RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03127
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050825

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “left testicular pain secondary to left varicocele…” with a disability rating of 0%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively impact his daily activities.  Additionally, Veterans Affairs evaluated the CI for multiple other conditions not identified by the MEB or PEB.  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 - 20050616	VARD - 20070416	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Testicular Pain Secondary to a Left Varicocele…	7599-7525	0%	Left Scrotal Varicocele with Chronic Left Testicular Pain	7599-7523	0%	20070211	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Testicular Pain Secondary to a Left Varicocele.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was diagnosed with a left-sided varicocele (dilated scrotal blood vessels) in March 2003.  Although offered, the CI declined surgical intervention.  Conservative pain control methods, to include many different medications, failed to provide complete relief.  His condition could not be rehabilitated to meet the physical requirements of his military specialty and he was referred to an MEB.  The MEB forwarded “left scrotal varicocele with chronic left testicular pain unresponsive to conservative treatment” to the PEB for adjudication.  

The MEB NARSUM examination on 2 May 2005, 4 months prior to separation, noted complaints of left sided scrotal/testicle pain aggravated by running, repetitive lifting, and driving over rough terrain.  His physical examination (PE) revealed a large left scrotal varicocele.  A VA Compensation and Pension (C&P) examination near separation was not contained in the case file and therefore, the STR and MEB derived documents were exclusively probative in rendering a final impairment rating.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 7525 code (epididymo-orchitis), citing a painful varicocele.  The VA also assigned a 0% rating using an analogous 7523 code (testis, atrophy, complete) based upon a remote C&P examination performed 18 months after separation, citing no actual atrophy in the testicle.  Board members first deliberated on the most appropriate and beneficial coding that best represents the CI’s condition.  The CI’s pathologic intervention in this case clearly indicated anatomical involvement of the left testicle and with surrounding inflammation of the adjacent structures of blood vessels and the epididymis and therefore, coding under the primary code of 7525 was appropriate.  VASRD §4.115b dictates that code 7525 be rated as the same as a urinary tract infection (UTI) under §4.115a.  The UTI coding pathway has two possible ratings; 10% (long term drug therapy) or 30% (recurrent infections and intensive management).  Despite the persistence of symptomatic and subjective pain, the continued use of various pain medications supported the 10% rating level of “long-term drug therapy”.  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 testicle condition.

BOARD FINDINGS:  In the matter of the left testicle 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	
Left Testicular Pain Secondary to a Left Varicocele	7599-7525	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140626, 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 XXX, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160017160 (PD201403127)

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