RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-03506
BRANCH OF SERVICE:  Army                                                                   SEPARATION DATE:  20050616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Microwave Systems Operator-Maintainer,  medically separated for “chronic testicular pain…” with a disability rating of 0%.  

CI CONTENTION:  “Please consider 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 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:  

SERVICE PEB - 20050419	VARD - 20060728 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Testicular Pain…	8730	0%	Bilateral Epididymectomy with Testicular Pain	7525	30%	STR	
Bilateral Shoulder Pain	Not Unfitting	No VA Placement	
Right Ankle Pain			
Bilateral Knee Pain			
Bilateral Carpal Tunnel Syndrome			
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Testicular Pain.  The CI was first seen for right testicular pain on 4 February 2003, 4 months after accession and a year after a vasectomy.  He reported a 1-day history of pain and that this was the same pain that he had experienced 4 months after the vasectomy.  He was treated with rest and medications, but had persistent pain.  He was seen the next day and reported the onset of pain 6 months previously.  His right testes was exquisitely tender and he was again treated with medications.  He was seen multiple times over the next 6 weeks and then seen in urology.  There, he reported that this was the fourth occurrence of these symptoms and that previously the pain had resolved with antibiotics.  His symptoms persisted and a bilateral epididymectomy was performed on 4 August 2003.  He was treated with narcotics, but continued to have pain.  He underwent a permanent change of station and was evaluated in urology at his new duty station on 17 June 2004.  His testes were noted to be minimally tender, but his prostate was boggy and tender.  Palpation of the prostate reproduced his pain.  He was thought to have chronic prostatitis and treated with antibiotics with improvement in his pain initially, but then it recurred.  An ultrasound on 14 July 2004 was normal other than expected post-surgical changes.  The CI was seen in the pain management clinic on 11 August 2004 and reported that his pain began 8 months after a vasectomy in February 2001.  (Note: elsewhere, the record indicated that it was February 2002).  He reported constant pain that varied in intensity (apparently with activity).  He was able to rise from a chair without using the arms and his gait was normal without either side being favored.  He stated that he had tenderness when walking, but was able to rise onto his toes, heels, and both sides of his feet without reproduction of the pain and without difficulty.  The testes were very tender to palpation, but the scrotum was not.  He was seen in follow-up in pain management on 8 September 2004 and was taking methadone for pain.  He requested a medication which allowed him to stay “sharp” as he desired to remain in the U.S. Army.  On examination, he was in no distress and his current medications continued.  

On 28 September 2004, he reported increased pain after having been in the field for 3 weeks and that he had increased his Methadone to three times a day vice twice a day (contrary to instructions).  He was noted to grimace and moan as he rose from the chair but to have a normal gait walking down the hall.  In pain management on 29 October 2004, he reported ongoing pain that prevented the performance of his duties and that he was going to be discharged.  He was noted to have a normal gait and an examination essentially unchanged from a month earlier.  The gradual discontinuation of Methadone was planned and the use of a spinal cord stimulator discussed.  On 17 November 2004 in pain management, he appeared to be in no acute distress, but had a slow and controlled gait.  The CI was again evaluated in urology on 3 January 2005 to see if any treatment options remained.  Each testis was “exquisitely tender,” but the examination otherwise unremarkable other than expected post-surgical findings.  The CI underwent a local block that day and again on 10 January 2005 with some temporary relief of his symptoms initially, but a third block on 24 January 2005 provided no relief.  The urology note dated 24 January 2005 noted “I cannot find any causative factor that is curable.”  There were no further clinical records in evidence prior to separation.  

At the Medical Evaluation Board (MEB) examination on 8 April 2005, 2 months prior to separation.  The testes were very tender.  The narrative summary (NARSUM) was dated 11 April 2005.  The CI reported ongoing pain despite treatment.  The examination appeared to mirror that of the above MEB examination in all areas.  Following separation, there were no records in evidence until 9 March 2006 when he had a computerized tomography scan for right flank pain after being hit by a fellow patient in inpatient drug rehabilitation.  A cancer of the right kidney was discovered and subsequently removed surgically.  At a follow-up appointment on 17 April 2006, he was healing well from the kidney removal, but reported chronic testicular pain.  

The VA Compensation and Pension (C&P) examination was not performed until 6 November 2007, 29 months after separation and well outside the normal 12-month window assigned high probative value for rating.  On examination though, the testes were normal size and shape and tenderness was not recorded.  The scrotum, however, was very tender and the CI recoiled with pain at the slightest touch.  The Board observed that this examination is unlike those prior to separation in which the testes were tender and the scrotum unremarkable.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic testicular pain at 0% using the code 8730 (neuralgia of the ilioinguinal nerve) at a mild to moderate level.  The VA rated bilateral epididymectomy with testicular pain at 30%, coded 7525 (epididymo-orchitis) for continuous intensive management.  The Board considered both coding options and determined that the 7525 code was a better clinical description of the underlying pathology.  However, there is no record that the CI was seen for the condition other than for the MEB examination for over a year from January 2005 until April 2006.  While the CI had been treated with medications and also a series of three injections, this level of care does not rise to the level of continuous intensive management to support a 30% rating.  A rating of 10%, for intermittent intensive management, better describes the clinical picture.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the chronic testicular pain condition coded 7525.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that bilateral shoulder pain, right ankle pain, bilateral knee pain, and bilateral carpal tunnel syndrome (CTS) conditions 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.  None were profiled and none were judged to fail retention standards.  The commander only noted the chronic testicular pain in his statement.  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 at separation.  After due deliberation and 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:  In the matter of the chronic testicular pain condition, the Board unanimously recommends a disability rating of 10%, coded 7525 IAW VASRD §4.115a.  In the matter of the contended bilateral shoulder pain, right ankle pain, bilateral knee pain, and bilateral CTS 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.  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 Testicular Pain… 	7525	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140722, 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 AR20160011984 (PD201403506)

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.

			      

CF: 
(  ) DoD PDBR
(  ) DVA