RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05029
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070613

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “chronic right inguinal neuropathic pain” with a disability rating of 0%.  

CI CONTENTION:  No specific contention was made.  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 - 20070508	VARD - 20080723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Inguinal Neuropathic Pain 	8730	0%	Right Inguinal Hernia 	7338	10%	20080626	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Inguinal Neuropathic Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgical repair (herniorrhaphy with mesh) on 30 March 2006 (14 months before separation).  Post-operative STR entries documented the absence of any surgical complications, but there were repeated visits for persistent right groin pain at the operative site.  Although ultrasound suggested a small incisional defect permitting herniation of fat that would spontaneously reduce, repeated surgical evaluations documented the absence of a palpable hernia or other pathology, and a contrast CT scan was normal.  Per available records, no service provider opined as to a neuropathic or other specific etiology for the persistent post-operative pain.  
The 6 April 2007 MEB NARSUM examination, 2 months prior to separation, noted a complaint of intermittent right groin pain rated 7/10 that was precipitated by abdominal straining (valsalva), bending, lifting or running more than a half-mile.  There was no associated abdominal distention, nausea or other gastrointestinal symptoms.  The physical examination recorded a well healed incision and some localized tenderness over the surgical site, with an otherwise normal abdomen and no evidence of recurrent hernia.  The MEB diagnosis was “right inguinal repair and post-operative pain” without reference to etiology.  

At the 26 June 2008 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported persistent right groin pain rated 3-6/10 aggravated by “certain hip movements” and after eating a full meal.  He denied associated symptoms.  He was employed digging trenches from which he had to periodically rest because of the pain.  The physical examination recorded a well healed incision, right groin tenderness, no recurrent hernia and otherwise normal findings.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right inguinal hernia condition 0%, coded 8730 (neuralgia of the ilio-inguinal nerve), citing the applicable criterion of “moderate” nerve impairment.  Code 8730 confers a maximum rating of 10% for “severe” impairment.  The VA rated the condition 10%, coded 7338 (hernia, inguinal), based on the C&P examination, citing the applicable criteria “postoperative recurrent, readily reducible and well supported by truss or belt.”  The next higher 30% criteria are “small, postoperative recurrent, or unoperated irremediable, not well supported by truss, or not readily reducible.”  

The panel first agreed there was no alternative VASRD code that was more favorable and applicable than either of the above codes.  The panel next agreed that the evidence did not support the criteria for higher ratings under either code (as above).  Finally, the panel considered whether the more favorable 10% rating under code 7338 was supported in lieu of the PEB’s 0% rating under the nerve code.  Members agreed that it was.  The PEB’s characterization of the rated diagnosis as neuropathic pain was not supported by a medical opinion from any provider involved in the case.  Conversely, code 7338 is very specific to the diagnosis in this case and is arguably mandated by VASRD §4.7 (higher of two evaluations).  Although there was no recurrent hernia per se, there was recurrent post-operative pain that reasonably satisfied the 10% criteria of code 7338 (above).  After due deliberation, considering all the evidence and conceding VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for the right inguinal hernia condition under code 7338.  

BOARD FINDINGS:  In the matter of the right inguinal hernia condition, the panel recommends a disability rating of 10%, coded 7338 IAW VASRD §4.114.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Inguinal Neuropathic Pain	7338	10%	

XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure