RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01144
BRANCH OF SERVICE:  Army	BOARD DATE:  20141210
SEPARATION DATE:  20080722

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (BCP Maintainer/Operator) medically separated for penile pain syndrome.  The condition 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 P3 profile and referred for a Medical Evaluation Board (MEB).  The penile pain syndrome condition, characterized as “chronic pelvic pain/penile pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The PEB adjudicated “painful penile retraction syndrome evaluated as neuralgia, ilioinguinal nerve,” rated 0% citing the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Received no rating for PTSD (posttraumatic stress disorder).”  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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting penile pain syndrome condition is addressed below.  The contended PTSD condition (or any other mental health disorder) was not identified by the PEB, and thus is not within the DoDI 6040.44 defined purview of the Board.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any condition or contention not requested in this application, or otherwise outside the Board’s defined scope of review (such as PTSD), remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20080505	VA - (At Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Painful Penile Retraction Syndrome…	8799-8730	0%	Disappearing Penis Syndrome	8799-8730	0%	20080710	
Other x 0 (Not In Scope)	Other x 4	
Combined:  0%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20081009 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Penile Pain Syndrome Condition.  The record indicated complaints of severe discomfort and penile pain (secondary to retraction) while doing physical training.  Painful retraction had onset approximately 8 months prior to separation.  There were no other abnormalities referable to the penis, testicles, bladder/urinary system, and no erectile dysfunction or penile masses.  There was no flank pain or change in bowel habits.  Evaluations were essentially normal to include cystoscopy (visualization of the bladder) and post-void residual.  Uroflow indicated urinary straining as the only abnormality.  Narrative summary physical exam performed 4 months before separation was normal.  At the VA Compensation and Pension exam performed the month of separation, the CI reported that his penis would retract at rest or in the cold for the last year.  He denied erectile dysfunction and had no bladder difficulty, or any other difficulties referable to the genitourinary system.  Exams of the abdomen and genital/rectal exams were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both coded the condition analogous to ilioinguinal nerve neuralgia (8799-8730) at 0%.  The ilioinguinal nerve was adjudged as correct given the symptoms and location in the groin area as well as IAW VASRD §4.120 (evaluations by comparison) and VASRD §4.124a (Schedule of ratings–neurological conditions and convulsive disorders).  The highest rating for severe to complete paralysis of the ilioinguinal nerve is 10%.  For the ilioinguinal nerve, the maximum rating level for neuralgia (§4.124-nerve pain) is “moderate” (0%).  The Board also considered alternative coding and rating for neuritis (§4.123-nerve irritation/inflammation); however, the maximum is “moderate” unless there are organic changes.  There was no paralysis and no evidence of organic changes (for a “severe” rating level of 10%) and “moderate” (0%) was therefore the maximum rating level for this condition.

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 adjudication for the painful penile retraction syndrome 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 painful penile retraction syndrome condition and IAW VASRD §4.124a, 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 20140228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAMR-RB									

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXX, AR20150007659 (PD201401144)

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 and hereby deny the individual’s application.  This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		
						         
CF: 
(  ) DoD PDBR
(  ) DVA