RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01724
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080523

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Vehicle Operations Craftsman, medically separated for “meralgia paresthetica of right thigh,” with a disability rating of 10%.  

CI CONTENTION:  Due to being assigned to a base with limited medical care, he did not receive treatment for his conditions and was discharged.  The 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 - 20080312	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Meralgia Paresthetica of Right Thigh	8729	10%	No VA Examination in Evidence	
Gastroesophageal Reflux Disease	Cat II		
Ankle Osteoarthritis			
Degenerative Disc Disease			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Meralgia Paresthetica of Right Thigh.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s meralgia paresthetica of the right thigh began in 2005 after jumping out of a truck.  The MEB forwarded “back pain,” “meralgia paresthetica,” and “herniated lumbar disc/degenerative disease,” for PEB adjudication.  

The MEB NARSUM examination on 8 January 2008, 5 months prior to separation, noted a chief complaint of back pain.  History included right leg pain and numbness for 2 years and worsening low back pain for 1 year.  A neurology evaluation in August 2007 had diagnosed the CI’s persistent "pins and needles" and numbness feeling in his right anterior-lateral thigh as meralgia paresthetica.  The CI had gone on a physically demanding TDY and after 3 days was in moderate-severe pain in his back, and lower extremities and it took him about 2 weeks to recover.  

Physical examination performed by orthopedics on 18 December 2007 was referenced and showed complaints of back pain and right lateral quadriceps (thigh) tingling and numbness.  There was no back tenderness or spasm.  There was no lower extremity muscle atrophy or motor weakness, and reflexes were normal.  Peripheral nerves were normal except for sensory abnormalities at the lateral anterior quadriceps region consistent with the lateral cutaneous femoral nerve (decreased response to tactile stimulation, sharp and dull testing).  Diagnostic imaging of the back (including MRI) showed lumbar degenerative disk disease (DDD) with loss of disc space and a diffuse Bulge at L4-5 and at L5-S1 without obvious root impingement.  There was no VA Compensation and Pension examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right thigh meralgia paresthetica condition 10%, coded 8729 (external cutaneous nerve of thigh, neuralgia), citing discomfort from nerve impingement interfering with duty.  The CI’s right thigh meralgia Paresthetica was at the level of the external cutaneous nerve of thigh by specialists in neurology and orthopedics, and clinical examinations agreed that symptoms were not from the sciatic nerve or radiculopathy from the back.  The CI had no paralysis of the external cutaneous nerve of the thigh distribution, and no organic changes.  IAW VASRD §4.124 (neuralgia, cranial or peripheral) rating for neuralgia is for a maximum equal to moderate incomplete paralysis.  The 8729 rating for mild or moderate incomplete paralysis is 0%.  There was therefore no rating higher than 10% available for the condition.  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 right thigh meralgia paresthetica condition.  

Contended PEB Conditions.  The panel’s main charge is to assess the fairness of the PEB’s determination that degenerative disc disease [DDD - back pain, herniated lumbar disc], GERD [gastroesophageal reflux disease], and ankle osteoarthritis, were not unfitting.  The only condition(s) implicated in the profile or in the commander’s statement were related to the back pain and herniated lumbar disc/degenerative disease.  The CI’s DDD/back pain was implicated in both the profile and the commander’s statement as well as the NARSUM and clinical history.  There was difficulty separating the unfit pain components of the back from the unfitting meralgia paresthetica condition.  However, the back showed no painful motion, tenderness, spasm, or limited motion at the NARSUM exam (or referenced specialty evaluations), and even if adjudged to have been unfitting, would not rate higher than 0%.  There was no performance-based evidence from the record that the GERD or ankle conditions significantly interfered with satisfactory duty performance at separation.  

After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right thigh meralgia paresthetica condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended DDD, GERD and ankle osteoarthritis, conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

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

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01724.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings