RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03336
BRANCH OF SERVICE:  aRMY	SEPARATION DATE:  20060830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Infantryman, medically separated for “neuropathic pain left groin” with a disability rating of 10%.  

CI CONTENTION:  Neuropathic pain should have been combat-related and the evidence supports a higher rating.  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 - 20060728	VARD - 20061031	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neuropathic Pain, Left Groin	8799-8730	10%	Left Neuropathic Groin Pain…	8730-8530	10%	20060814	
Hypertension	Not Unfitting	Hypertension	7101	0%	20060814	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Left Groin Neuropathic Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left direct inguinal hernia repair (plug and patch) on 1 June 2005 complicated by a hematoma, and underwent a second left inguinal surgery for complication of pain and bleeding under the mesh repair.  He was hospitalized for six days and following surgery had chronic left groin pain.  The CI had left inguinal pain exacerbation in May 2006, while deployed, and was medically evacuated from theater.  A genitofemoral nerve block completely eliminated the pain for 24 hours and the CI was diagnosed with neuralgia and nerve entrapment left groin.  
During the 8 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported chronic left groin pain with intermittent radiation to the scrotal area, or rectum, or left thigh.  Physical examination revealed left groin (inguinal) tenderness with pain elicited by left lower extremity and back motions.  There was scrotal tenderness.  The diagnosis was neuropathic pain syndrome.  

The 14 July 2006 MEB NARSUM neurology examination, 2 months prior to separation, noted complaints of chronic pain, intractable to multiple therapies including two drugs for neuropathic pain as well as narcotics.  Physical examination showed a normal gait.  Motor, sensory, and reflex testing were normal.  The neurologist diagnosed neuropathic pain and noted the main involvement was the left genitofemoral nerve, with possible posterior scrotal nerve involvement in the complex regional neuralgia-like pain syndrome.  

The 14 August 2006 VA Compensation and Pension (C&P) general examination, less than 1 month before separation, noted complaints of left inguinal scar and pain which was 4/10 and increased to 10/10 twice per week with normal activities, and decreased with Percocet (narcotic pain medication).  Physical examination showed normal posture and gait.  There was a tender postoperative scar in the left inguinal area and there was tenderness in the left inguinal area.  A right inguinal hernia was noted without indication of any left inguinal recurrent hernia.  Neurologic and motor examinations were normal.  The diagnosis was left inguinal hernia postoperative with left neuropathic groin pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left groin pain condition 10%, analogously coded 8799-8730 (neuralgia of ilio-inguinal nerve), citing “rated as severe incomplete paralysis.”  The VA also rated the left groin pain condition 10%, coded 8730-8530 (neuralgia – paralysis of the ilio-inguinal nerve), based on the C&P examination less than 1 month before separation, citing tenderness and “neuralgia of the ilio-inguinal nerve which is severe or complete.”  

All examiners and evidence indicated that the neuralgia was principally due to the ilio-inguinal nerve.  The 10% rating-awarded by the PEB is the highest VASRD rating available under any ilio-inguinal nerve coding.  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 pain condition.  

Contended PEB Condition:  Hypertension.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended 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 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 left groin pain condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hypertension condition, the panel agrees that 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 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180005927, 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