RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02356
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Unit Supply Specialist) medically separated for left genitofemoral neuralgia and a scar from left inguinal surgery and orchiectomy.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “left genitofemoral neuralgia status post left orchiectomy” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded 7 other conditions (see rating chart below) for PEB adjudication.  The Informal PEB adjudicated a scar (from left inguinal surgery and orchiectomy) and left genitofemoral neuralgia as unfitting, rated 10% and 0%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requested the Board 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 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 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 20090924	VA* - (~2 Mos. Pre/Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Scar	7804	10%	Left Orchiectomy	7524	0%	20100128	
Left Genitofemoral Neuralgia	8799-8730	0%	Left Genitofemoral Neuralgia	8530	Def.	20100212	
Erectile Dysfunction	Not Unfitting	Erectile Dysfunction	7522	0%	20100128	
Left Sacroiliitis	Not Unfitting	Left Sacroilitis	5294	Def.	20100128	
Bilateral Sensorineural Hearing Loss	Not Unfitting	Bilateral Sensorineural Hearing Loss	6100	Def.	20100221	
Cough	Not Unfitting	No VA Placement	
Migraine Headaches	Not Unfitting	Headaches (Claimed as Migraines with Dizziness and Blackouts)	8199-8100	NSC	20100212	
Snoring	Not Unfitting	Obstructive Sleep Apnea Syndrome	6847	50%	20100128	
Adjustment Disorder	Not Unfitting	Anxiety Disorder with Major Depressive Episode	9413	30%	20100119	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3 	
RATING:  10%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20100401 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Scar Condition.  The initial MEB did not specifically spell out a scar condition, but rather the surgical procedure that resulted in a scar that the PEB placed a 10% impairment rating for pain.  The CI had direct trauma to his left testicle.  In July 2008, he underwent a scrotal exploration with a left orchiectomy (testicle removal).  The surgical procedure left the CI with a single scar.  Both the NARSUM (narrative summary) examination (06 May 2009; 7 months pre-separation) and the VA Urology examination (17 March 2010; 4 months post-separation) noted a well-healed scar without further comment IRT any associated pain.  Absent absolute evidence of pain specific to a scar would not equate to any positive impairment rating according to VASRD criteria.  Therefore, 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 listed scar condition.        

Left Genitofemoral Neuralgia Condition.  The surgical removal of the CI’s left testicle resulted in a residual painful condition surrounding the entire scrotum and adjacent left groin.  Post-operative complications included the development of a hematoma (blood-filled cyst) as well as a hydrocele (water-filled cyst) within his scrotum.  His painful symptoms were persistent and progressed in intensity and constant duration, thus prompting additional consultations with anesthesia and pain management.  The CI failed all treatment levels in an attempt for complete pain relief to include narcotic pain medications as well as local and spinal nerve blocks.  Subsequently, he was referred to a MEB in October 2008.  Despite numerous emergency room visits for pain control, the STR did not reflect any prolonged hospitalizations associated with this condition.
 
At the narrative summary (NARSUM) (06 May 2009; approximately 7 months pre-Service separation), the CI endorsed a 9/10 stabbing-like pain about his left scrotum with extension into his left thigh and abdomen.  Painful aggravators included bearing down or prolonged sitting.  His physical examination (PE) revealed marked tenderness about the scrotum, right testicle, left groin and lower abdomen.  Guarding was clearly in evidence throughout the examination.  There was no comment IRT the presence of a hernia.  The examiner noted that the CI will likely continue to suffer from severe chronic pain of the left groin and leg and that he will require long term pain management.  His prognosis with regards to complete pain relief was poor.  At the VA general medical Compensation and Pension (C&P) examination (28 January 2010; 2 months post-separation), the CI indicated his positive surgical history as presented above with no new symptoms.  The VA PE indicated the absence of the left testicle without further noted abnormalities.  There was no comment or assessment of his functional abilities and the diagnosis remained as left groin pain/residuals of left orchiectomy.  The case file did not contain a commanders’ statement noting the CI’s functional capabilities.  

The Board directed attention to its rating recommendation based on the above evidence.  Although coded differently, both the PEB and VA utilized VASRD codes associated with the Illio-inguinal nerve and rated the condition as 0% and deferred, respectively.  The PEB rated it as neuralgia whereas the VA listed the nerve as paralyzed.  Board members first deliberated on the most appropriate and beneficial coding scheme in representing the CI’s condition.  The action officer opined that this particular surgical approach and intervention is anatomically proper to involve the Illioinguinal nerve, specifically.  No matter what as to the etiology of this nerve condition, the VASRD §4.124a has only two possible ratings; 0% or 10%.  The maximum of 10% is for severe to complete paralysis.  The marked degree of tenderness/pain found on PE clearly rose above the description of mild or moderate and therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left genitofemoral neuralgia condition.  Board members also considered a higher rating under code 7525 (epididymo-orchitis, chronic only), but the condition would not rate above the 10% level as well according to the urinary tract infection (UTI) criteria.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the conditions of erectile dysfunction, left sacroliits, bilateral hearing loss (HL), cough, migraine headaches, snoring, and adjustment disorder were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Despite the absence of a permanent profile in the case file, the DD Form 2808 clearly noted a P-3 profile with the only diagnosis being the chronic left groin/scrotal pain previously discussed above.  Additionally, none of these conditions were judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination for the any of these contended conditions and so no additional disability ratings are recommended. 

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 scar condition and IAW VASRD §4.118, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left genitofemoral neuralgia condition, the Board unanimously recommends a disability rating of 10%, coded 8530 IAW VASRD §4.124a.  In the matter of the contended erectile dysfunction, left sacroliits, bilateral HL, cough, migraine headaches, snoring, and adjustment disorder conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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	
Scar Condition	7804	10%	
Left Genitofemoral Neuralgia	8530	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140527, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160004388 (PD201402356)

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,
accept the Board's recommendation to modify the individual's disability rating to 20%
without re-characterization 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:

CF:
( ) DoD PDBR
( ) DVA