RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02681
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20080521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Human Resources Specialist) medically separated for scrotal and 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 L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic scrotal pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated the scrotal and testicular pain as unfitting, rated 0%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant has asked for consideration of all conditions 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 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 20080318	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Scrotal and Testicular Pain ...	8799-8730	0%	Chronic Scrotal Pain and Swelling	7525	NSC	STR	
Other x 0 (Not In Scope)	Other x 3 (equals SC, NSC & deferred)	
RATING:  0%	RATING:  NSC	
*    Derived from VA Rating Decision (VARD) dated 20100526 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Scrotal/Testicular Condition. According to the NARSUM (corroborated by the subsequent VA exam referenced above), the CI experienced an onset of “spontaneous groin (scrotal and testicular) pain in March of 2006” during prior Army Reserve service (active duty enlistment began 8 June 2006).  He was treated presumptively for epididymitis, but the pain persisted and defied a specific diagnosis.  Ultrasound demonstrated normal testicles, “moderate” bilateral varicoceles (engorged internal scrotal veins), and “small” bilateral hydroceles (fluid collections); and, urology opined that these findings were not associated with the symptoms.  Analgesics were prescribed which controlled the pain at rest but “did not prevent pain with running and lifting ... [and] ... after being on continuous temporary profiles for ten months the patient, at the request of his unit, received a fitness for duty evaluation [resulting in a permanent profile and MEB referral]).”  The NARSUM examiner stated that there was “minimal pain at rest 1-2/10 and significant pain 8/10 with running and lifting.”  The specified limitations were “wearing body armor, standing for prolonged periods of time, lifting greater than 40 pounds, and running.”  These were corroborated in the commander’s statement.  The NARSUM physical examination recorded “bilateral varicoceles, left testicle tender to palpation no masses, no hernias.”  The VA examination temporally remote from separation reported persistent intermittent pain treated with over-the-counter ibuprofen, and specified that there was no occupational interference. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating was under the analogous code 8730 (neuralgia of the ilio-inquinal nerve), which confers a 0% rating for “mild or moderate” impairment and a maximum 10% for “severe.”  The only other code available in the VASRD which might be considered is the VA’s initial choice of 7525 (epididymo-orchitis); but, this defaults to rating as urinary tract infection for which there are no ratable symptoms in this case.  Members agreed that the CI’s disability at separation was fairly characterized as mild to moderate and that the severe rating (10% under 8730) was not reasonably justified.  Within the confines of the VASRD, therefore, it was agreed that there was no defensible route to a higher rating recommendation.  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 scrotal/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 scrotal/testicular 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 20140521, 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 XXXXXXXXXX, AR20160003784 (PD201402681)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA