RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2014-03142
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Infantryman) medically separated for “chronic left testicular area pain due to persistent varicocele,” rated at 0%.  

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.  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 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: 

Revised PEB - Dated 20090219	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Testicular…	8799-8730	0%	Left Epididymitits Status Post Varicocelectomy with
Erectile Dysfunction	7599-7804	10%	20080507	
Erectile Dysfunction	Not Unfitting 					
Right Shoulder Pain	Not Unfitting 	Right Shoulder Subluxation	5202	0%	20080507	
Mild Bilateral Hearing Loss	Not Unfitting 	Right Ear Hearing Loss	6100	0%	20080510	
		Left Ear Hearing Loss	6100	NSC	20080507	
Tinnitus	Not Unfitting 	Tinnitus	6260	10%	20080507	
Headache Disorder	Not Unfitting 	Migraine/Tension Headaches	8100	0%	20080507	
Anxiety, Mild	Not Unfitting 	Anxiety Disorder	9413	10%	20080507	
Insomnia	Not Unfitting 					
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1  (equals SC, NSC & deferred)	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20080620 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Left Testicular Area Pain due to Persistent Varicocele Condition. The CI presented in 2005 with left groin pain.  He was evaluated by urology and diagnosed with a left testicular varicocele (prominent blood vessels).  He underwent a trial of conservative management with anti-inflammatory medications, jock strap, and activity modification.  The pain persisted and on 11 January 2006 the CI underwent ligation of the left varicocele.  Post-surgical radiographic evaluation dated 11 December 2006 demonstrated a stable left varicocele without a change in size with Valsalva maneuver.  Despite conservative and surgical management, the CI continued to report left testicular pain.  The narrative summary (NARSUM) examination demonstrated left testicular tenderness to palpation.  At the VA Compensation and Pension (C&P) examination performed 3 months after separation, the CI reported intermittent left testicular pain.  The physical examination demonstrated an enlarged, tender left epididymis and asymptomatic, small, left varicocele.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the unfitting chronic left testicular pain due to persistent varicocele condition at 0%; coded 8799-8730 (analogous to mild paralysis of the ilioinguinal nerve).  The VA rated the condition at 10%; coded 7599-7804 (genitourinary condition analogous to unstable or painful scar).  The Board considered whether the evidence supported a higher than 0% rating.  IAW VASRD § 4.124 neuralgia has a maximum rating equal to moderate incomplete paralysis which in this case is 0%.  The Board then considered that VA coding option and determined that persistent left testicular pain post-surgical residual met criteria for a 10% rating analogous to a painful scar.  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 left testicular pain condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that erectile dysfunction, right shoulder pain, mild bilateral hearing loss, tinnitus, mild anxiety, headache disorder, and insomnia 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.  

Erectile Dysfunction. At the VA C&P examination the CI reported intermittent erectile dysfunction.  The dysfunction was only present when he was experiencing increased testicular pain.  The VA rated the condition in conjunction with the left testicular condition. Erectile dysfunction does not constitute a physical disability.  

Right Shoulder Pain.  At the VA C&P examination the CI reported the onset of right shoulder pain in 2006 while deployed.  He was treated with ice. He continued with intermittent pain.    The pain was present with forward, overhead activities and “brief” in duration.  The examiner noted to subluxation of the right shoulder posteriorly with application of pressure to the right elbow.  The physical examination demonstrated normal muscle strength and range-of-motion.  The VA rated the right shoulder pain at 0%.

Hearing Loss/Tinnitus.  The CI had an audiogram dated 15 February 2005 which demonstrated mild bilateral hearing loss.  He was referred to the hearing conservation program.  At the VA C&P examination the CI reported difficulty understanding speech, hearing in the presence of background noise, and hearing on the phone.  He also reported tinnitus.  An audiogram performed 10 May 2008 demonstrated mild right ear hearing loss with 98% right and 100% left word recognition.  The VA rated the right hearing loss at 0%, tinnitus at 10%, and the left ear hearing loss was not Service connected.  

Anxiety.  The MEB forwarded mild anxiety as medical acceptable.  At the VA C&P examination 3 months post-separation, the CI endorsed low mood, anxiety, intermittent nightmares, vivid memories of Iraq, intrusive thoughts, being easily startled, hypervigilance, emotional numbing, and avoidance behavior.  also reported symptoms of depression (inability to focus, loos of interest, decreased appetite, and poor motivation) and anxiety (racing thoughts, heart flutters, and shortness of breath) The mental status examination was normal except for a Global Assessment of Functioning (GAF)score of 70 (mild) was assigned.  A diagnosis of anxiety disorder, not otherwise specified was rendered and the examiner opined that the ci did not meet the criteria for posttraumatic stress disorder (PTSD).  The VA rated the anxiety disorder at 10%.  At a VA mental health evaluation 6 months after separation continued to report symptoms of depression, anxiety, and PTSD (intermittent nightmares, vivid memories of Iraq, intrusive thoughts, being easily startled, hypervigilance, emotional numbing, and avoidance behavior).  The mental status examination was normal except an anxious, depressed mood and affect restricted and mood congruent. A GAF score of 50 (moderate) was assigned.  Diagnoses of PSTD and major depression, recurrent moderate were rendered.  

Headache Disorder.  The MEB forwarded headache disorder as medically acceptable.  At the VA C&P examination 3 months post-separation the CI endorsed the onset of headaches in 2005.  He reported the use of analgesic and ice pack for headaches.  The headaches occurred once to twice per month with associated light and sound sensitivity.   He also reported daily, mild occipital, cervical (back of the head) headaches.  The cervical and neurologic examinations were normal.  The VA rated the migraine condition at 0%.  

Insomnia.  The MEB forwarded headache disorder as medically acceptable.  At the VA C&P examination 7 months post-separation the CI endorsed poor, interrupted sleep. The CI attributed his insomnia to his headaches and flashbacks.  

The above conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  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 erectile dysfunction, right shoulder pain, mild bilateral hearing loss, tinnitus, mild anxiety, headache disorder, and insomnia 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 chronic left testicular pain condition, the Board unanimously recommends a disability rating of 10%, coded 7599-7804 IAW VASRD §4.118.  In the matter of the contended erectile dysfunction, right shoulder pain, mild bilateral hearing loss, tinnitus, mild anxiety, headache disorder, and insomnia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  

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	
Chronic Left testicular pain	7599-7804	10%	
RATING	10%	
The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140628 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 XXX, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXX, SSN XXX-XX-XXXX, AR20160004063 (PD201403142)

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: