RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-01336
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050803

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Cannon Crewmember, medically separated for “right groin pain status post hernia repair” with a disability rating of 0%.  

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 - 20050426	VARD - 20060731	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Groin Pain Status Post Hernia Repair	8799-8730	0%	Testicular Necrosis, and Erectile Dysfunction Residuals of Groin Injury, Status Post Surgery, and Infection	7522-7523	20%	20060506	
Hypogonadism	Not Unfitting 					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Right Groin Pain Status Post Hernia Repair.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a history of multiple hernia repairs from ages 1-13.  In January 2004, he was hit in the groin with a night stick during drills, and subsequently had a recurrence of his right femoral hernia.  He underwent right inguinal exploration in February 2004, right femoral hernia mesh repair and separation of his spermatic cords in April 2004, and right scrotal exploration surgery in May 2004.  

The 23 March 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of right inguinal pain and hypogonadism.  After the May 2004 surgery he developed an infection with resulting necrosis of both testicles that required him to receive weekly testosterone injection replacement. He suffered residual right groin pain that interfered with duty performance.  Physical examination showed tenderness in the right lower quadrant with invagination at previous fistula sites in the lower right abdomen.  Both testicles were absent. 

At the 6 May 2006 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported pain at the inguinal incision site that limited his ability to work.  The CI was working full-time as a heavy equipment operator.  He did not have any further recurrence of the hernia or of any infection.  Physical examination showed normal posture and gait.  Examination of the abdomen revealed a well-healed inguinal scar with depression of the skin at the area of the scar.  He was very tender over the incision site, and no hernia was present.  The right sided hemiscrotum was empty and there was no palpable testicle.  On the left he had a palpable testicle.  He had normal sensation and normal strength in his lower extremities and normal range of motion in all joints.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the groin condition 0%, analogously coded 8799-8730 (neuralgia), citing moderate pain following testicular hematoma with resultant testicular necrosis.  The VA rated the residuals of his groin injury condition; testicular necrosis, and erectile dysfunction at 20%, analogously coded 7522-7523 (penis, with loss of erectile power/testis, atrophy complete), based on the C&P examination, citing atrophy of both testes, causing them to be nonviable.  

The higher rating of 10% under the 8730 code is for severe to complete paralysis of the ilio-inguinal nerve.  There was no evidence of motor impairment or decreased sensory function.  The CI was working full-time after separation, but had reportedly missed a substantial amount of work.  The commander’s statement indicated that the CI should be found fit for duty.  Panel members agreed the evidence did not support the severe level of impairment.  The panel also noted that the condition is not compensable under 7338 (hernia, inguinal, postoperative recurrent) since there was no recurrence of the condition post-surgery during active duty.  There were no additional codes to consider for the condition.  After due deliberation, considering all 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 right groin pain status post hernia repair condition.  

Contended PEB Condition:  Hypogonadism.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Although the contended condition was profiled, it was not implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS: In the matter of the right groin pain status post hernia repair condition and IAW VASRD §4.115b and 4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hypogonadism condition, the panel agrees it cannot recommend it for additional disability rating.  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 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180007718, 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