RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00974
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040924

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “neuropathic pain, left thigh, due to interruption of lateral femoral cutaneous nerve” disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The 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 on 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 - 20040809	VARD - 20040928	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neuropathic Pain, Left Thigh…	8529	10%	Interruption of the Lateral Femoral Cutaneous Nerve, Left Thigh	8599-8529	10%	Service Treatment Record
(STR)	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Neuropathic Pain, Left Thigh.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left thigh condition began in April 2003 when he was struck by grenade fragments.  Although the wound was surgically explored and ultimately repaired, subsequent X-rays showed a very small particle of retained foreign body in the left anterior thigh.  The CI experienced continued left thigh pain, but treatment with medication and physical therapy (PT) did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “neuropathic pain syndrome…” for PEB adjudication.  

A neurologic evaluation on 7 January 2004 (9 months prior to separation) reported a complaint of pain in the left lower extremity with standing or running, or with touching the area of injury.  Pain was constantly present at a 2/10 level of severity, but increased to 6/10 with exacerbations.  Medication for neuropathic pain (Neurontin) resulted in some improvement.  Examination showed normal light touch sensation, but there was a patch of diminished sharp touch sensation around the surgical scar in the proximal anterior left thigh.  Lower extremity reflexes were normal.  There was subtle weakness of left hip flexion during part of the flexion arc.  An antalgic gait was present.  The examiner opined that neuropathic pain was present, and that subtle muscle weakness was likely not neurologic in origin, but related to pain.  There was little evidence of a femoral nerve or femoral cutaneous nerve neuropathy.  Subsequent electrodiagnostic testing was normal, confirming the examiner’s impression. 

At an outpatient appointment on 30 January 2004 (8 months prior to separation) the CI reported exertional leg pain that prevented running, but it was noted that he could pass an alternate fitness test.  Gait was observed to be normal.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 1 June 2004 (4 months prior to separation) the CI reported severe left thigh pain and that he sometimes had trouble walking.  He reported use of a cane.
   
The MEB NARSUM examination on 28 July 2004, 2 months prior to separation, noted complaints of constant left thigh pain that varied from moderate to marked in severity.  He had limited mobility due to the pain, and ambulated with a cane on occasion.  He took a medication for neuropathic pain.  Physical examination showed a moderately antalgic gait.  A well-healed 5 centimeter (cm.) long (approximately 2 inches) surgical scar was present in the left inguinal area.  There was a 2-3 cm. area of diminished light touch sensation around the scar.  Slight weakness of hip flexion was attributed to apprehension during hip motion.  Lower extremity strength was otherwise normal, and deep tendon reflexes were normal.  The examiner concluded that the neuropathic pain syndrome was likely due to disruption of the local cutaneous nerves surrounding the thigh wound.

At a 31 October 2004 VA Compensation and Pension (C&P) evaluation (1 month after separation) the CI reported ongoing pain after walking and sitting, which limited how much he could exercise.  He was not taking any medication.  At a VA primary care clinic appointment on 30 August 2005 (11 months after separation) the CI reported that he walked for 20-30 minutes per day.  At a VA clinic follow-up on 5 January Jan 2006 (15 months after separation) the CI reported “no current medical complaints…states leg pains occasionally.” He was taking no medication for leg pain, was currently employed and attending college, and planned on attending nursing school.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neuropathic left thigh pain condition 10%, coded 8529 (paralysis of external cutaneous nerve of thigh) while the VA also rated the condition 10% using the same code (analogized).  A 10% rating is the highest permitted under that code, and other nerve code options offered no advantage or were inapplicable.  The Board also considered a muscle disability code, 5314 (Group XIV. Function: anterior thigh group).  Under this code a “moderate” severity warrants a 10% rating while “moderately severe” is required for the 30% rating.  Board members agreed that “moderately severe” did not accurately describe the condition, thus the higher 30% rating was not warranted via this pathway.  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 thigh neuropathic pain condition.  

BOARD FINDINGS:  In the matter of the neuropathic pain, left thigh 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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005393, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure