RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03944
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20041215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Marine, medically separated for “chronic testicular pain…,” with a disability rating of 10%.  

CI CONTENTION:  The CI requested consideration of 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 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 - 20041025	VARD - 20130222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Testicular Pain…	7599-7525	10%	Varicocele, Left	7599-7120	10%	20130208	
Post-Surgical Infected Wound Abscess	Cat II	No VA Placement	
Non-Ossifying Fibroma Left Tibia	Cat III	No VA Placement	
Bilateral Patello-Femoral Syndrome	Cat III	No VA Placement	
Bilateral Iliotibial Band Syndrome	Cat III	No VA Placement	
Bilateral Posterior Tibial Tendonitis	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Testicular Pain.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s testicular pain condition began in March 2004 without any specific injury or trauma.  Two varicocele surgeries (microscopic, then laparoscopic) were performed in April and July 2004, with subsequent development of a groin abscess.  The groin abscess resolved without any complications.  Despite treatment, the testicular pain condition could not be adequately treated to meet the physical requirements of the CI’s military specialty and an MEB was initiated.  The MEB forwarded “chronic testicular pain post left subinquinal varicocele ligation x 2” for PEB adjudication.  

At a urology visit in September 2004, 3 months before separation, the CI reported pain resulting in hospital admission, and denied urinary and bowel difficulties.  He had not been working at all.  Physical examination showed a tender testicle with no lesions, and a normal urinalysis.  The examiner diagnosed a self-limiting condition of orchalgia, as there was no improvement after varicocele surgery, and recommended continuous wear of scrotal support and medications for pain.  

At the MEB NARSUM examination on 14 September 2004, 3 months prior to separation, the CI reported 6/10 pain, compliance with light duty restrictions, and inability to participate in any strenuous activities such as running, jumping, climbing, etc.  The examiner documented normal gait, full range of motion of all extremities, and tenderness of the left groin without masses.  At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated September 2004, the CI reported continued “moderate” pain.  Physical examination showed groin tenderness with no hernia, varicoceles, or masses noted.  There was no VA Compensation and Pension (C&P) examination performed within 12 months of separation.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 10% rating for the chronic testicular pain analogously coded 7599-7525 (epididymo-orchitis, chronic only).  The Navy PEB also listed post-surgical infected wound abscess as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The impairment from the post-surgical infected wound abscess was properly subsumed under the overall rating for the chronic testicular pain IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA also assigned a 10% rating analogously coded 7599-7120 (varicose veins) based on the STRs and the VA C&P examination 8 years post-separation, citing constant pain.  

The Board considered the evidence for a rating higher than 10%.  IAW VASRD §4.20 (analogous ratings), when an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the function is affected, but the anatomical localization and symptomatology are closely analogous.  In this case, rating the testicular pain or orchitis under either diagnostic codes for 7120 (varicose veins) or 7525 (epididymo-orchitis, chronic only) would be appropriate.  The 7525 code specifies rating as a urinary tract infection.  There was no evidence of urinary frequency, obstructed voiding, or voiding dysfunction.  There was no evidence of recurrent symptomatic infections requiring drainage or frequent hospitalizations (greater than 2 times per year), or continuous intensive management for this condition for a higher rating.  There was evidence of chronic pain requiring long term drug therapy (narcotics) in support of a 10% rating, analogously coded 7599-7525.  The 7120 code for varicose veins specifies persistent edema, incompletely relieved by elevation, with or without stasis pigmentation or eczema for a 20% rating.  There was no evidence of persistent edema or changes in the skin associated with chronic varicosities.  Therefore, rating analogously to 7120 would be of no benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the “chronic testicular pain” condition.  

Contended PEB Conditions: Non-Ossifying Fibroma Left Tibia; Bilateral Patello-Femoral Syndrome; Bilateral Iliotibial Band Syndrome; and Bilateral Posterior Tibial Tendonitis.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic testicular pain condition and IAW VASRD §4.115b, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended (Category II) post-surgical infected wound abscess condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  In the matter of the contended (Category III) non-ossifying fibroma left tibia, bilateral patello-femoral syndrome, bilateral iliotibial band syndrome, and bilateral posterior tibial tendonitis conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  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 20140903, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 9 Aug 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC

					XXXXXXXXXXXXXXXXXXXX
	     				Assistant General Counsel
					(Manpower & Reserve Affairs)