RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01216
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070507

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated for “bilateral groin pain, status post vasectomy,” with a disability rating of 0%.

CI CONTENTION:  The CI requests a review of all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20070301	VARD – 20091027	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Groin Pain, Status Post Vasectomy	8799-8730	0%	Chronic Epididymitis (Claimed as Pain and Groin Injury due to Vasectomy)	7599-7525	0%	20090804	
			Impotence Status Post Vasectomy	7522	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Groin Pain, Status Post Vasectomy.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral groin condition began in February 2006 status post vasectomy, which was performed on 3 February 2006 under local anesthesia.  Postoperatively, he initially had bruising and tenderness that was expected post-vasectomy.  In April 2006 he complained of right testicular pain.  On examination there was tender swelling of the vas deferens/spermatic cord bilaterally.  Treatment for right epididymitis consisted of ciprofloxacin (an antibiotic) followed by acetaminophen (a pain reliever).  Bilateral epididymis was diagnosed on 4 May 2006 which was treated with the antibiotics Rocephin (ceftriaxone) and Zithromax (azithromycin).  An ultrasound of the scrotum, ordered for right testicular pain, on 12 May 2006 revealed no abnormality in the right hemiscrotum.  The left testicle was normal in appearance with a small left epididymal cyst.  A small varicocele (collection of veins) was noted with a small amount of free fluid in the area of the left epididymis.  Antibiotics were again administered and tramadol (an opioid-like medication) was added to the treatment regimen for the pain.  Within a week Lortab (hydrocodone, a narcotic and acetaminophen) was prescribed for the pain.  Additional antibiotics were administered on 24 May 2006.  Because of continued bilateral epididymitis, long term Septra (an antibiotic combination of sulfamethoxazole and trimethoprim) and naproxen, a nonsteroidal anti-inflammatory drug (NSAID) were prescribed.  Despite narcotics, chronic testicular pain persisted and amitriptyline (an antidepressant and for nerve pain) was prescribed in July 2006.  Urologic evaluation revealed the right vas defect was very tender with reproduction and radiation of pain to the testicle and the left was moderately tender.  Neuropathic pain due to nerve entrapment was considered likely rather than obstructive pain.  Neurontin (gabapentin for nerve pain) was added to the amitriptyline in August 2006.  Pain was primarily on the right side in August and October 2006.  In November 2006 pain was on both sides but worse on the right.  Pain management and physical medicine specialists evaluated the CI.  A trial of Lyrica (pregabalin for nerve pain) was recommended in place of the Neurontin.  Nerve blocks were performed with no improvement and further nerve blocks were declined.  

The 29 November 2006 and 4 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, noted complaints of chronic pain.  Examination details were not available for review; however, the examiner noted bilateral testicular pain in the summary of defects and diagnoses section.  

The 31 January 2007 MEB NARSUM, 4 months prior to separation, which was based on a physical examination performed on 4 December 2006 noted complains of pain as waxing and waning with worsening with exertion.  The CI was up and down at work all the time trying to find a comfortable place and had about 4 hours of sleep each night.  Physical examination showed no hernias were palpated.  Both the right and left vas deferens were extremely tender to palpation beyond any objective findings as there was no redness, no swelling, and no edema or fullness.  Testicles were well descended and his penis was normal.  The CI had a normal gait and station and normal posture.  There was no tenderness of the paravertebral musculature of the back.  Straight leg raising (to determine nerve root irritation) was negative bilaterally.  Tone and strength of the upper and lower extremities were within normal limits.  Neurologic evaluation was unremarkable.  

There was no VA examination proximate to separation.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral groin pain status post vasectomy 0%, as a single unfitting condition, coded 8799-8730 code (ilio-inguinal nerve-neuralgia mild or moderate), citing analogy to moderate incomplete paralysis.  The approach by the PEB commonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting.  The panel’s initial charge in this case was directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel 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 referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the bilateral groin condition was presented together above.  In this case, a bilateral condition was noted in the profile, but there was no commander’s statement available for review, and the bilateral groin condition was implicated by the NARSUM.  Members agreed that each groin pain condition is separately unfitting and that identical coding and ratings are applicable.  Panel members considered whether the condition was mild or moderate at a 0% rating or severe at a 10% rating on each side of the scrotum as a result of the bilateral vasectomy procedure.   The panel majority favored a 0% rating for each side based on the neuralgia being mild or moderate and a rating option using code 7525 was not applicable since the CI did not report any significant urinary difficulty prior to separation on which rating for code 7525 is based.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral groin condition status post vasectomy condition.  

BOARD FINDINGS:  In the matter of the bilateral groin pain status post vasectomy condition and IAW VASRD §4.124a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent submitted the appended minority opinion.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150612, w/atchs
Exhibit B.  Service Treatment Record

	

Minority Opinion.  Multiple references in the STRs indicated pain on the right side was greater than the left side and the right vas defect was very tender with reproduction and radiation of pain to the testicle, which favors a 10% rating for severe neuralgia, which was not relieved by narcotics, gabapentin, amitriptyline, and pregabalin prior to separation and a 0% rating for the moderate neuralgia on the left side.  There was no higher rating option available since the CI did not report any significant urinary difficulty prior to separation on which rating for code 7525 is based.

Therefore, the minority voter recommends the ROP be amended to read:

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right groin pain condition, coded 8799-8730 and a disability rating of 0% for the left groin pain condition, coded 8799-8730.  

And

In the matter of the right groin pain status post vasectomy condition, the panel recommends a disability rating of 10%, coded 8799-8730 IAW VASRD §4.124a.  In the matter of the left groin pain status post vasectomy condition, the panel recommends a disability rating of 0%, coded 8799-8730 IAW VASRD §4.124a.  

The panel 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 Groin Pain, Status Post Vasectomy	8799-8730	10%	
Left Groin Pain, Status Post Vasectomy	8799-8730	0%	
COMBINED	10%	

AR20170007503, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and by a majority vote the DoD PDBR found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  The Board’s minority opinion recommended your disability rating be increased to 10%.  I have reviewed the Board’s record of proceedings, majority recommendation, and minority opinion (copy enclosed).  

I accept the minority opinion and I find that your disability rating should be modified to 10% but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure