RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2016-00253
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic groin pain”, with a disability rating of 20%.

CI CONTENTION:  “Condition is permanent.  Review all conditions”   The CI’s 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 - 20070307	VARD - 20071220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Groin Pain	5099-5003	20%	Residuals, S/P Right Inguinal Hernia Repair	7338-7804	10%	20070714	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  
Chronic Groin Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic groin condition began in February 2004 when he noticed a painless lump in his right groin. He experienced occasional pain with heavy lifting, but was able to tolerate it.  On a subsequent examination (5 year physical) an inguinal hernia was noted.  After general surgery unsuccessfully attempted to reduce the hernia, which had become painful, on 6 October 2005, the CI underwent a herniorrhaphy. 

The MEB NARSUM examination on 15 December 2006, 3 months prior to separation, noted complaints of right groin and testicular pain since the surgery.  He had nerve blocks, neurolysis and narcotic medications in attempts to resolve his pain.  Narcotic medications helped.   
Physical examination was within normal limits with the exception of tenderness in the right groin and decreased ROM in the right hip secondary to pain. The presence of a hernia was not appreciated.

At the 14 July VA Compensation and Pension (C&P) general medical evaluation, performed 4 months after separation, the CI reported he used a cane for walking due to foot pain.  Documentation of groin pain was absent.   Physical exam showed a normal gait, and absence of hernia.

During the VA C&P joint examination on 18 August 2007, 5 months after separation, the CI complained of right scrotal and incisional pain.  He reported that he had medications for his neuritis condition of the right groin which he took as needed.  Physical examination recorded a slightly antalgic gait and noted the surgical scar was mildly sensitive and tender to palpation.  There was no indication of infection or inflammation.  Lower extremity range of motion was recorded as “normal without painful limitation.”  The examiner noted hernia was absent, but that there was mild right inguinal hernia scar.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic groin pain condition 20%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy. The VA rated the chronic groin pain condition 10% analogously coded 7338-7804 (scars, superficial), based on the VA C&P examination 4 after separation, citing a scar that was painful on examination.

The panel considered code 7338 (inguinal hernia) and noted the condition did not meet the higher rating of 30% since there was no evidence of recurrent hernia.  The panel next considered code 8530 (illio-inguinal nerve) since the CI’s pain was associated with pain in the inguinal region; however, the highest achievable rating under this code is 10%.  There was no additional applicable nerve code that offered a rating higher than 10%.  The panel noted that codes 8630 or 8730 (neuritis, neuralgia) was compensable only to the 10% level.  The panel found no path to a higher 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 chronic right groin pain condition.   

BOARD FINDINGS:  In the matter of the chronic grain pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the Board’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 20160425, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170015191, 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