RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01464
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20080815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Field Radio Operator) medically separated for a pain condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The “other chronic pain” and “displacement of lumbar intervertebral disc without myelopathy,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “left chronic orchialgia (testicular pain), refractory” as unfitting, rated 0%.  The remaining condition was determined to be Category III, not separately unfitting and did not contribute to the unfitting condition.  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 Military/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 20080605	VA* - (~1 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Chronic Orchialgia	8530	0%	Left Spermatocele	7525	0%	20080714	
Other MEB/PEB Conditions x 1(Not in Scope)	Other x 6 	
RATING:  0%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20081106 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:

Scrotal Condition.  In 2007 the CI insidiously developed left testicular pain which progressed in intensity and constant duration.  Scrotal ultrasounds revealed left epididymal swelling and a spermatocele (fluid-filled cyst).  The service treatment record reflected a pain scale of 5-8/10 intensity and increased with lifting and standing.  The CI failed all treatment levels in an attempt for complete pain relief to include medications, local blocks, and rest.  He was placed on LIMDU on 1 November 2007 and eventually was sent to a MEB.  At the narrative summary performed on 30 April 2008 (4 months prior to separation), the CI endorsed continued left testicular pain.  The examination revealed acute tenderness of a normal-appearing left testicle.  Urologic laboratory analyses were normal.  His diagnosis was left chronic orchialgia.  The examiner’s prognosis included the likelihood that the CI “…would continue to have chronic bothersome orchialgia which may limit function and impair him from doing activities which require physical exertion.”  The recommended treatment included scrotal support, sitz baths and non-steroidal anti-inflammatory medications.  

At the VA Compensation and Pension (C&P) examination performed on 14 July 2008 (a month prior to separation), the CI reported having constant left testicular pain with occasional swelling and worsened with any activity including sitting, walking, or running.  His examination revealed marked tenderness of the left scrotum.  There was no evidence of testicular swelling or mass.  The VA’s diagnosis remained left orchialgia with associated spermatocele.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating coded 8530 (paralysis; ilioinguinal nerve) whereas the VA also assigned a 0% rating coded 7525 (epididymo-orchitis; chronic) IAW §4.115b.  The action officer opined, and Board members agreed that the most accurate and clinically appropriate diagnosis in this case was the epididymo-orchitis as designated by code 7525 and utilized by the VA.  VASRD guidance dictates code 7525 be rated under the urinary tract infection (UTI) criteria IAW §4.115a for consideration of a possible 10% or 30% impairment rating.  Members considered the referenced UTI criteria and agreed that the evidence supported the 10% rating analogous to 7525 for use of long-term drug therapy (in this case for pain control), but does not meet the 30% criteria of poor renal function or evidence that demonstrated recurrent symptomatic infection requiring drainage or hospitalization greater than two times per year, or continuous intensive management.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the left 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 left testicular condition, the Board unanimously recommends a disability rating of 10%, coded 7525 IAW VASRD §4.115a.  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:  

CONDITION	VASRD CODE	RATING	
Chronic Left Orchialgia	7525	10%	
RATING	10%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140223 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 16 Dec 15 ICO XXXXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 22 Dec 15 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 28 Dec 15 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 21 Dec 15 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 16 Dec 15 ICO XXXXXXXXXXXXXXXXXXXX 

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (f) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.
       
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)