Citation Nr: 21028348 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 16-16 810 DATE: May 11, 2021 ORDER An initial rating higher than 20 percent for right lower extremity inguinal nerve entrapment is denied. FINDING OF FACT The Veteran's right lower extremity inguinal nerve entrapment has manifested in severe pain, weakness, and radiating pain to the groin, scrotum, right shoulder, and right knee. CONCLUSION OF LAW The criteria for an initial rating higher than 20-percent for right lower extremity inguinal nerve entrapment have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 3.321(b)(1). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 2009 to June 2009 and from July 2011 to October 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2020, the Board remanded the matter for referral to the Director, Compensation Services for consideration of entitlement to an extraschedular rating. The Director recommended an extraschedular rating of 20-percent, which was granted by the RO in a January 2021 rating decision. The matter now returns to the Board for consideration of entitlement to an initial rating higher than 20 percent. See AB v. Brown, 6. Vet. App. 35, 38 (1993). Disability evaluations (ratings) are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects the Veteran's ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (rating schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Veteran's right lower extremity ilio-inguinal nerve entrapment is rated under Diagnostic Code (DC) 8530, for paralysis of the ilio-inguinal nerve. Under DC 8530, a noncompensable rating is warranted where paralysis is incomplete at a mild or moderate severity, and a 10-percent rating, which is the highest available under these criteria, is warranted where incomplete paralysis is severe or where paralysis is complete. 38 C.F.R. § 4.124a, DC 8530. The 20-percent rating has been assigned under 38 C.F.R. § 3.321(b), which permits the Director, Compensation Service to approve an extra-schedular evaluation commensurate with the impairment of earning capacity in cases where application of the regular schedular standards is impractical because the disability is so exceptional or unusual due to additional factors of disability. 38 C.F.R. § 3.321(b). Turning to the evidence from the effective date of March 5, 2014, at a May 2015 VA examination the examiner reported "severe lancinating inguinal pain on the right." Muscle strength testing, deep tendon reflex testing, and sensory testing were normal. Overall, the examiner graded the nerve as normal, but the functional impact section found the Veteran "is unable to perform physical labor jobs." In his June 2015 notice of disagreement, the Veteran wrote that his disability prevents him from engaging his core muscles without suffering pain rated at seven out of ten. He reported he cannot sit or lie comfortably for extended periods or perform any physically demanding exercise. At a March 2016 VA examination, the Veteran still had severe, constant pain on the right side, with shooting pains when engaging his core. The short walk from the parking lot to the examiner's office caused pain. The examiner wrote that the Veteran "cannot do heavy physical labor, [but] he can do sedentary labor." At a July 2018 Board hearing before the undersigned Veterans Law Judge, the Veteran testified that he had a constant pain rated five out of ten, and after activity he felt shooting pain rated ten out of ten; at that point, he had to stop doing any activity for the rest of the day and go lie down for at least an hour. Such pain could also be triggered by sitting for prolonged periods. The episodes occurred at least three times a day, in total requiring him to stop activity and lie down for at least three hours a day. For most physical activity, including anything activating the core, he could "only do it for ten minutes" before an episode of pain. The Veteran related that he applied for a job as a firefighter, but he was unable to pass the physical examination due to pain on the sit-up portion of testing. Following the Board's prior November 2018 decision, new VA examinations were provided in December 2019 and March 2020. The Veteran continued to have shooting pain that worsened with activity engaging the core, which the December 2019 examiner noted radiated up to his right shoulder and down to his right knee. The March 2020 examiner graded the overall severity as moderate and stated the Veteran would be precluded from heavy lifting. In the April 2021 informal hearing presentation for this post-remand matter, it was asserted that the Veteran has complete nerve paralysis that causes severe pain, weakness, and atrophy, with severe pain in the groin and scrotum. Based on all the evidence, the Board finds that a rating higher than 20 percent is not warranted. The Board acknowledges the April 2021 contention that the Veteran has pain in the groin and scrotum; the Board finds, however, that the extraschedular 20-percent rating assigned under DC 8530 compensates the Veteran for these symptoms, as DC 8530 contemplates paralysis of the ilioinguinal nerve, a nerve responsible for distribution to the scrotum area. See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY, available at https://www.dorlandsonline.com/dorland/references/5-Anatomy-Nerves.htm (last visited May 2021). Likewise, regarding the evidence that the pain radiates to the Veteran's right shoulder and right knee, the Board notes that the assignment of the 20-percent rating has expressly included those symptoms as justification for the rating, and the Board finds that the 20-percent rating adequately compensates the Veteran for the severity, frequency, and duration of the radiating pain shown by the evidence of record. The Board also acknowledges the present contention of the severity and complete paralysis of the Veteran's condition. The Board notes that the Veteran's current 20-percent rating is already above the schedular 10-percent rating provided for severe incomplete paralysis or complete paralysis, and the Board finds that the Veteran is being compensated for the impairments created by the severity of his condition. (Continued on the next page) Because the Board finds that the Veteran's current extraschedular 20-percent rating compensates the Veteran for the severity of his condition and all associated symptoms shown by the evidence of record, an initial rating higher than 20 percent for right lower extremity inguinal nerve entrapment is denied. 38 U.S.C. § 1155; 38 C.F.R. § 3.321(b)(1). K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.