RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-04047
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20070709	

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

CI CONTENTION:  The CI requests the Board 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 - 20070709	VARD - 20080205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Testicular Pain	8799-8730	0%	Left Chronic Testicular Pain	7599-7525	NSC	20071127	
Intermittent Back Pain	Not Unfitting	Chronic Lumbar Strain	5237	10%		
Intermittent Bilateral Knee Pain		Internal Derangement, L Knee	5260	10%		
		Right Knee Condition	5260	NSC		
Panic Disorder		Panic Disorder with Anxiety and Depression	9412	30%		
Atypical Depressive Disorder						
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Left Testicular Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s testicular condition began in May 2006.  On 25 May 2006, the CI had an ultra-sound of the testicles for chronic left testicular pain.  Four days later, a CT scan of the abdomen and pelvis was accomplished for a history of left lower quadrant pain.  Both tests were normal.  He was then referred to urology where it was noted that the pain increased with activity and remitted with rest.  No benefit was noted with antibiotics.  The physical examination was remarkable for tenderness on the left.  He was again seen on 30 October 2006 with similar findings.  A cord block reduced his symptoms.  An ultrasound was again unremarkable.  He was referred to a different urologist who also noted a normal examination other than tenderness, left greater than right.  A higher block (in the inguinal canal) was unsuccessful and actually increased his pain.  He was then referred to the MEB process for this 2 ½ year history of intractable left testicular pain.  The urology addendum to the narrative summary (NARSUM) dated 2 February 2007, 5 months prior to separation, reviewed the above and noted that the pain persisted.  The left epididymis was slightly tender, but the examination unremarkable otherwise.  A third ultrasound, dated 9 February 2007, was also normal.  At the MEB examination on 13 February 2007, the CI reported testicular pain.  The MEB physical examination showed tenderness of the left epididymis.  At the NARSUM dated 9 April 2007, the CI reported that he was in pain 50% of the time while awake and that it was aggravated by activity.  He used a cane full-time since January of 2007 to take pressure off of his testicle.  No examination was performed.  At the VA Compensation and Pension (C&P) examination performed on 27 November 2007, 5 months after separation, the CI reported a 3½ year history of left epididymal pain without urinary or sexual dysfunction.  No activity limitations were reported.  The examination of the penis and testicles was normal.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left testicular pain of unknown etiology at 0%, coded 8799-8730 (analogous to neuralgia of the ilio-inguinal nerve).  This is the mild to moderate level of impairment.  The VA determined that the left chronic testicular pain was not service connected as no pathology was present on examination.  It was coded 7599-7525 (analogous to epididymo-orchitis).  The Board considered the evidence.  The examination was consistently normal other than tenderness until the VA examination which was normal without tenderness.  No etiology for the pain was determined.  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 left testicular pain condition.  

Contended PEB Conditions.  Intermittent back pain, intermittent bilateral knee pain, panic disorder without agoraphobia, and atypical depressive disorder.  None of these conditions were profiled or judged to fail retention standards.  The commander noted that the CI performed below standards and had an anxiety attacks dealing with the normal stressors of military life.  However the mental health evaluation determined that he met retention standards from a mental health standpoint.  All conditions were reviewed and considered by the Board.  There was no performance based evidence from the record that any of the contended conditions significantly interfered with satisfactory duty performance at separation.  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 any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic left testicular pain condition and IAW VASRD §4.115 and §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended intermittent back pain, intermittent bilateral knee pain, panic disorder without agoraphobia, and atypical depressive disorder 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, 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 with attachments
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 AR20160013818  (PD201404047)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA