RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXX	CASE:  PD-2016-01044
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20050115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Rifleman, medically separated for “bilateral testalgia” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  The testicular condition continues to worsen, and he requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20041109	VARD - 20050301	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Testalgia	8730	10%	Status Post (S/P) Bilateral Varicocelectomy with Residual Bilateral Testalgia, Left Varicocele ...	7599-7525	10%	20050113 	
Left Testalgia	8730	10%					
Bilateral Varicoceles	Cat II	S/P Left Varicocelectomy w/ Residual Scar	7804	10%	20050113	
		S/P Right Varicocelectomy w/Residual Scar	7804	0%	20050113	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right and Left Testalgia.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI first presented in January 2004 with a complaint of right testalgia (testicular pain) that evolved into bilateral testalgia.  He was diagnosed with bilateral varicoceles (engorged scrotal veins) and underwent surgical ligations on the left in April and the right in June of 2004.  The bilateral testalgia persisted after surgery without a clear etiology, and did not respond to conservative treatment.  Clinical entries in the STR confirmed the absence of dysuria (painful urination), frequency, incontinence, and recurrent infections, and there were no hospitalizations, additional urologic procedures, or need for continuous intensive management.

The 9 August 2004 MEB NARSUM examination, 5 months prior to separation, documented persistent bilateral testicular pain.  Although specific functional limitations were not elaborated, the examiner stated, “The resurgence of his pain was without obvious cause as the patient had continued to be on light duty during this time...[and there is]...an extremely high likelihood of persistent pain rendering the patient unable to perform full duties.”  Physical examination recorded bilateral scrotal tenderness without hernia, mass, or testicular abnormality.  

At the 13 January 2005 VA Compensation and Pension (C&P) examination, 2 days before separation, the CI reported increasing pain in both testicular areas and impotency difficulty, but otherwise he denied functional limitations, dysuria, frequency, incontinence or other urinary symptoms.  Physical examination recorded “mild...bilateral scrotal” tenderness without mass or other positive finding.  Laboratory testing confirmed the absence of urinary tract infection or renal complications.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left testalgia condition 10% each, both coded 8730 (neuralgia of the ilio-inguinal nerve).  The PEB also listed bilateral varicoceles as a related Category II condition (contributes to the primary unfitting condition but was not separately ratable), and members agreed that it was intrinsic to the rated condition such that a separate rating could not be supported without violation of VASRD §4.14 (avoidance of pyramiding), and it was thus appropriately subsumed in the same rating.  The VA rated the bilateral right and left testalgia condition 10% each, analogously coded 7599-7525 (neuralgia of the ilio-inguinal nerve), based on the C&P evidence, citing bilateral tenderness and partial erectile dysfunction.  The VA also rated a right residual scar at 0%, coded 7802 (scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear), citing a noncompensable examination.  The VA also rated a left residual scar at 0%, coded 7804 (scar(s), unstable or painful), citing tenderness.  The panel noted that while there is no precise clinical fit for testicular pain in the VASRD, the PEB’s §4.124a peripheral nerve code 8730 and VASRD §4.115b genitourinary code 7525 are reasonable choices for analogous rating.  Under code 8730, the highest rating is 10% for a severe condition, which is the most favorable coding option for either testicle.  In regards to VASRD §4.115b, given the absence of urinary symptoms or renal impairment, there are no ratable 4.115b code criteria in evidence to justify a minimum compensable, and no criteria for a higher rating under code 7525 for either testicle.  Code 7525 defaults to the general formula for urinary tract infection and the 10% rating criteria stipulate “long-term drug therapy, 1-2 hospitalizations per year and/or requiring intermittent intensive management,” which were note met in this case.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded t there was insufficient cause to recommend a change in the PEB adjudication of the right and left testalgia condition.

BOARD FINDINGS:  In the matter of the right and left testalgia condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  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.  

JAN 1 5 2019
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  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: