RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00104
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040514

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “right testicular pain….and also involves the left testicle,” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20040325	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Testicle Pain	8799-8730	0%	No VA examination in evidence proximate to separation	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Bilateral Testicular Pain. The PEB rated the bilateral testicle pain as a single unfitting condition coded 8799-8730 (ilio-inguinal nerve) and rated 0%. The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore 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.  

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s recurrent scrotal and testicular pain started in approximately November 2001.  The pain occurred every time he began heavy physical activity and he had a numb sensation in the right testicle constantly.  The right testicle would swell to the size of a baseball.  The condition was diagnosed as epididymitis.  There was no known preceding injury or infection.  Conservative treatment with courses of antibiotic therapy, anti-inflammatory and a spermatic cord block provided no continued relief.  An ultrasound was consistent with right epididymitis.  Repeat ultrasound 4 months later showed normal bilateral epididymitis and a tiny 2.5mm left epididymal head cyst.  

The 21 November 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of recurrent epididymitis.  The CI had pain in the right testicle and occasionally had pain in the left testicle.  The pain was unrelenting in the past 3 months.  Any physical activity made it worse.  He was currently taking no medication.  The pain inhibited his ability to perform his duties or complete any aspects of the physical fitness test.  He was fit for desk type duties.  There was no indication for surgery.  Urology examination one month prior to NARSUM showed a normal scrotum.  The left testicle was of normal size, shape and consistency, descended and non-tender.  The associated epididymis and spermatic cord was unremarkable.  The right testicle also appeared normal in descent, size, shape and consistency.  There was significant tenderness along the posterior aspect of the right testicle and along the epididymis, which felt normal.  The sperm cord was somewhat tender.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral testicular condition 0%, coded 8799-8730 (neuralgia, ilio-inguinal nerve), citing “mild-moderate.”  As previously elaborated, the panel must first consider whether the left testicle pain condition remains separately unfitting, having de-coupled it from a combined PEB adjudication.  In analyzing the intrinsic impairment for appropriately coding and rating the condition, the panel is left with a questionable basis for arguing that the left testicular condition was indeed independently unfitting.  

The left testicle was referred to as an “occasional” source of testicular pain and clinical findings were never described as equal to the clinical findings of the right testicle.  The well-established principle for fitness determinations is that they are performance-based.  The panel could not find evidence in the commander’s statement or elsewhere in the STR that documented any significant interference of left testicular condition with the performance of duties at the time of separation, nor were any physical findings documented by the MEB examiner which would logically be associated with significant disability.  It should also be noted that there is insufficient evidence in support of a compensable rating for the left testicular condition, even if it were conceded as unfitting.  After due deliberation, the panel agreed that evidence does not support a conclusion that left testicular pain, as an isolated condition, would have rendered the CI incapable of continued service within his MOS; and, accordingly cannot recommend a separate Service rating for it.  Most of the significant symptoms, clinical findings and ultrasound findings implicated the right testicle.  Under the 8799-8730 code, severe or complete impairment would be necessary to achieve a higher 10% disability rating for a testicular pain condition.  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 testicle pain condition.  

BOARD FINDINGS:  In the matter of the bilateral testicle condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20160120, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013355, 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