RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02896
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Motor Transport Operator, medically separated for “chronic testicular pain” with a disability rating of 0%.  

CI CONTENTION:  The CI requested consideration of all conditions.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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:  

SERVICE PEB - 20041021	VARD – 20051017	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Testicular Pain	8799-8730	0%	Chronic Testicular Pain	7599-7532	10%	20050728	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Testicular Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right testicular pain condition coincided with his second vasectomy (vasectomy twice in 1996, reversed in 1997, and redone again in 1998).  The MEB NARSUM examination on 12 August 2004, 3 months prior to separation, noted complaints of right testicular pain described as deep and squeezing in nature with no burning or lancinating (sharp radiating) component.  Pain was constant at 3-4/10 and was exacerbated by prolonged standing, heavy sexual activity, or heavy exertion.  The CI was on narcotic pain medication and had a prior “fracture” of his penis.  Physical examination showed the right testis as “exquisitely tender” with a small palpable nodule (less than 1 cm) on the medial aspect of the testis.  There was a well-healed scars on the penis.  The diagnosis was recalcitrant orchalgia (right testicular pain).  

At the 5 August 2004 VA Compensation and Pension (C&P) evaluation, performed 3 months before separation, there was no reported testicular pain condition, although VA treatment notes did indicate medication for groin pain.  Genital examination was normal.  

At the 28 July 2005 C&P evaluation, performed 9 months after separation, the CI complained of chronic right groin pain that occasionally shot down the right medial thigh.  Examination showed that the right testicle was larger than the left and much more tender to any palpation.  There were no abnormality of spermaticords or vessels noted, and no lesions or masses.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic testicular condition 0%, coded 8799-8730 (Ilio-inguinal nerve neuralgia), citing pain rated as moderate.  The VA rated testicular pain at 0% analogous to 7532 (renal tubular disorders) based on treatment notes.  Following the VA examination 9 months after separation, the VA rated the chronic testicular pain at 10% coded analogous to 7525 (epididymo-orchitis, chronic only) citing long-term drug therapy.  

The Board deliberated if the condition was more appropriately rated under a peripheral nerve code (neuritis of the ilio-inguinal nerve), or under the genitourinary system (chronic epididymo-orchitis).  The Board adjudged that given the testicular tenderness and mass at the NARSUM (or testicular enlargement on the VA examination), with a clinical diagnosis of recalcitrant orchalgia, the condition most nearly approximated chronic epididymo-orchitis rather than a neuralgia of the inguinal nerve (IAW §4.20, analogous rating).  There were no frequent hospitalizations or requirement for intensive management, however, the CI was on long-term drug therapy, supporting a rating of 10%.  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 chronic testicular pain condition, coded 7599-7525.  

BOARD FINDINGS:  In the matter of the chronic testicular pain condition, the Board unanimously recommends a disability rating of 10%, coded 7599-7525 IAW VASRD §4.115b.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Testicular Pain…	7599-7525	10%	
COMBINED	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX AR20160013874 (PD201402896)

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