RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00463
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Postal Services Specialist, medically separated for “chronic left groin pain” with a disability rating of 0%.   

CI CONTENTION:  He was given a higher rating for his condition by the VA. 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 - 20061213	VARD - 20070921 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Groin Pain	7399-7338	0%	Bilateral Varicocele	7199-7120	0%	20070410	
Carpal Tunnel Syndrome	8799-8715	Cat II	Right Carpal Tunnel Syndrome (Dominant)	8599-8515	10%	20070410	
Severe Obesity, BMI 36.59	Cat III	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Left Groin Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left groin pain condition began in March 2005 after heavy lifting.  Numerous specialty evaluations failed to determine a cause of the pain.

The 15 October 2006 MEB NARSUM examination, 4 months prior to separation, noted a chief complaint of groin pain, left greater than right.   The pain was sometimes unbearable, even at rest.  During the 22 December 2006 separation physical, the CI reported that frequent narcotic medication was partially helpful for the left groin pain.  His current pain severity was characterized as 6/10 (moderate).  Examination noted he was in no acute distress.  At a physical medicine evaluation on 5 January 2007, 1 month prior to separation, the CI reported left groin and testicular pain that was “severe and constant.”  Physical examination showed the CI to be “in no acute distress.”  Gait was normal and hip flexion did not reproduce pain.  Resisted hip abduction and adduction likewise did not provoke pain.  There was tenderness of the groin area just above the scrotum.

At the 10 April 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported pain in the left groin and testicle.  The CI was being treated for a persistent abdominal wound after a recent appendectomy.  Physical examination showed a normal posture and gait.  No testicular tenderness or evidence of varicoceles (enlarged testicular veins) were present.  There was no inguinal hernia and no mention of groin tenderness.  Lower extremity sensation, strength and reflexes were normal.  The examiner concluded with a diagnosis of varicoceles (noted on ultrasound) that were not the cause of left groin pain.  At a second C&P examination on the same day, the CI reported 8-10/10 pain in the left groin.  Examination showed no hip joint tenderness.  Left hip flexion was 90 degrees (normal 125), adduction 25 degrees (normal 45) and abduction 45 degrees (normal).  Other hip motion parameters could not be assessed due to the unhealed abdominal wound, but painful motion was not present.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left groin pain condition 0%, analogously coded to 7338 (inguinal hernia).  The VA also rated the left groin pain condition 0%, analogously coded to 7120, (varicose veins), based on the C&P examination 2 months after separation.  The VA acknowledged the issue of evaluating the groin pain as a varicocele, but noted there was no identifiable cause of the groin pain and that pain alone (without an underlying cause) did not constitute a service-connected disability.  Rating as a varicocele was therefore favorable to the CI. 

In debating the appropriate coding and rating for the abdominal pain condition, panel members acknowledged that no code ideally described the condition and associated disability.  Under the PEB’s 7338 coding, the next higher 10% rating stipulates “postoperative recurrent, readily reducible and well supported by truss or belt.”  Since this requirement was not present, the higher rating was not warranted.  Higher ratings under the 7120 code require intermittent or persistent edema, which were not present.  The “asymptomatic palpable or visible varicose veins” stipulation of the 0% rating accurately depicted the condition via this pathway.  In deliberating other rating options, a 5003 coding approach (degenerative arthritis) was considered.  However the relevant joint (hip) did not display limited motion sufficient to warrant a 10% rating under the 5252 (thigh, limitation of flexion of) or 5253 (thigh, other impairment of) codes, and there was no painful motion evident to support a rating under §4.59.  

An analogous 8630 or 8730 code (neuritis or neuralgia of ilioinguinal nerve) was also considered.  A 10% rating requires “severe to complete paralysis.”  VASRD §4.123 states that the maximum rating which may be assigned for neuritis not characterized by organic changes will be that for moderate incomplete paralysis. VASRD §4.124a specifies that when peripheral nerve involvement is wholly sensory, the mild, or at most moderate, rating is applicable.  The panel determined the evidence at hand could not be reconciled with the 10% rating requirement via this pathway.  It was thus concluded there were no available VASRD-compliant options to a rating higher than 0%.  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 left groin pain condition.

Contended PEB Conditions:  Carpal Tunnel Syndrome and Severe Obesity.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting. The PEB determined the contended carpal tunnel syndrome condition was Category II, a condition that can be unfit, but is not compensable/ratable.  At the separation physical examination, the CI reported that carpal tunnel syndrome was “not currently bothering him.”  The carpal tunnel syndrome condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that it significantly interfered with satisfactory duty performance at separation.  The PEB determined the contended obesity was Category III, a condition that is not separately unfitting and not compensable; in fact, obesity is not a condition that constitutes a physical disability.  The panel therefore has no reasonable basis for recommending it as additionally unfitting for separation rating.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left groin pain condition and IAW VASRD §4.114, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended carpal tunnel syndrome and severe obesity conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160721, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00463.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings