RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01515
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Cardiac Catheter Technician, medically separated for “intermittent left lateral thigh pain,” with a disability rating of 0%. 

CI CONTENTION: The CI’s daily activities continue to be affected by his condition. His 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 - 20041028	VARD - 20050104 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intermittent Left Lateral Thigh Pain, Meralgia Paresthetica	8729	0%	Chronic Left Femoral Cutaneous Nerve Meralgia	8729	0%	20041027	
			Chronic Left Hip Condition	5255	NSC	20041027	
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Left Thigh.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), beginning 24 January 2003 the CI complained of pain, numbness, and tingling of the left lateral thigh with activity and at night for 6 months.  The CI wore a lead apron in a catheterization laboratory, which constantly rubbed and pressed down on his left thigh, although there was no swelling or discoloration.  Motrin (a nonsteroidal anti-inflammatory drug (NSAID)) was prescribed.  Electrodiagnostic studies performed on 24 February 2003 noted that the left lateral femoral cutaneous nerve was “unobtainable,” although the right was normal.  A note in March 2003 indicated the a physical medicine and rehabilitation (PM&R) specialist diagnosed the CI’s condition as femoral cutaneous neuropathy with symptoms of burning of the left thigh with prolonged sitting or standing and noted the CI had a left hip dislocation in 1997 secondary to a motor vehicle accident.  Gabapentin (for nerve pain) was prescribed.  In April 2003 the CI reported the pain was worse when bending over and with sit-ups.  On examination, both legs had full range of motion (ROM) and normal strength without motor or sensory deficits.  In July 2003 he was issued a sick slip for 30 days that precluded running, jumping, marching, and carrying or wearing a ruck sack, load-bearing equipment; and a pistol belt and the gabapentin for numbness of the foot was discontinued.  A follow-up sick slip limited standing more than 20 minutes without a 5-minute rest.  The CI then began to complain he could not walk, run, or do anything that required hip flexion, although examination of the hip was normal.  No lesion was seen on X-rays of the left hip.  Follow-up evaluation noted that as a result of the hip pain, he experienced lower back and left knee pain.  There was decreased sensation to light touch in an area about 10 x 15 cm at the superior left lateral upper leg.  Basic lab results were normal.  A neurology examination on 30 July 2003 was unremarkable except for slight hyporeflexia at the left knee and ankle.  Meralgia paresthetica was considered the most likely diagnosis, but there was a question about the etiology and persistence of symptoms.  Further laboratory studies were ordered and an anesthesia consult was considered.  Physical therapy was instituted in August 2003.  An MRI of the hips in September 2003 was normal as was an MRI of the left femur.  Neurologic evaluation in May 2004 noted a decreased response to pain and temperature stimulation on the lateral upper aspect of the left thigh, but it was not decreased to tactile stimulation or vibration.  Muscle bulk was normal as was strength, gait and stance.  The neurologist recommended that since the condition was painful only with hip flexion, the gabapentin should be discontinued.  Electrodiagnostic studies in August 2004 revealed electrophysiologic evidence consistent with a left-sided meralgia paresthetica.  ROM measurements of the left hip on 31 August 2004 are in the chart below.  No pain was noted.  The left thigh measured 58.5 cm, 1.5 cm greater than the right thigh, and the calf was 43.0 cm, 0.5 cm greater than the right calf.  X-rays of the left hip, left femur, and lumbosacral spine were unremarkable in October 2004.

During the MEB examination (recorded on DD Forms 2807 and 2808) dated June 2004, 6 months prior to separation, the CI reported his left leg was numb and he had limited use of the left leg, while the examiner noted that the CI claimed numbness of the left anterior/lateral thigh.  The MEB NARSUM examination also dated June 2004, 6 months pre-separation, documented the normal workup and no response to multiple medications.  The CI described his pain of the left lateral thigh as coming on rather quickly after walking about a half a mile, and resolving quickly when he stopped.  The pain was aggravated when he wore a heavy load, did physical training, or walked too fast or too far and likewise resolved when he stopped.  The author opined it “clearly has been a strange sort of phenomenon but appeared to have stabilized over the past 2 years and to a somewhat of a predictable pattern . . . unable to determine a particular cause . . . finally described as a left lateral cutaneous nerve palsy.”  ROM measurements are in the chart below.  There was no tenderness over the greater trochanter; the Thomas test (to rule out hip flexion contractures) was negative; there was no pain on internal or external hip rotation; motor strength was normal; and there was no groin lymphadenopathy or tenderness.

A permanent L3 profile was issued in July 2004 for left hip pain with limitations of moving with a fighting load and no physical fitness testing.  Additionally the CI was precluded from lifting more than 100 pounds, was limited to marching to tolerance, and had to be allowed to move around to seek a position of comfort.  The commander’s statement dated 19 October 2004 indicated the CI was physically capable of reasonably performing his clinical duties in a garrison environment despite hip pain, but was not able to move with a fighting load for more than 2 miles, a consideration should he be deployed.

At the VA Compensation and Pension (C&P) general examination 27 October 2004, 2 months prior to separation, the CI noted the condition existed for 18 months and occurred from wearing a lead “skirt” (apron) for his job.  Symptoms were intermittent with certain activities and resolved with their cessation.  He had an inability to run or jump, or sit greater than an hour, but the condition did not result in any time lost from work.  Gait was normal and leg length was 100 cm bilaterally.  Examination of the left and right femurs was normal and there was no joint involvement or use of assistive device for ambulation.  ROM measurements of the hip are in the chart below and the ROMs were not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination.

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Hip (Thigh) ROM
(Degrees)	NARSUM
~5 Mo. Pre-Sep	NARSUM Addendum
~4 Mo. Pre-Sep	VA C&P
~2 Mo. Pre-Sep	
Flexion (125 Normal)	120	117	125	
Extension (20)	20	20	30	
External Rotation (45)	30	30	60	
Abduction (0-45)	45	45	45	
Adduction (45)	25	30	25	
Comment	No tenderness over the greater trochanter, negative Thomas test, no pain with internal or external hip rotation, motor strength normal	“Average of 3 trials”; left hip began to “tingle” with repetition 	DeLuca negative	
§4.71a Rating	PEB 0%	PEB did not reference	VA 0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating using code 8729 (external cutaneous nerve of thigh, neuralgia, rated as moderate) for intermittent left lateral thigh pain, meralgia paresthetica.  The VA also assigned a 0% rating using code 8729 for chronic left femoral cutaneous nerve meralgia paresthetica neuritis.  The Board sought a route to a higher rating, but the pain did not rise to a 10% rating, which requires severe to complete neuralgia. The Board considered application one of the VASRD codes between 5250 and 5255, which are used for ankylosis, limitation of ROMs, a flail joint of the hip, or femur impairment, but the CI manifested no condition to warrant a rating with those codes.  However, although the CI did not have full ROMs, there was no reported pain on motion of the hip joint, but there was pain in the left thigh when the hip moved in certain positions.  Therefore, the Board considered use of code (8729-)5099-5003 to address the pain as a result of hip joint movement, which would afford a 10% rating IAW VASRD §4.59 (painful motion).  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 intermittent left lateral thigh pain, meralgia paresthetica condition.

BOARD FINDINGS:  In the matter of the intermittent left lateral thigh pain, meralgia paresthetica condition, the Board unanimously recommends a disability rating of 10%, coded (8729-)5099-5003 IAW VASRD §4.124a and VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board therefore recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Intermittent Left Lateral Thigh Pain, Meralgia Paresthetica 	(8729)5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160014802 (PD201501515)

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.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA