had a right inguinal hernia corrected surgically.  Physical examination revealed a scar right inguinal hernia with palpable mesh and anesthesia medial to the scar.  The MEB NARSUM examination on 17 May 2007, 1 month prior to separation, noted pain in the right groin after the hernia repair not relieved by medication.  Physical examination showed no recurrent hernia, but there was a 7 cm scar in the right inguinal crease with point tenderness over the CI’s mesh plug with some movement.  There was no shooting pain to either the thigh or scrotum. There was direct tenderness to palpitation over the deep ring and the mesh plug was faintly palpable in the very thin CI.  There was also an area of anesthesia extending from the lower medial edge of his scar about 6 cm medially and distally in the upper thigh secondary to cutaneous nerve laceration from the surgery.  The CI failed to report to a scheduled VA Compensation and Pension (C&P) examination on 1 April 2008.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 0% rating using an analogous 8799-8730 code (mild or moderate neuralgia ilio-inguinal nerve), citing “chronic right inguinal pain, following hernia repair” and “rated as mild.” The VA denied service-connection for the groin pain, citing the CI failed to report to a required examination and no evidence of a disability condition.  Board members considered whether the pain (neuralgia) rose to a level equivalent to a severe to complete paralysis of the ilio-inguinal nerve, but such was not the case since the neuralgia was centered in the vicinity of the deep ring and mesh and did not radiate.  Since there was no hernia on examination and ultrasound, the use of code 7338 for rating purposes was not applicable.  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 right inguinal pain following hernia repair condition.  

BOARD FINDINGS:  In the matter of the chronic right inguinal pain following 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 20150526, w/attachments
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

20 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018689 (PD201500349)

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