RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02841
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20060406

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cargo Specialist, medically separated for “right groin pain” with a disability rating of 10%.  

CI CONTENTION:  He is in constant pain.  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 - 20060223	VARD - 20061019	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Groin Pain	5099-5003	10%	Right Inguinal Area Scar Associated with S/P Right Inguinal Hernia with Nerve Damage	7804	10%	20060726	
			S/P Right Inguinal Hernia with Nerve Damage	8599-8528	0%	20060726	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Right Groin Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right groin pain condition began in November 2000 with right groin pain and a lump without specific injury.  He underwent a right inguinal repair with mesh in March 2001.  In August 2004 the CI reported right inguinal pain that was sharp or stabbing, worse with activity and radiating to the scrotum.  An ultrasound showed no hernia during rest or application of the Valsalva maneuver (a forceful exhalation against a closed airway).  He underwent a right groin wound exploration with resection of iliohypogastric and ilioinguinal nerves in March 2005 since he failed conservative management.  During a surgical clinic visit in October 2005 the CI indicated his pain relief was short lived despite removal of the nerves (one of which was quite scarred into the mesh).  After doing some heavy lifting, he had recurrence of the pain, worse than before with pain shooting down his groin and inner right leg.  No surgical option was available.  

The 9 November 2005 MEB NARSUM examination, 5 months prior to separation, noted groin pain after hernia surgery.  Physical examination showed the abdomen was soft, nontender, and not distended.  Bowel sounds were normal.  There was a well-healed right lower quadrant incision which was tender along its length.  There was no recurrent inguinal hernia evidence, but inguinal canal tenderness was present.  The scrotum was not tender and the testicles were normal.  At the 26 July 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported he could not do any heavy lifting, but the pain did not affect his activities of daily living.  Current medications included gabapentin (for nerve pain) and Celexa (citalopram, an antidepressant).  Physical examination showed a gait within normal limits.  The abdomen was soft and nontender without hernias.  There was inguinal region tenderness without scrotal edema or tenderness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right groin pain condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing pain, frequent, moderate.  The VA rated the right groin pain condition 10%, coded 7804 (scar(s), unstable or painful), based on the C&P examination, citing a superficial scar that is painful on examination.  The VA also rated the status post right inguinal hernia with nerve damage condition 0%, analogously coded 8599-8528, (obturator nerve paralysis mild or moderate), citing a noncompensable evaluation is assigned for incomplete paralysis of the obturator nerve which is mild or moderate.  Panel members noted the CI had resection of iliohypogastric and ilioinguinal nerves.  Therefore, the use of code 8530 (ilioinguinal nerve, paralysis) or code 8730 (neuralgia) for a severe or complete disability at 10% is reasonable; however, the 10% rating offers no rating benefit to the CI.  Therefore, there was no higher rating option.  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 condition.

BOARD FINDINGS:  In the matter of the right groin pain condition and IAW VASRD §4.71a, 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 20170425, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008726, 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