DEPARTMENT  OF  THE NAVY
. SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309 WASHINGTON NAVY YARD, DC 20374

IN   REPLY   REFER TO:
1850
CORB:003
20 Feb 20

From: To:

Subj: Ref:

Director, Secretary of the Navy Council of Review Boards 
PD-2016-01792

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 9 Oct 18

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the. Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2016-01792 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20040930

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Rifleman, medically separated for “persistent left 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 Medical Evaluation Board (MEB), but determined by the PEB 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. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20040615	VARD - 20041117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Groin Pain	8730	10%	Residual Ilioinguinal Nerve Damage	7338-8530	10%	20040708	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Left Groin Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a left inguinal hernia repair in May 2003. Approximately a month later, he started having pain around the surgical site that radiated to the left groin, but ultrasound and CT scans showed normal scar tissue, without evidence of infection, inflammation or neuroma (nerve growth/scarring due to surgery). After multiple injections to identify nerve involvement in the groin area, the ilioinguinal nerve was found to be primarily affected. Despite treatment with multiple pain medications, as well as radiofrequency nerve ablation, the CI’s pain continued.

The 16 March 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of groin pain. Physical examination showed tenderness around the surgical scar and decreased sensation along the distribution of L1 and L2, “though not clearly in the distribution of only the ilioinguinal nerve.” The CI was scheduled to have another treatment with radiofrequency. During the 1 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported his groin felt tight and painful to touch with numbness of the inner left thigh. Physical examination showed tenderness around the hernia repair site.  At a surgical follow-up visit on   7 July 2004, the CI was offered exploratory groin surgery to search for a cause (such as recurrent hernia or nerve entrapment) and solution to his ongoing pain and possibly allow him to stop taking narcotic pain medication.

At the 8 July 2004 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported abdominal pain and tenderness around the hernia incision site, medial thigh and groin region numbness, and groin pain when lifting the leg. Upon examination, the provider noted moderate tenderness, but no hernia. There was also increased sensation and tingling to light touch to the medial aspect of the thigh. On 9 July 2004, the CI underwent the recommended exploratory surgery and a recurrent left inguinal hernia was found and repaired with mesh. At surgical follow-up visits through September 2004, he reported some continued, but improved, pain from prior to surgery and much less along the course of the ilioinguinal nerve.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left groin condition 10%, coded 8730 (ilioinguinal nerve, neuralgia), citing persistent pain post left inguinal hernia repair. The VA rated residual ilioinguinal nerve damage 10%, dual coded 7338-8530 (inguinal hernia-ilioinguinal nerve, incomplete paralysis), based on the C&P examination, citing moderate tenderness and increased sensation and tingling to touch, without evidence of a recurrent hernia. Members noted that following the July 2004 left inguinal hernia repair, the CI continued to report pain, which was appropriate for his post-operative status. However, there was evidence of continued groin pain to support a 10% rating under 8730. There was no evidence of a recurrent hernia after the second surgery for a rating greater than 0% under 7338, and no higher than a 10% rating supported under any other applicable VASRD code. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left groin condition.

BOARD FINDINGS: In the matter of the left groin condition and IAW VASRD §4.124a the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends 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 20160910, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record	

2	PD-2016-01792