RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00601
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040902

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Bradley Fighting Vehicle Systems Mechanic, medically separated for “left inguinal pain with bilateral orchialgia,” with a disability rating of 0%.

CI CONTENTION:  “I believe I should have more of a rating due to military doctor refusing to fix me and making it so I cannot get back into the service.”  His complete submission is 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 on 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 - 20040325	VARD - 20151015	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Inguinal Pain with Bilateral Orchialgia	8799-8730	0%	Left Testicle Condition	7599-7523	NSC	20150908	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  --%	

ANALYSIS SUMMARY:  

Left Inguinal Pain with Bilateral Orchialgia (testicular pain).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was diagnosed with a left-sided varicocele (dilated scrotal blood vessels) in early 2002 and underwent surgery for the same in August 2002.  Subsequently, he developed a persistent bilateral testicular pain that did not resolve despite numerous medications as well as local injections.  His condition could not be rehabilitated to meet the physical requirements of his military specialty and he was referred for an MEB.   The MEB forwarded “bilateral orchialgia” for PEB adjudication.
At the MEB NARSUM examination on 5 February 2004, 7 months prior to separation, the CI complained of bilateral testicular pain that was aggravated by physical activities including lifting, walking, and aerobic exercise.  His physical examination (PE) revealed bilateral testicular tenderness and the presence of a left epididymal cyst.  There was no evidence of a hernia nor the persistence of a varicocele.  There was no comment with regards to the presence of testicular atrophy.  The Report of Medical Assessment (DD Form 2697) noted ongoing medication use was Zoloft for “anxiety and depression.”  A VA Compensation and Pension examination near separation was not contained in the case file and therefore, the STR and MEB-derived documents were exclusively probative in rendering a final impairment rating.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left inguinal pain and bilateral testicular condition at 0% under the analogous code of 8730 (neuralgia of the illio-inguinal nerve), whereas the VA rated the condition unilaterally (left testicle) under the analogous code of 7523 (complete, atrophy of one testicle) as not service connected, citing failure to show that a disability had been clinically diagnosed.  

The Board’s initial charge in this case was directed at determining if the PEB’s approach of combining the right and left testicle conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be found unfit because of a physical disability.

The Board medical officer explained that although this case depicts a surgical procedure to correct a problem within the scrotum, the incision is not made within the scrotum, but rather in the low pelvic/groin area; hence the groin pain involvement.  Post-operatively, it is not uncommon for this procedure to have either direct pain (same side as surgery) or indirect pain (referred to the adjacent testicle) within the scrotum.

While the surgical evidence pointed only to the left side of the body, the right testicle pain was nearly as frequent, assessed as equally intensive, and was indirectly referred to in the duty limitations as genital organs (testicular pain) as well as in the non-medical assessment.  After a thorough review, the Board members determined that the right testicular pain was additionally and separately unfitting.  In reference to VASRD coding, all Board members agreed that the epididymal involvement (as evidenced by the corresponding cyst) coupled with surrounding inflammation about the testicles would more closely be related to the VASRD code of 7525 (epididymo-orchitis).      

VASRD §4.115b dictates that code 7525 be rated the same as a urinary tract infection (UTI).  The UTI coding pathway has two possible ratings; 10% (long term drug therapy) or 30% (recurrent infections and intensive management).  Despite the persistence of symptomatic and subjective bilateral testicular pain, the record did not reveal evidence for the need of “long-term drug therapy” and therefore, did not reach an impairment level of 10%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that each testicle was separately unfitting and rated at 0%.   

The Board also considered if additional disability rating was justified for the left-sided inguinal pain.  While the CI may have experienced residual surgical cite discomfort or a component of referred pain from the scrotum, such expected finding is subsumed under the ratings of the genitourinary system dysfunctions.  There was no specific objective evidence that the single-sided groin pain/discomfort by itself resulted in functional impairment that directly impacted fitness for duty.  The Board therefore concluded that an additional disability rating was not justified on this basis.  

BOARD FINDINGS:  In the matter of the left inguinal pain with bilateral orchialgia condition and IAW VASRD §4.115b, the Board unanimously recommends separate ratings of 0% for the right testicle and 0% for the left testicle condition.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Testicle Pain	7525	0%	
Left Testicle Pain	7525	0%	
COMBINED	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150605, 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 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170000276 (PD201500601)

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,   I accept the Board’s recommendation to modify the individual’s disability description without modification of the combined rating or recharacterization 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:
 						         
Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA