RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03228
BRANCH OF SERVICE:  Army	BOARD DATE:  20150610
SEPARATION DATE:  20090127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Human Resources) medically separated for ilio-inguinal neuralgia.  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  “Chronic left scrotal pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other medically acceptable conditions (parasomnia-sleep walking & sleep talking disorder, obstructive sleep apnea [OSA], nicotine dependence, gastroesophageal reflux disease and G6PD deficiency) for PEB adjudication.  The Informal PEB adjudicated “ilio-inguinal neuralgia” as unfitting, rated 0%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  He was not evaluated for his TBI, PTSD or migraine conditions.  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 20081223	VA* - (~5 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ilio-inguinal Neuralgia	8799-8730	0%	Left Varicocele	7599-7525	0%	20090507	
Other MEB/PEB Conditions x 5 (Not In Scope)	Other x 4 	
RATING:  0%	RATING:  80%	
*Derived from VA Rating Decision (VARD) dated 20100127 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Ilio-Inguinal Neuralgia.  Prior to 2005, the CI was diagnosed with bilateral varicoceles (varicose veins within the scrotum above the testicle) with the left side being larger and more painful than the right.  The initial clinical document within the service treatment record was a request from the CI to extend his temporary profile due to scrotal pain with activities.  Throughout a 3-year period (2005-2008) the CI was seen numerous times in both primary care and urology for either scrotal and or groin pain.  Although surgical correction was offered, the CI refused such option in fear of “possible” resultant sterility.  Despite all measures of conservative treatment, his painful symptoms remained and he was referred to a MEB.  At the MEB narrative summary examination the CI’s chief complaint was chronic left scrotal pain.  The physical examination (PE) revealed a left tender varicocele.  There was no description of any right-sided pathology.  The documented prognosis was “Without corrective surgery [the CI] has the possibility of the varicocele causing progressive pain, increasing limitations of activities and possible infertility.”  At the VA Compensation and Pension examination the CI endorsed not having any functional impairment from the varicocele condition.  The PE revealed “thickening of the left spermatic cord’.  His VA diagnosis was ‘possible asymptomatic left varicocele.”  The Board directed its attention to its rating recommendation based on the above evidence.

The PEB and the VA used different coding options for the condition but arrived at the same rating determination.  The PEB coded as analogous to ilio-inguinal neuralgia, moderate (8799-8730), rated 0%.  The VA coded as analogous to epididymo-orchitis (7599-7525), also rated 0%.  The Board members agreed that the selected ilio-inguinal nerve was appropriate in this case as it provides the majority of sensation to the upper portion of the scrotum.  Per VASRD §4.124, Board members then acknowledged that the maximum rating allowed for neuralgia is equal to “moderate incomplete paralysis” (in this case, 0% for the ilio-inguinal nerve).  The record of evidence did not support a diagnosis of neuritis IAW VASRD §4.123, and there were no organic changes.  There was no documentation of voiding dysfunction, urinary frequency or recurrent urinary tract infection to justify alternate coding as directed under code 7525.  There is no route to a rating higher than 0% under any applicable code and no coexistent pathology which would merit additional rating for the scrotal pain condition under a separate code.  All evidence considered, there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s coding or rating decision for the ilio-inguinal pain 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 Ilio-inguinal pain condition and IAW VASRD §4.124, 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 20140705, 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 XXXXXXXXXXXXXXXXXXXXX AR20160003181 (PD201403228)

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:

CF:
( ) DoD PDBR
( ) DVA