RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03785
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060830

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Aircraft Power Plant Repairer, medically separated for “chronic right ilioinguinal pain/neuralgia” 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 - 20060705	VARD - 20060928	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Chronic Right Ilioinguinal Pain/Neuralgia and	
8799-8730	
10%	
Neuralgia, Genitofemoral Nerve Distribution	
8730-8530	
10%	
20060329	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Right Ilioinguinal Pain/Neuralgia. According to the service treatment record and MEB narrative summary (NARSUM), the CI was first seen in November 2005 for chronic right scrotal pain. Six years earlier he had a vasectomy and with progressive scrotal pain that began approximately 1 year thereafter and which radiated to the inner thigh and lower abdomen. Examination revealed the right epididymis was mildly full with firmness at the lower pole and tenderness along it and the cord.        A urology note dated 22 December 2005 indicated he had

minimal to no benefit from nonsteroidal anti-inflammatory drugs, Ultram (an opioid-like medication), Neurontin (for nerve pain), and Elavil. He required Percocet (a narcotic) and rest to relieve the pain and was he was medically evacuated from deployment. He had no urinary symptoms and denied swelling of the right testicle or having a lump.

A scrotal ultrasound dated 29 December 2005 showed a suggestive sperm granuloma posterior to the mid body of the enlarged right epididymis and a spermatocele was associated with the right epididymal head. No intratesticular lesions were identified and no abnormal vascular flow patterns to the right testis or epididymal area were present. At a physical medicine and rehabilitation clinic visit, the CI complained of 7/10 pain. He had a block of the right ilioinguinal nerve, which supplies sensation to the skin over the root of the penis and upper part of the scrotum, without relief. He was started on Neurontin (for nerve pain) and continued Elavil (also for nerve pain). On 7 February 2006 he then had a block of the genitofemoral nerve which supplies sensation to the upper anterior thigh as well as the skin of the anterior scrotum; this had poor success. He did not consent to an offered spinal block. He was started on methadone (a narcotic) for  chronic  pain  and  the  Neurontin  was  changed  to  Lyrica  (for  nerve  pain)  on  17 February 2006. At a urology clinic visit on 27 February 2006, he was advised surgery would not likely improve his symptoms since he had no improvement with the nerve blocks, and might make his pain worse.

During the 14 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported groin pain. Physical examination was deferred to the VA. The 29 March 2006 MEB NARSUM examination noted the complaint of chronic right scrotal pain. Physical examination showed no tenderness in the inguinal canal and a soft abdomen with no tenderness and no hernia. The bladder was neither distended nor tender. The penis was normal with no lesions. The scrotum was non-tender with no palpable mass. No varicocele or hydrocele were noted. The testicle on both sides was not tender and there was no swelling or palpable mass. The epididymis did have a mildly tender mass, a small spermatocele, on the right side in the globus major area. However, that was not what was reproducing his pain. The vas deferens and spermatic cord were normal as was the perineum. The examiner’s diagnoses was neuralgia affecting the genitofemoral nerve distribution with extension onto the right thigh with chronic right scrotal and groin pain refractory to oral medication and multiple nerve blocks.

At the 29 March 2006 VA Compensation and Pension (C&P) examination, 5 months before separation the CI reported right testicular pain precipitated by exercise and prolonged standing and sitting. Physical examination showed the external genitalia were within normal limits. No palpable masses were noted. No hernia was present and the rectum appeared normal on external examination. No sensory deficits were noted. The examiner’s diagnosis was right testicular neuralgia post vasectomy.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic right ilioinguinal pain/neuralgia condition 10%, analogously coded 8799- 8730 (neuralgia), citing severe, incomplete paralysis. The VA also rated the neuralgia, genitofemoral nerve distribution condition 10%, dual coded 8730-8530 (neuralgia-paralysis of the ilioinguinal nerve), based on the C&P examination, citing the rating is the highest possible rating allowed under the VASRD.

The panel noted the CI had chronic right scrotal pain with ultrasound findings of a suggestive sperm granuloma posterior to the mid body of the enlarged right epididymis and a spermatocele was associated with the right epididymal head. Neither a right ilioinguinal nerve block, a genitofemoral nerve block, nor medication relieved the CI’s right groin pain. Code 8530 offers a maximum of a 10% rating for severe to complete paralysis of the ilioinguinal nerve.   VASRD
§4.124 (neuralgia, cranial or peripheral) states “Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be

rated on the same scale, with a maximum equal to moderate incomplete paralysis,” while VASRD
§4.123 (neuritis, cranial or peripheral) states: “Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The panel noted the PEB used an analogous code 8730 (neuralgia) to rate the CI’s pain; however, the maximum rating for that code is 0%, but the PEB indicated the rating was based on severe, incomplete paralysis, which is better coded as 8630 (ilioinguinal nerve-neuritis) or 8530 ilioinguinal nerve, severe to complete, either of which warrants a 10% rating. The panel also considered code 7525 (epididymo-orchitis, chronic only), which is rated as urinary frequency. However, there was no urinary frequency reported to warrant a rating higher than 0%. 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 chronic right ilioinguinal pain/neuralgia condition.

BOARD FINDINGS:  In the matter of the chronic right ilioinguinal pain/neuralgia 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:

	PD-2017-03785

AR20190010891, XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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.

	PD-2017-03785