RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
	
NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01311
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20030115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Marine, medically separated for “post-operative incisional pain, likely neuroma” with a disability rating of 10%.  

CI CONTENTION:  Contends his scar, pain and limited mobility.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20021121	VARD – 20110225	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Postoperative Incisional Pain, Likely Neuroma	8799-8719	10%	Residual, Scarring…Kidney Surgery	7804	10%	20101214
20021011	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Incision Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s postoperative incisional pain began after undergoing right kidney surgery in December 2001.  The right-handed CI had continued pain that interfered with sitting and ambulating despite treatment.  The MEB forwarded “postoperative incisional pain, likely neuroma” for PEB adjudication.  

The MEB NARSUM examination on 29 July 2002, 6 months prior to separation, noted complaints of persistent right flank incisional pain.  Physical examination showed point tenderness on the right flank (costovertebral angle) with pain on percussion.  There were no masses and the abdomen was soft and without organomegally.  The remainder of the examination was normal.  

At the 11 October 2002 VA Compensation and Pension (C&P) evaluation, performed 3 months before separation, the CI reported surgical scar pain with pulling and difficulty sitting or playing sports.  Physical exam showed the right flank with a 14 cm disfiguring scar that was depressed and moderately tender with hypersensitivity.  There was no evidence of neuroma.  Gait and posture were normal and there was no motor or sensory deficit documented.  

The 14 December 2010 VA C&P evaluation, performed over 8 years after separation, documented a 1 inch by 6 inches painful deep scar with no signs of skin breakdown.  The scar was painful to twist and bend trunk when turning to the right.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the incision pain condition 10%, analogously coded 8799-8719 (long thoracic nerve, neuralgia).  The VA also rated the incision/scar condition 10% effective 23 April 2010, coded 7804 (scar, unstable or painful), based on the VA C&P examination 8 years after separation, citing a painful superficial scar.  

The panel adjudged that the long thoracic nerve neuralgia was the best nerve coding analogy for the site of the scar and the CI’s disability picture.  There was no motor loss and IAW VASRD §4.124 (Neuralgia) rating is at a maximum equal to moderate incomplete paralysis; which is 10% as awarded by the PEB.  Alternative rating for the pain as a scar under VASRD 4.118 (Schedule of ratings—skin) IAW the 2003 VASRD code 7804 (Scars, superficial, painful on examination) has a maximum rating of 10% and would offer no benefit.  No dual rating was possible IAW the tenants of VASRD §4.14 (Avoidance of pyramiding).  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the postoperative incisional pain condition.

BOARD FINDINGS:  In the matter of the “postoperative incisional pain, likely neuroma” condition and IAW VASRD §4.118, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS

Subj: PHYSICIU. DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDAT IONS Ref:	(a) DoDI 6040.44
In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual's records not be corrected to reflect a change in either characterization of separation or in the disability
rating previously assigned by the Department of the Navy 's Physical Evaluation Board :

-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX, former USN
-            XXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXX,former USMC
-	XXXXXXXXXXXXXXXXXX,former USN