RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01786
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Satellite Communications System Operator/Maintainer, medically separated for “right groin and upper leg pain,” with a disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  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 - 20050907	VARD - 20060818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Groin and Upper Leg Pain	8726	20%	Neuralgia, Right Inguinal Nerve	8630	0%	20060410	
			Right Inguinal Hernia … Postoperative…with Painful Scar	7804	10%	20060403	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Groin and Upper Leg Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right groin and upper leg pain condition began in February 2003 after a step aerobics session for unit physical training.  Pain was intermittent and went down to the right great toe.  Diagnostic imaging (MRI) of the lumbar spine in June 2003 was read as normal with the exception of minimal central disk protrusion at L5-S1 with no significant mass effect.  The CI was found to have a right inguinal hernia which was surgically repaired.  Pelvic MRI in July 2005 found a left varicocele with no evidence of recurrent right hernia.  There was no further surgical option and although activity restriction decreased the pain, physical therapy (and/or nerve ablation) led to the addition of paresthesias (abnormal sensations with skin friction).  The MEB forwarded “right anterior femoral cutaneous neuropathy” and “right>left neuropraxia” for PEB adjudication.  

The 12 July 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of right groin pain and upper leg pain (“with occasional and much milder left groin pain as well”).  The general physical examination done on 13 May 2005 was reported as essentially normal with the exception of the herniorrhaphy scar.  The physician referenced the September 2004 neurologist’s and January 2005 Physiatrist examinations the diagnoses of right anterior femoral cutaneous nerve neuropathy with dysesthesias (possibly due to entrapment) and right greater than left femoral neuropraxia respectively.  

The 12 July 2005 Neurology examination, 5 months prior to separation, noted complaints of electrical sensations and sharp shooting pains in the right mid groin (femoral nerve area), with paresthesias of the right upper leg.  Examination showed an antalgic gait to the right with normal heel and toe walking.  There was weakness (4+/5) of both thighs due to pain on adduction with no muscle atrophy.  Manual motor testing was otherwise normal.  Sensory exam showed decreased sensation to areas on both thighs.  There was painful paresthesias on Tinel’s testing of the bilateral femoral nerves.  Electrodiagnostic testing (EMG/NCV) on the right was normal, however the neurologist indicated the clinical and NCV testing suggested (femoral) nerve axonal damage.  The diagnosis was neuralgia.  

At the 3 April 2006 VA General Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported right femoral neuropraxia pain that markedly affected his physical activities, and hernia scar sensitivity.  Physical examination showed a 7cm right inguinal herniorrhaphy scar that was thin and well healed.  There was tenderness beginning at about the area of the inguinal scar but was more marked below the scar with significant tenderness.  Genital examination was normal except for sensitivity to finger probe of the right inguinal ring area.  Ultrasound of the abdomen and pelvis were normal.  

At the 10 April 2006 Neurology C&P evaluation, performed 4 months after separation, the CI reported right leg pain.  The CI related decreased activity with current pain once a week lasting 2-5 minutes.  Physical exam showed normal gait with no muscle atrophy.  The CI could stand on heels and toes and deep knee bend without difficulty.  Motor strength, reflexes, and sensory testing were normal.  There was a well healed scar over the right inguinal area with diffuse tenderness to palpation in the right inguinal area.  The examiner stated “I am unable to define neurologic condition to explain this patient's symptomatology.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB combined the “right anterior femoral cutaneous neuropathy” and “right>left neuropraxia” conditions as a single unfitting condition of “right groin and upper leg pain” coded 8726 (anterior crural nerve [femoral]; neuralgia) and rated 20%, citing intermittent, pain with opioid and non-opioid medications.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

The VA rated the right groin and upper leg pain condition 0% coded 8630 (ilio-inguinal nerve; neuritis), based on the C&P examination 4 months after separation, citing incomplete paralysis of the ilio-inguinal nerve which is mild or moderate.  The VA also rated the CI’s painful hernia repair scar condition 10% coded 7804 (scars, superficial, painful on examination) based on the examination 3 months after separation.  

The panel first considered if the left neuropraxia, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The panel could not find evidence in the profile or commander’s statement that indicated any significant interference of the left leg neuropraxia with the performance of duties, nor were any physical findings documented by the MEB or VA examiners which would logically be associated with significant disability.  Therefore, the panel concluded that the preponderance of evidence showed the left neuropraxia condition would not reasonably have caused the CI to be referred into the DES or be found unfit due to the left neuropraxia condition.  The right neuropraxia and right anterior femoral cutaneous neuropathy are related conditions and the right neuropraxia is properly subsumed under the overall rating.  The panel considered the NARSUM and specialist’s evaluations had the highest probative value for rating at separation and that there was likely post-separation improvement by the time of the C&P examinations.  

The STR and specialists’ evaluations clearly identified the nerve level as the femoral nerve [anterior crural nerve], and as a neuritis.  There was no muscle paralysis and no evidence of organic changes and therefore IAW VASRD §4.123 (neuritis), the maximum rating is that for moderate incomplete paralysis, which is the 20% as awarded by the PEB.  There was no recurrent inguinal hernia for alternative rating under code 7338 (hernia, inguinal), and no evidence of an unfitting tender scar for additional rating.  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 groin and upper leg pain condition.  

BOARD FINDINGS:  In the matter of the right groin and upper leg pain condition and IAW VASRD §4.124a, 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009067, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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