RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01884
BRANCH OF SERVICE:  Army	BOARD DATE:  20140710
SEPARATION DATE:  20041207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SGT/E-5 (92G/Food Service Specialist) medically separated for right testicular pain.  The right testicular pain could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right testicular pain, characterized as “right chronic orchalgia” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions as meeting retention standards for PEB adjudication.  The PEB adjudicated “right testicular pain, status post spermatocele removal” as unfitting, rated 0% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting and not ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI documented a lengthy contention regarding his unfit condition, chronicling his constant pain, which he claimed was starting to increase; and its detrimental effect on his quality of life.  He also mentioned the requirement for him to take pain medication to deal with his condition.  He felt his 10% rating should be higher given the long term pain condition which he faced.  Finally, he mentioned his condition “affects my sleep my work and my family life.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right testicular pain condition is addressed below and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20041101	VA - (~6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Testicular Pain	8730	0%	Chronic Right Orchalgia	7525	10%	20050524	
Other x 2 (Not in Scope)	Other x 5	20050524	
Combined:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20050603 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Testicular Pain.  Service medical records show that the CI had a vasectomy (surgery where tubes [vas deferens] that carry sperm are cut/interrupted) in 2001.  In the summer of 2004, the CI complained of right testicular pain at the prior vasectomy site.  Initial treatment with medication for possible epididymitis (inflammation) and local injection by urology did not improve his symptoms.  Ultrasound imaging revealed a small right spermatocele (abnormal sac/cyst that develops in the epididymis), but was otherwise unremarkable.  He was offered the option of a spermatocelectomy (excision of spermatocele) understanding there was only a 40-50% chance of improvement in his pain.  On 1 September 2004, the CI underwent a right spermatocelectomy.  At the 14 September 2004 post-operative urology follow-up, the CI complained of constant 6-7/10 right groin and testicle pain.  Additionally he complained of a burning sensation to the left testicle and feeling an odd shaped lump.  Physical examination showed the scrotum had mild postoperative swelling and tenderness with vasectomy scar tissue on the left.  The surgical incision was clean, dry, intact and without drainage.  The testes and epididymis were normal.  The assessment and plan listed unchanged right groin, mainly right hemi-scrotal pain.  The urologist deemed that the CI could not do daily duties, initiated a permanent profile and referred him to the medical evaluation board.  In the 14 October 2004 MEB narrative summary completed by urology, the CI complained of continued pain since the surgery which required oral narcotics for control symptoms.  He was unable to run, jump or perform his normal duties without significant pain.  Physical examination showed a normal scrotum, bilateral testes of equal size, shape and consistency with no masses present.  There was mild tenderness on the right and none on the left.  There were no palpable varicoceles or hernias and minimal scar tissue from the vasectomy and spermatocelectomy.  The urologist reported that secondary to unrelieved right orchalgia, the CI was unable to perform the full duties of his rank and station, but was able to perform activities of daily living without a problem.  The diagnosis was listed as right chronic orchalgia and further treatment and operative procedures were not indicated.  At the 31 May 2005 VA Compensation and Pension (C&P) examination, performed 6 months after separation, the CI complained of persistent right testicular pain.  He reported baseline, chronic, dull, aching pain, with exacerbations of severe sharp, stabbing, burning, 9/10 pain.  Exacerbations were caused by standing, walking, running, hiking, activity, lifting, physical labor and orgasm.  The CI reported that the pain had impacted his employment options and income as he was no longer able to perform the physical labor required in his previous job.  Pain was relieved by rest, inactivity, and medications (muscle relaxants and opioids).  A March 2005 scrotal ultrasound was reported to reveal symmetrical testes, no testicular mass, a moderate right hydrocele, a small left hydrocele and normal epididymides.  The physical examination showed a normal scrotum without redness or swelling.  The left testicle was smooth and non-tender with no mass.  The right testicle was quite tender, particularly in the area of the epididymis, with no mass.  The diagnosis was listed as chronic right orchalgia without objective evidence of testicular abnormality.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the unfitting right testicular pain 0%, rated analogously ilio-inguinal nerve neuralgia (8730) of moderate severity.  The VA rated the chronic right orchalgia 10% coded 7525 (epididymo-orchitis) which is rated analogously to the VASRD guideline for chronic urinary tract infection requiring long-term drug therapy, 1–2 hospitalizations per year and/or requiring intermittent intensive management.  At the time of the PEB, the CI was able to perform activities of daily living without a problem but was unable to perform vigorous, physical activities.  At the time of the VA C&P examination, the CI reported a greater impact on his activities of daily living in addition to work restrictions.  The Board considered the rating under the different codes selected by the PEB and VA.  The maximum rating under the ilioinguinal nerve code (8730) used by the PEB is 10% (severe).  At the time of the PEB, the pain condition did not more nearly approach the severe (10%) than the moderate (0%) under 8730.  The post-separation C&P examination recorded symptoms supportive of the 10% rating.  The code for chronic epididymo-orchitis (7525) selected by the VA is rated by analogy to urinary tract infection.  All Board members agreed that the orchalgia condition did not warrant the higher 30% rating under diagnostic code 7525 consistent with recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times per year), and/or requiring continuous intensive management.  The 10% rating under code 7525 is supported when there are up to two hospitalizations per year or intermittent intensive management.  The Board discussed whether the orchalgia condition more nearly approximated a 0% versus a 10% rating under either diagnostic code.  The Board concluded the activity limitation and treatment recorded in the service treatment records supports the 10% rating under code 7525.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.7 (higher of two ratings), the Board recommends a disability rating of 10% for the right testicular pain condition (coded 7525).

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right testicular pain condition, the Board unanimously recommends a disability rating of 10%, coded 7525 IAW VASRD §4.115b.  There were no other conditions within the Board’s scope of review for consideration.

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

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Right Orchalgia	7525	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130926, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150001242 (PD201301884)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						

CF: 
(  ) DoD PDBR
(  ) DVA