RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00506
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20060112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Maintenance Technician) medically separated for chronic orchialgia.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating.  He was referred for an Medical Evaluation Board (MEB).  Unspecified disorder of male genital organs was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated chronic orchialgia, left greater than right as unfitting, rated 20% (bilateral factor applied).  The CI made no appeals and was medically separated.

CI CONTENTION:   The applicant makes no specific contention in his application.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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 Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON

IPEB - Dated 20051025	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Orchialgia, Left greater than Right	8630	20%	Chronic Testalgia Status Post Bilateral Orchiopexy Repair for Testicular Torsion and Epididymal Tear	7599-7525	10%	20060406	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20060502 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  

Chronic Orchalgia Condition.  The CI had a history of scrotal surgery with fixation of both testicles and correction of a testicular torsion (twisting) in 1997.  The service treatment record (STR) indicated the new onset of testicular pain, aggravated with running in June 1999.  Despite multiple consults with Urology, General Surgery, and Pain Management, coupled with normal ultrasounds and treatments of anti-inflammatories, narcotics, and local anesthetic blocks, the CI’s scrotal pain continued throughout his military career.  His diagnoses remained testalgia (testicular pain) and chronic epididymitis (inflammation of the sperm sac…adjacent/attached to the testicle).  He was referred to an MEB which was conducted on 21 September 2005.  At the MEB narrative summary (NARSUM) performed on 21 September 2005 (4 months prior to separation), the CI endorsed a constant scrotal pain (left > right) worsened with prolonged periods of sitting and anything with increased physical activity such as heavy lifting or running.  He reported no urinary symptoms.  The physical examination (PE) revealed bilateral testicle tenderness with the right side described as somewhat tender and the left side described as exquisitely tender.  There was no right-sided inguinal hernia present and the left inguinal area was unable to be examined due to associated scrotal pain and discomfort.  His diagnosis was chronic orchalgia (testicular pain; unknown etiology); left greater than right.  The examiner opined that the CI’s condition was unlikely to resolve and that the persistent scrotal pain severely interfered with his ability to perform his duties.  The commander’s non-medical assessment (NMA) noted that the CI was on 16 months of limited duty “with no positive results” in relation to pain relief.

The VA Compensation and Pension (C&P) examination was performed on 06 April 2006 (3 months after separation), whereby the CI voiced no new complaints.  The encounter chronicled the CI’s condition since 1994.  The VA PE demonstrated tenderness and induration (localized tissue hardening) of the left testicle.  There was no comment with regards to the right testicle.  Additionally, there was no comment or assessment of his functional abilities and the diagnosis was listed as chronic testalgia by history following surgical exploration and repair.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned 10% to each testicle for a combined 20% utilizing code 8630 (Neuritis; ilioinguinal nerve) IAW §4.124; Schedule of ratings, neuralgia (Cranial or peripheral); whereas the VA assigned a single 10% rating coded analogous to 7525 (Chronic epididymo-orchitis) and rated under urinary tract infection (UTI) criterion.  Board members first acknowledged the various coding options available in this case and concluded that the more appropriate code in reference to the CI’s physical condition was clearly the VA’s choice of 7525.  In addition, this code has the potential to rate at 30% whereas the maximal achievable rating under the peripheral nerve code of 8630 is 10%.  Members then deliberated an impairment rating utilizing the UTI criterion and concluded that the 30% level was not supported.  There were no additional or alternative coding schemes that would rate higher than the PEBs current rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the bilateral testicular condition.

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 scrotal pain condition and IAW VASRD §4.115b, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.
RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131229, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 7 Dec 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXXX, former USN  
- XXXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXXX, former USMC 

						  XXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)