RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-02986
BRANCH OF SERVICE:  Army  	BOARD DATE:  20150430
SEPARATION DATE:  20070201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Infantryman) medically separated for chronic right scrotalgia.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, his physical profile authorized him to perform an alternate aerobic Army Physical Fitness Test event.  He was issued a permanent P3/L3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “chronic refractory right scrotalgia” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (see rating chart below) for PEB adjudication.  The Informal PEB adjudicated “chronic right scrotalgia refractory to multiple treatments” as unfitting, rated 20%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “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 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 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:  

IPEB – Dated 20061018	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Refractory Right Scrotalgia	5099-5003	20%	Scars, Abdominal and Inguinal…	7805	0%	20061207	
			Right Orchiectomy	7524	0%	20061207	
LFHL and HFHL	Not Unfitting	Bilateral Hearing Loss	6100	NSC	20061207	
GERD	Not Unfitting	GERD and Ulcer	7399-7346	10%	20061207	
Left Ankle Pain	Not Unfitting	…Left Ankle…	5262	0%	20061207	
Other x 0 (Not In Scope)	Other x 6 	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070221 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Refractory Right Scrotalgia.  The CI first presented with right sided groin pain on 4 October 2002 and was thought to have inflammation of the epididymis (a tube which carries sperm from the testis).  He was treated with an antibiotic.  An ultrasound (U/S) was non-diagnostic.  He again presented to the emergency room with right sided pain on 4 November 2002 and was referred to urology, but deployed prior to his evaluation.  His pain persisted and he was then evaluated again after re-deployment.  A repeat U/S on 24 August 2004 was unremarkable other than a non-specific accumulation of fluid (hydrocele) in the epididymes bilaterally.  The right epididymis was surgically removed and the left vas deferens transected (vasectomy).  A month after surgery, he was doing well and released to full activity.  He subsequently developed significant pain in the right testis (orchalgia) and on 8 August 2005 had denervation of the right spermatic cord.  His pain continued though and on 20 January 2006 he had a right orchiectomy (removal of the testis).  His pain persisted despite the surgery and medications; he was then entered into the MEB process.  At the MEB examination on 21 June 2006, the CI made no comment on the right scrotalgia condition.  The examiner noted that there was moderate to severe pain with palpation of the right side of the scrotum and a tender surgical scar.  Movement of the hip aggravated the pain.   The narrative summary (NARSUM) was dated 27 August 2006, 5 months prior to separation.  The CI reported persistent pain refractory to the above treatment and that he used narcotics daily for pain control.  The examiner cited the above MEB examination.  

At the VA Compensation and Pension (C&P) examination performed on 7 December 2006, 2 months before separation, the CI reported continued pain, but denied complications or functional impairment from the right sided groin pain.  He reported that he could do all activities, including pushing a lawnmower, except for gardening.  It was not explained why this was limited.  On examination, the scars were well healed and without complications or tenderness.  Examination of the groin was unremarkable other than an absent right testis.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the right scrotalgia condition at 20% using the code 5099-5003 (analogous to degenerative arthritis) utilizing the pain policy.  The VA rated the condition at 0% for the right orchiectomy using the code 7524 (removal of a testis) and 0% for the scars using the code 7805 (scars).  The Board considered these codes and others applicable to the condition and found no route to a rating higher than the 20% adjudicated by the PEB.  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 right scrotalgia condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended low and high frequency hearing loss; gastroesophageal reflux disease (GERD) and left ankle pain conditions.  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.  All were reviewed and considered by the Board.  None were profiled, implicated in the commander’s statement, or judged to fail retention standards.  The VA C&P examination showed normal hearing.  The CI was on medications for the GERD condition and reported no functional impairment to the C&P examiner.  Regarding the left ankle, he reported that he could function without medications, had no functional impairment, and denied incapacitation.  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 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the right scrotal pain was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right scrotalgia condition and IAW VASRD §4.115b, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended low and high frequency hearing loss, GERD, and left ankle 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, 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 20140619, 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 XXXXXXXXXXXXXXXXXX, AR20150018809 (PD201402986)

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