RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02482
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050509  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Canon Crewmember) medically separated for bilateral testicular pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent P3E2 profile and referred for a Medical Evaluation Board (MEB).  The “testicular pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded eight other conditions (see rating chart below) for PEB adjudication.  The Informal PEB adjudicated the bilateral testicular pain condition as unfitting, rated 0% with 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 applicant has asked for consideration of all conditions.  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 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 20050408	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Testicular Pain…	8799-8730	0%	Orchalgia (Claimed as Testicular Pain)	7599-7525	10%	20050705	
Adjustment Disorder	Not Unfitting	Schizoid Personality Disorder (Also Claimed as
Adjustment Disorder)	9399-9327	NSC	20050705	
Schizoid Personality Disorder	Not Unfitting					
Attention Deficit Disorder	Not Unfitting 	Attention Deficit/Hyperactive Disorder	9399-9327	NSC	20050705	
Gastroesophageal Reflux	Not Unfitting	Gastroesophageal Reflux Disease	7346	10%	20050705	
Recurrent Back Pain with Scoliosis	Not Unfitting	Thoracokyphosis with Lumbosacral Strain	5237	10%	20050705	
Pes Planus with Recurrent Ankle Tendinitis	Not Unfitting	Left Ankle Sprain	5271	NSC	20050705	
		Right Ankle Sprain	5271	0%	20050705	
		Bilateral Pes Planus	5276	NSC	20050705	
Visual Defect…	Not Unfitting	Visual Defect	No VA Placement	
Recurrent Elbow Tendinitis	Not Unfitting	Left Elbow Epicondylitis	5024	NSC	20050705	
		Right Elbow Epicondylitis	5024	NSC	20050705	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3 (equals SC, NSC & deferred)	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20060207 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Bilateral Testicular Pain:  The narrative summary (NARSUM) and treatment record indicated that the CI developed bilateral testicular pain following a vasectomy in September 2004.  The pain interfered with duty and was not relieved by medications, scrotal support, or other treatments.  At the MEB exam, the CI reported constant bilateral scrotal pain aggravated by physical exertion and mental stress.  He could walk at his own pace up to 15 minutes but could not lift over ten pounds or tolerate running or impact activities without significant increase in pain.  The MEB physical exam noted “bilateral testicular tenderness, left greater than right, and the left at the point of vasectomy was markedly tender, but otherwise the urological examination was normal.”  At the VA Compensation and Pension (C&P) exam performed 2 months after separation, the CI reported similar history with pain at 5/10 on a daily basis.  He had some flare ups that occurred during stressful times and during physical activity; approximately two times per week and lasting for two hours.  Sexually active did not increase the testicular pain.  Genital examination showed normal testes without tenderness to palpation. There were no other scrotal masses or hernia.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 0% analogous to 8730 (ilioinguinal neuralgia) as moderate.  The VA rated the condition at 10% analogous to 7525 (chronic epididymo-orchitis).  Given the tenants of VASRD §4.124 (neurologic system) and §4.124a, 0% is the highest available rating for ilioinguinal neuralgia of either side or both sides.  Either analogous coding could reasonably represent the CI’s underlying pathology; however, coding under 7525 was predominant.  The disability rating level of 10% coded 7599-7525 (under §4.115a and b; genitourinary system) best represented the CI’s condition at separation.  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 bilateral testicular pain condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that adjustment disorder, attention deficit disorder, schizoid personality disorder, GERD, recurrent back pain with scoliosis, pes planus, ankle tendinitis, visual defect, and recurrent elbow tendinitis 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.  None of the conditions were profiled or judged to fail retention standards.  The commander’s statement implicated only the post-vasectomy (unfitting) condition and behavioral (mental health) conditions.  All contended condition were reviewed and considered by the Board.  

The CI’s mental health / behavioral-related conditions of adjustment disorder, attention deficit disorder, and schizoid personality disorder are all conditions not constituting a physical disability IAW DODI 1332.38, E5 in effect at the time.  Ideally they would have been adjudicated as non-compensable conditions.  There was no performance based evidence from the record that any of the contended and potentially compensable 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 fitness determination for the any of the 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 bilateral testicular pain condition, the Board unanimously recommends a disability rating of 10%, coded 7599-7525 IAW VASRD §4.115a and b.  In the matter of the contended adjustment disorder, attention deficit disorder, schizoid personality disorder, GERD, recurrent back pain with scoliosis, pes planus, ankle tendinitis, visual defect, and recurrent elbow tendinitis 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	
Bilateral Testicular Pain	7599-7525	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140519, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160005110 (PD201402482)

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 10%
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