RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02481
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Parachute Rigger, medically separated for “chronic bilateral groin pain” with a disability rating of 10%.  

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 - 20050727	VARD - 20051216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Groin Pain	5099-5003	10%	Left Inguinal Lymphadenopathy	7819	0%	20050824	
			Right Groin Pain	5314	NSC	20050824	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Bilateral Groin Pain.  The PEB combined the left and right groin pain conditions as a single unfitting condition coded 5099-5033 (analogous to arthritis, degenerative) and rated 10%.  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 disability evaluation system (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 evidence for the left and right groin pain conditions are presented separately, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

Left Groin Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left groin pain began in January 2004 during airborne training after a hard landing.  The CI was referred to general surgery over concerns of a possible left inguinal hernia.  At the 2 August 2004 general surgery evaluation, 15 months prior to separation, the CI related a 1-month history of left groin pain.  Physical examination revealed normal testes without mass and no inguinal hernia.  The surgeon ordered an ultrasound of the left groin which only showed mildly enlarged lymph nodes.  A bone scan ruled out a pelvic stress fracture as the cause of the pain.  

During a 19 April 2005 general surgery clinic appointment, 5 months prior to separation, the CI complained of left scrotal pain that was not exacerbated by activity but by jumping.  The examiner noted the pain was in the upper scrotum along the spermatic cord.  

At the 27 April 2005 urology evaluation, 5 months prior to separation, the CI complained of left inguinal (groin) pain that was present every day that was sometimes minimal and other times made it difficult to do PT and aspects of his job.  Physical examination found no mass or tenderness in the abdomen, groin, scrotum or the testicles.  

At the 5 July 2005 MEB NARSUM examination, 4 months prior to separation, physical examination showed the abdomen was soft, non-tender with normal bowel sounds and no palpable masses.  The groin area was without redness, swelling or masses.  There was tenderness of the inguinal ring (deep in the groin) bilaterally with the left being greater than the right.  

At the 24 August 2005 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported a previous history of a sharp pain to the inguinal region (does not specify side) that did not interfere with his posture, gait, activities of daily living, bowel or bladder functions or sexual function.  Physical examination showed a soft abdomen with no enlarged organs or tenderness.  No scars, abnormal blood vessels or hernias were found.  The testicles and epididymes were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral groin condition 10%, coded 5099-5003 (analogous to arthritis, degenerative), citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left groin condition 0% coded 7819 (benign skin neoplasms), based on the VA C&P examination 2 months before separation, citing no pathology of a chronic bilateral groin condition.  

The panel first considered if the left groin pain, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  All of the visits to various clinics for groin pain were found to be for the left sided groin pain with no mention of right.  Panel members agreed that the preponderance of the evidence indicates the left groin pain was unfitting for continued service.  The panel considered using the code for ilio-inguianl nerve neuritis (8630).  However, IAW §4.123 the maximum rating which may be assigned for neuritis not characterized by organic changes will be that of moderate which is 0%.  The panel further noted that the CI had not had an operation to correct an inguinal hernia (7338).  In the matter of the left groin condition, the panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  

Right Groin Pain.  The panel then considered if the right groin pain, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The panel found no mention of right sided scrotum, inguinal, or abdominal pain in any of the available clinic notes.  The only mention of tenderness to the right inguinal area is a single mention in the MEB NARSUM.  The panel members concluded that the preponderance of evidence showed that the right inguinal pain condition would not reasonably have caused the CI to be referred into the DES or be found unfit due to the right inguinal condition; therefore, the panel cannot recommend a separate disability rating for the right groin 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 chronic bilateral groin pain condition.  

BOARD FINDINGS:  In the matter of the chronic bilateral groin pain condition, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20151010, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20170013251, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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