RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00301
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051230

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard O2, Chemical Officer, medically separated for “meralgia paraesthetica not responsive to gabapentin” with a disability rating of 0%.

CI CONTENTION:  The CI contends that he was rushed through the disability evaluation system before his treatment was finished and said: “Please 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 - 20051214	VARD - 20060419	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Meralgia Paraesthetica 	8729	0%	Meralgia Paraesthetica, R Hip	8599-8526	10%	20051128	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Meralgia Paraesthetica.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first noted tingling in his right anterior thigh in November 2004.  His symptoms persisted and the diagnosis of meralgia paresthetica (sensory changes in the distribution of the lateral femoral cutaneous nerve due to compression) was made.  The physical examination was unremarkable other than decreased and abnormal sensation in the anterior lateral thigh (the distribution of the nerve) on the left.  He was begun on medications and also had injections and radio-frequency ablation, but his symptoms persisted and were aggravated by running and the wear of body armor.  An MRI of the lumbar spine and X-rays of the hips were negative for pathology.  
During the 29 September 2005 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation, the CI reported persistent symptoms.  On examination, the sensory changes noted above were present.  Atrophy was absent and the motor function was (implied) normal.  The 3 October 2005 MEB NARSUM examination, 2 months prior to separation, noted the above persistent sensory changes.  The motor function, reflexes, and gait were normal.  At the 28 November 2005 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported persistent symptoms which limited strenuous activities, but had not resulted in lost time from work.  The neurological examination was unchanged from above.  X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the meralgia paresthetica condition 0%, coded 8729 (neuralgia of the external cutaneous nerve of the thigh) noting no response to treatment.  The VA rated the meralgia paresthetica condition 10%, coded 8599-8526 (analogous to mild paralysis of the anterior femoral nerve), based on the C&P examination 1 month prior to separation.  The panel observed that meralgia paresthetica involves the lateral femoral cutaneous nerve which is a separate nerve from the anterior femoral nerve.  The panel determined that the 8729 code used by the PEB more accurately described the condition.  The panel considered the evidence.  Sensory abnormalities were consistent between examinations and persistent for over a year despite treatment.  Neuralgia is characterized by pain, but not by muscle atrophy or loss of reflexes which are found in neuritis.  Regardless, both are limited to a maximum rating at the moderate level of severity.  While the code 8526 supported a rating of 10% for mild symptoms or 20% for moderate symptoms, it is a less accurate code than 8729 which supported a 0% 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 meralgia paresthetica condition.  

BOARD FINDINGS:  In the matter of the meralgia paresthetica condition and IAW VASRD§4.124 and §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 20160520, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015257, 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