RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02590
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20021004

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Officer Candidate, medically separated for “chronic pain after redo right inguinal hernia repair,” 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 - 20020910	VARD - 20030321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain…Right Inguinal Hernia Repair	8730	10%	Right Inguinal Hernia Repair with Nerve Entrapment and Tender Scar	8730-7338	10%	20021118	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Pain after Redo Right Inguinal Hernia Repair.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right inguinal hernia repair in 1995.  In July 2001, the CI experienced right lower quadrant (RLQ) pain at officer candidate school and underwent a redo right hernia repair on 24 July 2001.  The CI continued to have RLQ pain without evidence of a recurrent hernia.  Ilioinguinal nerve blocks provided temporary relief, and the CI reasonably refused radiofrequency nerve ablation.  Despite further treatment, the CI’s condition did not improve sufficiently to complete training.  The MEB forwarded “chronic pain after redo right inguinal hernia repair” for PEB adjudication.

The MEB NARSUM examination on 14 August 2002, 2 months prior to separation, noted complaints of RLQ pain (exacerbated by abdominal exercises).  Physical examination showed slight tenderness to palpation over the RLQ at the site of the scar.  The scar was well healed.  There was no sensory deficit and motor strength was normal.

At the 18 November 2002 VA Compensation and Pension (C&P) evaluations, performed a month after separation, the CI reported daily right groin discomfort, intermittent, aggravated by activities, and better on Neurontin.  Physical examination showed a normal abdominal examination.  There were bilateral inguinal scars with an otherwise normal genital/rectal examination.  “Pressure over well healed scar causes pain into right genitofemoralis and ilioinguinal nerve distribution.”  The diagnoses were ilioinguinal nerve entrapment post operatively (general examination) and right genitofemoralis/ilioinguinal nerve damage secondary to herniorrhaphy (peripheral nerve exam).  The CI underwent a right groin exploration in May 2003 (7 months after separation) with no indication of either recurrent direct or indirect inguinal hernia.  There was entrapment of the ilioinguinal and genital nerves by sutures and mesh plug which were removed.  The hernia following removal of sutures/mesh was repaired with new mesh.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right inguinal hernia condition 10%, coded 8730 (ilio-inguinal nerve neuralgia).  The VA also rated the right inguinal hernia condition 10%, analogously coded 8730-7338 (ilio-inguinal nerve neuralgia – hernia, inguinal), based on the C&P examinations a month after separation, citing status-post right inguinal hernia repair, right groin pain and burning.  The 10% rating awarded by the PEB is the highest rating available under code 8730.  There was no evidence of any recurrent hernia (following the redo surgery in 2001) for any higher alternative rating under code 7338.  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 pain after redo right inguinal hernia repair condition.

BOARD FINDINGS:  In the matter of the chronic pain after redo right inguinal hernia repair 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151222, 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:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 26 Apr 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						                				(Manpower & Reserve Affairs)