RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01678
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141010
SEPARATION DATE:  20020331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCPL/E-3 (0341/Mortarman) medically separated for a left testicular condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The left testicular condition was characterized as “severe left testalgia,” and “persistent varicocele,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The Informal PEB adjudicated “severe left testalgia” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD); with the related varicocele condition listed as a related but unrated condition. The CI made no appeals and was medically separated.

CI CONTENTION:  “To include – Anxiety, PTSD [posttraumatic stress disorder], Stress fractures, Ingrown toe nails Please consider all conditions”

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 left testalgia with associated varicocele is addressed below.  The requested PTSD, stress fracture and toe conditions were not identified by the PEB and are not within the DoDI 6040.44 defined purview of the Board.   Those, and any conditions or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20020128	VA *	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Severe Left Testalgia	7599-8730	10%	Chronic Testalgia (Specifying Surgical Residuals and Neuritis)	7599-7525	10%	*	
Persistent Varicocele	“Related to [Above]”					
Other x 0  (Not in Scope)	Other x 11 (Not in Scope)	
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20021019 (most proximate to date of separation [DOS]).
* The original VARD is not in evidence, and above is extrapolated from subsequent VARD dated 2013041 (earliest of VARDs in evidence). It is not clear if the VA post-separation rating was based on Service records or VA exam evidence.  There are no VA Compensation and Pension (C&P) examinations in evidence.

ANALYSIS SUMMARY:  The Board acknowledges the missing VA records as per the above footnote, but it was judged by the members that the additional delay in a possibly futile attempt to retrieve this evidence was unwarranted; since, the VASRD rating parameters (as elaborated below) for this condition do not allow for higher rating options which would be reasonably supported by any probative evidence that might be retrieved.
Testalgia/Varicocele Condition.  The narrative summary (NARSUM), corroborated by the treatment record, provides the following chronology and evidence.  The CI first developed left scrotal pain while shipboard in September 2000, was diagnosed with a large left varicocele (engorged internal scrotal veins) and underwent a spermatic vein ligation 2 months later.  Despite the surgery, the varicocele persisted and the pain gradually increased.  He underwent a repeat ligation in May 2001 and initially improved, but his pain recurred upon return to duty.  A trial of light duty (2 weeks) and analgesics did not provide adequate relief and ultrasound confirmed the persistence of a small varicocele.  A nerve block provided temporary relief, but the pain returned and a second nerve block (September 2001) did not help.  The MEB was initiated at this point.  The NARSUM did not provide a physical examination and was conducted 7 months prior to separation.  The last entry in the treatment record (urology) was 2 months prior to separation and documented “pain level 6/10 if does not use meds, varies with activity.”  The physical exam noted a tender left varicocele, commenting “no change from previous encounters.”  As noted above there is no temporally probative VA or other post-separation evidence available.

The Board directs attention to its rating recommendation based on the above evidence.  Members first agreed that the separate conditions of testalgia and varicocele as identified by the MEB could not be considered for separate ratings IAW VASRD §4.14 (avoidance of pyramiding).  The PEB’s 10% rating was under the analogous code 8730 (neuralgia of the ilio-inquinal nerve [anatomically accurate]) is the highest rating possible under that approach.  The VA’s 10% rating was under analogous 7525 (chronic epididymo-orchitis) which defaults to the VASRD §4.115a criteria for urinary tract infection.  The 10% criterion of “long term drug therapy” under that schedule would reasonably support the VA’s decision.  The only higher rating under that schedule is 30% which specifies “frequent hospitalization” or “continuous intensive management,” and the evidence does not support either criterion.  There are no other available coding options (analogous or otherwise) under VASRD §4.115a or §4.115b which are rationally applicable to this condition.  It is worth noting that code 7524 for the loss of one testicle yields a 0% 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 adjudication of 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 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 20140417, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXXXX, DAF
President
DoD Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 13 May 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 USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX , former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN

XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)