RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02597
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “chronic bilateral testicular pain” with a disability rating of 10%.

CI CONTENTION:  Additional unfitting conditions were not considered.  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 - 20090804	VARD - 20110524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Testicular Pain	8799-8730	10%	No VA Placement	
Phase of Life or Life Circumstance Problem	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Bilateral Testicular Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s testicular pain condition began in September 2008.  Evidence of injury or serious infection was not present.  Clinical work-up and radiographs (testicular ultrasound, CT of the abdomen and pelvis) were essentially negative.  MRI of the sacrum revealed disc protrusion of L5-S1 “likely contacting the descending S1 nerve root and bilateral hydroceles, incompletely evaluated.  The condition was treated with a trial of antibiotics, and pain medications with no significant improvement in his pain.  He was later treated with a neural stimulator implant (spinal cord stimulation) which provided marginal relief.

At the July 2009 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation, the CI reported chronic scrotal pain.  He was no longer taking pain medication.  Physical examination showed tenderness to palpation of the testes.  Scrotal mass or lesion was absent.

The 10 July 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic testicular and groin pain; during activity and while sitting.  He was no longer able to participate in once enjoyable activities, and was not able to perform his military specialty duties since the onset of pain.  As an alternative, he worked staff duty 24 hours on and 48 hours off.  The neural implant had provided approximately 70% pain reduction.  Physical examination showed both testes properly descended without palpable masses and an unremarkable scrotal sac.  No inguinal hernia was noted on either side.  The examiner noted the CI’s pain symptoms were localized to the scrotum.  He was able to rise from a seated position without difficulty and ambulated without noticeable limp.

There was no VA examination for the panel to review.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral testicular pain condition 10%, analogously coded 8799-8730 (ilio-inguinal neuralgia), noting the condition was severe.  A VA claim was not submitted for bilateral testicular pain.

A 10% rating is the highest rating granted for this nerve condition under the 8730 code.  There was no route to a higher rating under any applicable nerve code.  The Board also considered code 7525 (epididymo-orchitis, chronic), which rates the condition under urinary tract infection.  Panel members agreed the evidence did not support a rating as there was no:  recurrent symptomatic infection requiring drainage; long-term drug therapy; 1-2 hospitalizations per year and/or requirement for intermittent intensive management.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral testicular pain condition.

Contended PEB Conditions:  Phase of Life or Life Circumstance Problem.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic bilateral testicular pain condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended phase of life or life circumstance problem condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151228, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013344, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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. 

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX

Sincerely,					      
						      					
Enclosure