RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00683
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20041031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Field Wireman, medically separated for “right epididymal cysts” with a disability rating of 10%.   

CI CONTENTION:  “Review 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040908	VARD - 20050118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Epididymal Cysts	7525	10%	Left Epididymal Cyst  	7599-7525	10%	20040818	
Dysuria	Cat II	No VA Placement	
Right Epididymalgia			
History of…Migraine Headaches…	Cat III	Common Migraines	8100	30%	20040818	
History of Adjustment Disorder	Cat IV	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Epididymal Cysts.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s testicular condition began in August 2003 with no history of trauma, injury, or infections identified; however, he did have dysuria (painful or difficult urination).  He had not been sexually active since well before August 2003, and had no history of a hernia or surgery.  He had constant low-level bilateral testicular pain, which worsened with activity.  Examination on 17 March 2004 revealed tenderness of the left testicle at the epididymis without any masses noted.  There was no urethral discharge or lesions of the genitalia.  A urinalysis was normal.  Treatment consisted of antibiotics (Rocephin and doxycycline).  On 29 March 2004, the CI was seen in the emergency room with testicular and right-sided abdominal pain.  The assessment was acute pain in the scrotum and a suspected hernia.  The CI was continued on modified duty and referred for hernia evaluation.  He was seen in the urology clinic on 20 April 2004 for right greater than left testalgia (pain in the testicle) with a history of dysuria most of the time and pain with running.  Examination revealed descended testicles without masses or ulcers.  There was mild to moderate tenderness on the right epididymis.  The examiner’s assessment was epididymalgia on the right side.  Treatment consisted of naproxen, a nonsteroidal anti-inflammatory drug (NSAID).  Urine culture and sensitivity on 17 March 2004 were negative and urinalysis on 29 March 2004 was negative with a specific gravity of 1.030 and pH 6.0.  

At a urology follow-up visit on 17 May 2004 there was no change in the pain.  Ultrasound of the scrotum revealed at least three small 2-mm epididymal cysts involving the right epididymis.  There were two present in the head (globus major) and one in the tail of the epididymis.  There was a small left varicocele present as well and a small amount of hydrocele fluid.  There were no masses present.  Examination revealed descended testicles with a normal left testicle, cord, and no varices.  There was tenderness of the right testicle and epididymis without any focal mass and a supple cord.  The right inguinal ring was very tender without a hernia, and there was no left inguinal hernia on examination.  The examiner’s assessment was testalgia and dysuria.  Cystoscopy was performed on 18 May 2004 to eliminate structural abnormalities of the lower urinary system to account for the dysuria.  There were no strictures and an open bladder neck with normal mucosa with grade II-III trabeculations.  There was an early calculus (stone formation) posterior to the left hemitrigone (upper portion of the bladder where the ureter enters).  Urine output was normal without evidence of obstruction.  

The 19 May 2004 MEB NARSUM examination, 5 months prior to separation, noted the complaint of right testicular pain.  Physical examination showed both testicles descended.  There were no palpable masses and no hernia.  There was tenderness involving the right testicle and epididymis without focal masses.  The cord was supple without evidence of induration.  The right inguinal ring was tender with a hernia and there was no left inguinal hernia.  No varicoceles were noted on either side and the left testicle was normal without masses.  The examiner noted the CI was unable to perform full duty due to his complaints of pain.  “The only findings [were] of right epididymal cysts, which could be the source of the pain or an indication of epididymal tubular obstruction that could lead to chronic pain.  The size of the cysts were sufficiently small to offer significant chance of improvement with surgical removal,” although “surgery increases the risk for continued pain due to the scarring process following surgery.”  There was “no specific etiology identified for his dysuria.”  During the 21 June 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported bad pain in the testicles and groin.  No physical finding were reported; however, testalgia was listed in the summary of defects and diagnoses.

At the 18 August 2004 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported pain in the left testicular area and he urinated about six times  a day, but did not awaken to void at night.  He had an occasional burning feeling and denied urinary incontinence.  Physical examination of the left testicle showed evidence of an epididymal cyst, which was tender and measured 4 x 5 mm, and was soft, but not visible.  There was no evidence of a mass or a hernia.  Palpation of the remainder of the genitalia was within normal limits. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated right epididymal cysts 10%, coded 7525 (epididymo-orchitis, chronic).  The Navy PEB listed dysuria and epididymalgia conditions as related diagnoses (Category II) contributing to the disability in this case.  The panel concluded the Category II diagnoses were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  The VA also rated epididymal cysts 10% (though on the left side), analogous to the code used by the PEB (7599-7525), based on the C&P examination, citing findings of a tender left epididymis measuring 4 x 5 mm with reported symptoms of pain and an occasional burning feeling during urination. 

The panel noted the PEB addressed the right epididymal pain, but the VA addressed and rated the left side.  Panel members then noted that code 7525 is rated as a urinary tract infection; however, the CI did not have any documented urinary tract infections nor was he on “long-term drug therapy, 1-2 hospitalizations per year and/or requiring intermittent intensive management” to warrant a 10% rating.  He also did not have a “recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times/year), and/or requiring continuous intensive management” warranting a 30% rating.  He did have urinary frequency that met the §4.115b requirements of “daytime voiding interval between two and three hours, or; awakening to void two times per night” for 10%.  Nevertheless, this offers no benefit since the CI was rated 10% by the PEB.  Alternatively, use of code 7525-8730 (epididymo-orchitis, chronic-ilio-inguinal nerve neuralgia) offers a 0% rating for mild to moderate paralysis or a 10% rating for severe to complete paralysis.  Although there was no nerve paralysis per se, there was neuralgia, and although it may have risen to the severe level, the 10% rating also does not offer any benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right epididymal cysts condition.  

Contended PEB Conditions:  History of Complicated Migraines and History of Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions were noted on MEB referral to the PEB or implicated in the non-medical assessment.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  Furthermore, adjustment disorder is not a compensable disability.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right epididymal cysts condition and IAW VASRD §4.115, the panel recommends no change in the PEB adjudication.  In the matter of the contended history of migraine headaches and history of adjustment disorder conditions, the panel recommends no change from the PEB determination as not unfitting and as not constituting a physical disability respectively.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20160914, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

					XXXXXXXXXXXXXXXXXX
	     				Acting