RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXX	BRANCH OF SERVICE: ARMY
CASE NUMBER:  PD0900279          BOARD DATE: 20100105
SEPARATION DATE: 20000312 (To TDRL)   20050316 (Off TDRL)
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SUMMARY OF CASE:  This covered individual (CI) was a Staff Sergeant/E6 (Tank Systems Mechanic) medically separated from the Army in 2005 after 14 years of service.  The medical basis for the separation was Undifferentiated Somatoform Disorder.  The CI appeared well until elective bilateral vasectomy in 1997 when he had residual pain post operatively.  The CI was diagnosed with Irritable Bowel Disease (IBS) and was apparently restricted from field duties.  While stationed in Korea, the CI's somatic complaints increased and he met an MOS/Medical Retention Board Proceedings 19990226 for limitations and symptoms of IBS.  The CI was referred into the disability evaluation system and multiple evaluations for multiple somatic complaints beyond those expected from his diagnoses led to the diagnosis of Undifferentiated Somatoform Disorder.  Undifferentiated Somatoform Disorder was determined to be medically unacceptable IAW AR 40-501, while the seven other diagnoses including IBS, left carpal tunnel syndrome, bilateral plantar fasciitis, and four genitourinary system-related conditions were medically acceptable.  The CI was referred to the PEB, found unfit for the Undifferentiated Somatoform Disorder condition, determined unfit for continued military service and placed on TDRL at 30%.  The CI was reevaluated and PEB of 20050316 found the CI unfit for Undifferentiated Somatoform Disorder.  Additional diagnoses, including Anxiety Disorder, were noted and the PEB determined they were unrelated to the TDRL condition and were excluded from fitness and/or rating determination.  The CI was separated at 10% disability using the Veterans Affairs Schedule for Ratings Disabilities (VASRD) and applicable Army and Department of Defense regulations.  

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CI CONTENTION:  “Veteran was determined to be 30% disabled on January 05, 2000 due to Undifferentiated Somatoform Disorder and placed on Temporary Disabled Retired List.  On March 16, 2005 the veteran was then determined to be 10% disabled for the same disability as previously considered 30% disabling and placed on Permanent Disabled Retired List.”

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RATING COMPARISON:  

Service PEB	VA (3 Mo. after Separation)	
Unfitting Conditions	Code	Rating	Date	Condition	Code	Rating	Exam	Effective	
Undifferentiated Somatoform Disorder
(MEB Dx I-1) 

(TDRL Re-eval Dx I-1) 	9423	30%

10%	20000105 
TDRL start 

20050316 
TDRL end	Undifferentiated Somatoform Disorder
(Acute and Transitory) 	9421	NSC	20000611		
Anxiety Disorder 
(TDRL Re-eval Dx I-2) 	Not ratable, not listed on the original MEB 	Anxiety Disorder, Dysthymic Disorder and Depression (Claimed as Anxiety Disorder)	9413	NSC			
Parasomnia 
(TDRL Re-eval Dx I-3) 	Not ratable, not listed on the original MEB	Not diagnosed or rated 	
Obstructive Sleep Apnea (TDRL Re-eval Dx I-3) 	Not ratable, not listed on the original MEB 	Obstructive Sleep Apnea	6847	NSC			
Left Carpal Tunnel Syndrome
(MEB Dx I-2) 	Not Unfit		Scar, Residuals Left Wrist, S/P Carpal Tunnel Release	7805	0%	20000530 	20000313	
Bilateral Mild Plantar Fasciitis 
(MEB Dx I-3) 	Not Unfit		Bilateral Plantar Fasciitis	5299- 5279	0%	20000530	20000313	
Irritable Bowel Syndrome
(MEB Dx I-4) 	Not Unfit		Irritable Bowel Syndrome	7319	30%	20000530	20000313	
Chronic Left Orchialgia
(MEB Dx I-5)	Not Unfit		Residuals, S/P Vasectomy and Dissection of Vas Deferens with Orchalgia (NWG No Actual Disability), (Elective Procedure)	7529- 7527	NSC	20000530		
Status Post Dissection of Bilateral Vas Granulomas (MEB Dx I-8)	Not Unfit							
Status Post Bilateral Vasectomy (MEB Dx I-7)	Not Unfit							
Chronic On-Going Epididymo-Orchitis (MEB Dx I-6)	Not Unfit		Chronic Epididymitis 	7527 - 7804	10%
then 
0%	20000530

	20000313

20050501	
No PEB entry	MEB Addendum & Med Hx (SF 93)…Frequent or severe headaches	Migraine Headaches	8100	10%	20000530	20000313	
No PEB entry	Med Hx (SF 93)… Recurrent back pain or any back injury	Mild Degenerative Changes of the Lumbosacral Spine	5010 then
5242	10%	20000522    &         20000530	20000313	
No PEB entry	Not addressed in DES /CC Statement /Profile	Scar, Residuals Right Wrist, S/P Carpal Tunnel Release	7805	0%	20000530	20000313	
No PEB entry	Not addressed in DES/CC Statement /Profile	Bilateral Knee Condition (Acute and Transitory)	5257	NSC	20000530		
TOTAL Combined:  10%	TOTAL Combined (Includes Non-PEB Conditions):    
50%  from 20000313
40% from 20050501	

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ANALYSIS SUMMARY:  The CI's multiple somatic complaints beyond those expected from his medical conditions (IBS, left carpal tunnel syndrome, bilateral plantar fasciitis, and four genitourinary system-related conditions) led to the diagnosis of Undifferentiated Somatoform Disorder.  The CI was placed on TDRL for Undifferentiated Somatoform Disorder at 30% and on final re-evaluation was separated at 10% for that condition although it was noted as unimproved.  The PEB appeared to rate the CI using DODI 1332.39 ENCL 2, Attachment 1, E2.A1.5.1.5 regarding VASRD social and industrial impairment: Mild 10%, Definite 30%.  The final psychiatric evaluation noted new onset of additional mental health diagnoses that were not related to the CI's Undifferentiated Somatoform Disorder and noted apportionment of disability due to each mental health diagnosis.  The VA did not adjudge that the CI was disabled by a somatoform disorder, but instead attributed the CI's disabilities to his underlying medical conditions of IBS and chronic epididymitis that resulted in very different ratings. 

The Commander's Statement 19990714 noted: Permanent profile…incapable of performing PMOS, APFT, field duty, cannot lift more than 30 lbs, good NCO but physical limitations render him ineffective as 63E.  The CI's Profile 19991222 was:  P3L2S4: Undifferentiated Somatoform; Bilateral Plantar Fasciitis; Irritable Bowel Syndrome.   

Military 

Condition 1: Undifferentiated Somatoform Disorder 

IPEB/TDRL Initiated 20000105: "Undifferentiated Somatoform Disorder. Rated as definite"  

IPEB/TDRL Removal 20050316 (9423 at 10%): "Undifferentiated Somatoform Disorder. Placed on TDRL 13 Mar 00, this appears to be the first interval TDRL reevaluation submitted.  The present evaluation indicates there has been no change in the rated condition, with symptoms of abdominal pain, gastrointestinal symptoms, fatigue, in excess of what would be expected from physical examinations.  Reportedly compliant with treatment, competent.  Working about 24 hours weekly as school bus driver.  Considered stable for final rating.  Mild industrial impairment. (TDRL Eval Dx Axis I -1)"   

"The TDRL re-evaluation diagnoses Axis I-2 (Anxiety Disorder), Axis I-3 (Parasomnia), Axis I-4 (Obstructive Sleep Apnea) and Axis III are not ratable now since they were not listed on the original Medical Evaluation Board as not meeting retention standards and appear to be new conditions which are unrelated to any previously rated unfitting conditions." 

Med Record Report (TDRL Evaluation) 20050222: ID: This is the second Psychiatric TDRL evaluation performed on 01 February 2005, since being placed on TDRL status January 2000.  

HISTORY OF PRESENT ILLNESS: CI was first psychiatrically evaluated and treated in October 1998, while stationed in Korea.  This was due to ongoing complaints of abdominal discomfort, diarrhea, and testicular pain, all following a vasectomy he had in 1996.  He was treated by a psychiatrist with Zoloft and Trazodone in February 1999, with some improvement.  He was placed on profile in 1998 for no field duty, due to his inability to eat MRE's, and his chronic diarrhea.  The level of physical complaints were in excess of would have been expected from examination and testing.  As a result of ongoing, generally unchanging symptoms, and poor prognosis, for what was felt to be an Undifferentiated Somatoform Disorder he received an MEB in December 1999.  At the time of his first TDRL in May 2000, he continued to report ongoing somatic complaints related to the gastrointestinal system.  He had received a subsequent colonoscopy, in which mild inflammation was noted, and did receive a diagnosis of IBS.  He was continuing to take Zoloft, which provided some positive response to his symptoms; but further complained of insomnia, fatigue, problems with concentration and memory, anhedonia, and feelings of hopelessness.

INTERIM HISTORY: Since his first TDRL in May 2000, he has received ongoing outpatient psychiatric treatment on a regular basis, every 1 to 2 months frequency, depending on his current level of symptoms.  Although he has chronically and consistently continued to complain of somatic symptoms, i.e., diarrhea, constipation, abdominal discomfort, and testicular pain; all in excess of physical findings would indicate, and qualify as a somatoform disorder; he has developed other psychiatric symptoms over the last four years, associated with mixed mood and anxiety, as well as sleep disorders.  SM has experienced a chronic wavering course of a mixture of neurovegetative and anxiety symptomatology, but because of variability and degree of presence, not meeting criteria for a specific mood or anxiety disorder.  He has suffered with symptoms of depressed mood, insomnia, anhedonia, problems with concentration and memory, hopelessness, intermittent periods of generalized worry, periods of withdrawal and isolation, a phobic avoidance of crowds, panic-related symptoms, and quasi-states of dissociation and depersonalization.  He has also experienced intermittent episodes of violent motor activity during sleep states (physically attacking wife during sleep), but amnestic to these events.  Over the last 2 1/2 years he has experienced multiple changes in pharmacologic treatment trials; current regime consists of Topiramate (anti-migraine), Buspirone (psychotropic drug and Anxiolytic), and Sertraline (Zoloft-SSRI for depression/anxiety/etc.), with moderate stability gained in a generally positive response.  He has been employed as a part-time school bus driver, working at most 24 hours per week, reporting that he is unable to handle any more hours due to his level of anxiety and irritability.  Due to the above noted symptoms, he perceives an inability to complete a higher degree of education, and inability to maintain a consistent level of functioning in full a time employment.  He was diagnosed with obstructive sleep apnea and placed on C-PAP in January 2003, with some temporary positive response to his sleep related behaviors.  He was recently hospitalized in November 2004 for chest pains and shortness of breath, received a coronary catheterization, documenting mild coronary artery disease.

MENTAL STATUS EVALUATION: SM presented on time for the evaluation, was appropriately groomed and dressed, provided fair eye contact.  Displayed no significant psycho-motor agitation or retardation. Thought processes were generally logical, linear and goal directed; no loosening of associations, no flight of ideas.  Speech was of normal rhythm, rate, volume and tone.  Thought content was clear and coherent.  Mood and affect were depressed.  Denied perceptual disturbances, as well as suicidal ideations.  Normal cognitive function and memory on gross examination.  Judgment and insight both considered fair. 

DIAGNOSIS: … AXIS I:

1. Undifferentiated Somatoform Disorder, as manifested by one or more physical complaints including fatigue and gastrointestinal symptoms, which are in excess of what would be expected from the history, physical examination, and results of testing.  These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  The duration of the disturbance is at least 6 months. This disturbance is not better accounted for by another mental disorder, and the symptoms are not intentionally produced or feigned.  Predisposition: None. Degree of Impairment for Military Duty Marked. Degree of Impairment for Social and Industrial Adaptability: Definite. Existed Prior to Service: No. Service Aggravated: Not Applicable.  

2. Anxiety Disorder Not Otherwise Specified, as manifested by a chronically wavering course of a mixture of depression and anxiety related symptoms, to include depressed mood, insomnia, anhedonia, problems with concentration and memory, hopelessness, intermittent periods of generalized worry, periods of withdrawal and isolation, a phobic avoidance of crowds, panic-related symptoms, and quasi-states of dissociation and depersonalization.  This anxiety disturbance is severe enough to cause impairment in his occupational and social functioning redisposition: Moderate, prior symptoms associated with a somatoform disorder. Degree of impairment for Military Duty: Marked. Degree of impairment for Social and Industrial Adaptability: Definite. Exited Prior to Service: No. Service Aggravated: Not Applicable.

Parasomnia Not Otherwise Specified (REM Sleep Behavior Disorder), as manifested by the history of violent motor activity during sleep, felt to be directly a result of stress related dream and nightmare.  This sleep disorder is sufficient enough to cause severe impairment in his occupational and social functioning. Predisposition: Moderate, prior symptoms associated with a somatoform disorder. Degree of Impairment for Military Duty: Marked. Degree of impairment for Social and Industrial Adaptability: Definite. Existed Prior to Service: No. Service Aggravated: Not Applicable.

Breathing-Related Sleep Disorder (Obstructive Sleep Apnea on C-PAP).  This sleep disorder is sufficient enough to cause severe impairment in his occupational and social functioning. Predisposition: Moderate, prior symptoms associated with a somatoform disorder. Degree of Impairment for Military Duty: Marked. Degree of Impairment for Social and Industrial Adaptability: Definite. Existed Prior to Service: No. Service Aggravated: Not Applicable.

AXIS III: Obstructive Sleep Apnea on C-PAP since Jan 03, IBS, CAD s/p cardiac cath, GERD, HTN, DJD, lactose Intolerance, R/O NIDDM.

AXIS IV: Moderate psychosocial stressors to include chronic mental illness; uncertain future relating to employment, role and purpose; perceived loss of military career and identity as a soldier.  

AXIS V: GAF 55 

PRESENT CONDITION/FUNCTIONAL STATUS: SM currently continues to suffer with the same level and degree of somatic complaints, as noted on and consistent with the Undifferentiated Somatoform Disorder diagnosis, per the original MEB, dated December 1999. This condition is considered stable and prognosis is poor for future improvement.  Additionally, since the time of the original MEB, he has developed significant mood, anxiety and sleep related symptomatology, all of which being significant enough to cause a moderate level of impairment, in both occupational and social functioning.  It would appear these conditions are distinct, and there was no evidence at the time of the original MEB, that a separate anxiety or mood disorder existed, co-morbid with the Somatoform Disorder diagnosis present at the time.  It is anticipated that he will require and benefit from ongoing outpatient mental health treatment, in the form of pharmacologic and individual psychotherapy, in the foreseeable future.  CONCLUSION/RECOMMENDATIONS: "SM fails to meet retention standards …."

Veteran Affair’s Rating Decision (VARD) 20000912 (Undifferentiated Somatoform Disorder (Acute and Transitory): Not Service Connected.  The 20000611 exam and subsequent rating determination noted a lack of medical records with the specific diagnosis of the CI's somatic diagnoses.  Assessment was history of undifferentiated somatization disorder.  The examiner indicated that the veteran did not appear to be suffering from a primary, thought or anxiety disorder."  "The veteran did not have any paperwork, medical chart or claims file. The evaluation was based entirely on his self-report…. In this case, I have no records of any type and the report of the Compensation and Pension examination is not available.  Consequently, I am unwilling to make a diagnosis of somatization disorder in this case.  Perhaps after examination of the medical record, one could come to that conclusion.  Psychological testing in these kinds of cases is sometimes useful.  So while, the veteran has a self-reported history of somatization disorder, I am unwilling to officially assign that diagnosis.   In fact, the veteran appears to be functioning very well. … GAF of 75 based on his self report."   

The CI was placed on TDRL at 30% for the single diagnosis of Undifferentiated Somatoform Disorder.  The original rating of code 9423 at 30% appears to have been IAW DODI 1332.39 ENCL 2, Attachment 1, E2.A1.5.1.5 regarding VASRD social and industrial impairment: Definite 30%.  The VA examination of 20000611 did not diagnose this condition; however, the examiner did not review the CI's medical records.  The records do not contain any VA mental health rating exams proximate to the CI's separation in 2005.  VA treatment record MHC Medication Management note of 20051027 noted a long-standing diagnosis of dysthymic disorder and continued psychotropic medications.  The VA did not adjudge that the CI was disabled by a somatoform disorder, but instead attributed the CI's disabilities to his underlying medical conditions of IBS and chronic epididymitis that resulted in different disability diagnoses and ratings than the military for similar symptomatology.  On final TDRL re-evaluation, the PEB appears to have applied DODI 1332.39 and rated the CI at 10% for "Mild industrial impairment."  However, the psychiatric NARSUM noted that the CI had "the same level and degree of somatic complaints, as noted on and consistent with the Undifferentiated Somatoform Disorder diagnosis, per the original MEB, dated December 1999."  The psychiatrist detailed the CI's mental health disorders diagnosed since entry into TDRL and appeared to separate mental health symptoms and disability due to each mental health diagnosis:  "It would appear these conditions are distinct, and there was no evidence at the time of the original MEB, that a separate anxiety or mood disorder existed, co-morbid with the Somatoform Disorder diagnosis present at the time."  The specific impairment related to Undifferentiated Somatoform Disorder was noted as "Degree of Impairment for Social and Industrial Adaptability: Definite" and the CI was on chronic medications without consistent good control "experienced a chronic wavering course of a mixture of neurovegetative and anxiety symptomatology".  The CI was employed part-time and had a GAF of 55 which could not be easily separated from the CI's other diagnoses.  Using only the VASRD §4.130, General Rating Formula for Mental Disorders, the CI more closely fits the 30% criteria for Undifferentiated Somatoform Disorder for Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal).  The CI's other mental health conditions were not MEB or initial PEB diagnoses, did not appear to be "missed diagnoses," and were as much as possible distinguished from the Undifferentiated Somatoform Disorder.  No other mental health condition should be added as unfitting.  All evidence considered and IAW VASRD §4.3, reasonable doubt is resolved in favor of the CI in recommending a separation rating of 30% for the 9423 Undifferentiated Somatoform Disorder condition.   

Condition 2: Left Carpal Tunnel Syndrome.  IPEB 20000105: Not unfit.  MEB Addendum 19991122: The patient underwent a left carpal tunnel release on September 8, 1999 and tolerated the procedure well.  Currently, he is doing very well.  The majority of numbness, tingling and pain have resolved in his left hand and he has only mild tenderness at the surgery site.  His wound is well healed.  IMPRESSION: (1) Left carpal tunnel syndrome, status post carpal tunnel release with excellent outcome.  I expect him to have complete resolution of his symptoms.

VARD 20090912 rated this condition at 0% based on exam of 20000530.  "… scars which are not considered disabling because of limited motion or tenderness."  "…surgical release of the carpal tunnel was done in 1995 and helped alleviate symptoms in the right hand.  The release was done on the left in September 1999.  The patient states that he has wrist pain residual to this surgery.  There is no paresthesia in the left hand.  The patient states that he has wrist pain with pushups or any weightbearing on the left wrist.  He says that the wrist is sore daily. He denies any restriction of movement in the bilateral wrist.  He does not use splints. There is no swelling of the wrists or hands.  He states that his grip is good and that he does not drop objects.  There is no weakness in the wrists or hands.  The last time the patient saw a physician for the carpal tunnel syndrome was in January 2000."  

This condition did not rise to the level of being unfitting at the time of placement onto TDRL.  

Condition 3: Bilateral Mild Plantar Fasciitis  IPEB 20000105: Not unfit.  MEB Addendum 19991122:  The patient also complains of bilateral heel pain with the left greater than the right.  This is interfering with his ability to run.  He has been instructed and stretching exercises and placed in heel cups.  IMPRESSION: (2) Bilateral mild plantar fasciitis and I expect this to resolve with inserts.

VARD 20090912: This condition is evaluated as 0 percent disabling from March 13, 2000.  A noncompensable evaluation is assigned in the absence of anterior metatarsalgia (Morton's disease).  C&P 20000530: 5. Bilateral plantar fasciitis. The patient was diagnosed with this in 1999. Treatment consisted of an insert in his boots. However, he had continued pain.  He says that there is persistent soreness in the bilateral arches of the feet.  There has been no further treatment for plantar fasciitis.  The patient describes this current soreness in the feet as a constant mild type of pain.  Standing, walking, and wearing dress shoes make it worse.  Alleviating measures include trying to wear a comfortable soft shoe.  The patient has not recently seen a physician for plantar fasciitis.

This condition did not rise to the level of being unfitting at the time of placement onto TDRL.  

Condition 4: Irritable Bowel Syndrome  IPEB 20000105: Not unfit.  MEB Addendum 19991129: Reportedly irritable bowel syndrome which is somewhat improved with antidepressants.  The patient also claimed a history of chronic diarrhea, however, does not appear to have chronic diarrhea, and certainly has no supporting data for that. Irritable bowel in itself is not a boardable condition.  

VARD 20000912: An evaluation of 30 percent is assigned whenever there are symptoms of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.  Since there is a likelihood of improvement, the assigned evaluation is not considered permanent and is subject to a future review examination.

This condition did not rise to the level of being unfitting at the time of placement onto TDRL.  

Condition 5: Chronic Left Orchialgia  IPEB 20000105: Not unfit.  MEB Addendum 19991123: The patient had a vasectomy and subsequently developed chronic low-grade bilateral testicular pain greater on the left than on the right.  The patent initially was treated for epididymo-orchitis.  Antibiotics and anti-inflammatories helped somewhat but did not significantly change the overall discomfort.  The patient was subsequently taken to the Operating Room and bilateral vas granulomas were dissected free from his previous vasectomy site.  Postoperative right testicular pain and discomfort resolved.  The left testicular pain and discomfort improved and initially went away but away but returned a few months later.  The patient intermittently has been treated with antibiotics, as well as anti-inflammatories on a long-term basis without complete resolution.  The patient has subsequently some low-grade erectile dysfunction which is being treated with Yohimbine and he is doing well.  ASSESSMENT: 1. Chronic left orchialgia; 2. Chronic on-going epididymo-orchitis; 3. Status post bilateral vasectomy; 4. Status post dissection of bilateral vas granulomas.  

COMMENTS: After further discussion with the patient.  It is understood that he may be dealing with an on-going long-term chronic low-grade orchialgia from now on.  The exact etiology of this is unclear, although there was some thought that there may be same issues involving having bad the vasectomy.  

VARD 20000912: Not Service Connected - The evidence regarding residuals, status post vasectomy and dissection of vas deferens with orchialgia fails to show a disability for which compensation may be established.  It is therefore not a well-grounded claim which can be resolved.  In order to establish a well-grounded claim, it is necessary to provide evidence which demonstrates an actually disabling condition.  The claim is not well grounded as there is no disability for which compensation may be paid.  The vasectomy was an elective procedure which was elected by the veteran, and was not caused by disease or injury.  

C&P 20000530:  Status post bilateral vasectomy, chronic left orchialgia, chronic epididymitis, orchitis, and status post dissection of bilateral vas deferens.  The patient states that he underwent vasectomy in 1996.  Twenty-four hours after the procedure, he had severe swelling of the testicle.  He was diagnosed with epididymitis and treated with antibiotics.  This problem was persistent over the next 10 months with swelling, pain, and treatment with various antibiotics.  The patient subsequently underwent a second procedure that was a dissection of the vas deferens to release fluid and pressure.  He said that this took care of the swelling and pressure.  The vasectomy was successful, with follow up 0 sperm count.  

This condition did not rise to the level of being unfitting at the time of placement onto TDRL.  

Condition 6: Chronic On-Going Epididymo-Orchitis  IPEB 20000105: Not unfit.  MEB Addendum 19991123:  See Condition 5 comments.  

VARD 20000912: This is being rated as analogous to a painful or tender scar.  An evaluation of 10 percent is granted for scarring which is tender and painful on objective demonstration. Since there is a likelihood of improvement, the assigned evaluation is not considered permanent and is subject to a future review examination.  C&P 20000530:  See C&P comments above

This condition did not rise to the level of being unfitting at the time of placement onto TDRL.  

Condition 7: Status Post Bilateral Vasectomy  IPEB 20000105: Not unfit.  MEB Addendum 19991123:  See Condition 5 comments.  

VARD 20000912: Not Service Connected - The evidence regarding residuals, status post vasectomy and dissection of vas deferens with orchialgia fails to show a disability for which compensation may be established.  It is therefore not a well-grounded claim which can be resolved.  In order to establish a well-grounded claim, it is necessary to provide evidence which demonstrates an actually disabling condition.  The claim is not well grounded as there is no disability for which compensation may be paid.  The vasectomy was an elective procedure which was elected by the veteran, and was not caused by disease or injury.  C&P 20000530:  See C&P comments above.

This condition did not rise to the level of being unfitting at the time of placement onto TDRL.  

Condition 8: Status Post Dissection of Bilateral Vas Granulomas  IPEB 20000105: Not unfit.  MEB Addendum 19991123:  See Condition 5 comments.  

VARD 20000912: Not Service Connected - The evidence regarding residuals, status post vasectomy and dissection of vas deferens with orchialgia fails to show a disability for which compensation may be established.  It is therefore not a well-grounded claim which can be resolved.  In order to establish a well-grounded claim, it is necessary to provide evidence which demonstrates an actually disabling condition.  The claim is not well grounded as there is no disability for which compensation may be paid. The vasectomy was an elective procedure which was elected by the veteran, and was not caused by disease or injury.  C&P 20000530:  See C&P comments above.

This condition did not rise to the level of being unfitting at the time of placement onto TDRL.  

VA Other Conditions:  The CI had various other conditions rated at 0% or not ratable (NSC) by the VA, but his only additional compensable ratings were for Mild Degenerative Changes of the Lumbosacral Spine and Migraine Headaches that did not rise to the level of being unfitting.  The Board can make no recommendation for any additionally unfitting conditions.

Scar, Residuals Carpal Tunnel Syndrome of the Right Wrist, S/P Carpal Tunnel Release (0% by the VA) and Bilateral Knee Conditions (NSC by the VA) were not addressed in the PEB file and are therefore outside of the scope of the Board to adjudicate.   
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BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on DoDI 1332.39 for rating Undifferentiated Somatoform Disorder was operant in this case and the condition was adjudicated independently of that instruction by the Board.  

In the matter of the Undifferentiated Somatoform Disorder condition, the examining provider noted that the CI's condition had not improved from entry into TDRL, the CI was on chronic psychotropic medications, was not fully employed, and was opined to have definite industrial impairment.  Even separating out the contributions of the CI's non-ratable mental health conditions, using only the VASRD criteria in effect at the time, the CI more closely met the criteria for a 30% rating.  The Board unanimously recommends a rating of 30% coded 9423 IAW VASRD §4.3 and §4.130.  

All evidence considered, there is not reasonable doubt in the CI’s favor supporting recharacterization of the PEB fitness adjudication for the Left Carpal Tunnel Syndrome, Bilateral Mild Plantar Fasciitis, Irritable Bowel Syndrome, Chronic Left Orchialgia, Status Post Dissection of Bilateral Vas Granulomas, Status Post Bilateral Vasectomy, or Chronic On-Going Epididymo-Orchitis conditions.  

In the matter of the Anxiety Disorder, Parasomnia, and Obstructive Sleep Apnea (OSA) that were noted at the final TDRL evaluation: the Board unanimously agrees that it cannot recommend a finding of unfit for additional rating at separation.  In the matter of the Migraine Headaches and Mild Degenerative Changes of the Lumbosacral Spine noted in the original MEB package: the Board unanimously agrees that it cannot recommend a finding of unfit for additional rating at separation.  In the matter of the Scar, Residuals Right Wrist, S/P Carpal Tunnel Release; and Bilateral Knee Conditions, evaluated by the VA, they were not mentioned in the Disability Evaluation System (DES) package and are therefore outside the scope of the Board.  The CI retains the right to request his service Board of Correction for Military Records (BCMR) to consider adding these conditions as unfitting.  The Board therefore had no reasonable basis for recommending any additional unfitting conditions for separation rating.  

The Board voted unanimously to rate the CI for Undifferentiated Somatoform Disorder at 30% coded 9423 IAW VASRD §4.130.    
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RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows and that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation.

UNFITTING CONDITION	VASRD CODE	RATING	
Undifferentiated Somatoform Disorder	9423	30%	
COMBINED	30%	

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The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20090331, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.