RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01748
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20040504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Surface Ship Nuclear Propulsion Plant Operator-Engineering Laboratory Technician, medically separated for “chronic left groin pain status post varicocelectomy x 2 and status post varicocele embolization ” with a disability rating of 10%.  

CI CONTENTION:  “The scars from operation were not very visible when I had the disability exam.  I thought this impacted me getting 10% vs 20% disability.  Scars are still visible today.”  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 - 20040112	VARD - 20040428	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Groin Pain Status Post Varicocelectomy x 2 and Status Post Varicocele Embolization	7599-7525	10%	Chronic Left Groin Pain Residual of Surgeries, Varicocelectomies and Varicocele Embolization	7599-7525	10%	20040412	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Groin Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI developed left groin discomfort sometime in 2001 and reported he was lifting weights for at least 3 hours a day on a regular basis.  He was noted to have a left varicocele and upon referral to urology, underwent a varicocelectomy in July 2001.  He continued to have recurrence of the left varicocele approximately 2 months after the procedure with left testicular pain and swelling after doing sit-ups.  After a second varicocelectomy in April 2002, the CI   continued to have some discomfort with physical activity, driving, and prolonged standing, but did well otherwise and was subsequently found fit for duty in August 2002.  

When his pain worsened with a left varicocele recurrence, the urologist referred him for a spermatic vein embolization in May 2003.  This procedure was unsuccessful in relieving the CI’s chronic left groin pain and no further surgical treatment was recommended.  At a urology visit, the CI reported groin pain with physical straining or exertion.  The examiner noted “an unrealistically jumpy young male to any type of an examination of the testicles or groin area.”  Varicocele veins were still palpable with was no hernia and an unremarkable right testicle. 

The 1 September 2003 MEB NARSUM examination, 9 months prior to separation, noted complaints of left groin pain with prolonged standing or lifting.  Physical examination showed the left scrotum appeared to be enlarged compared to the right, but the testicles were of normal size.  The CI was very uncomfortable to any manipulation of the groin area because of worsening pain, so the further examination was very limited.  There was no evidence of any hernia.  

At the 12 April 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported pain rated at 1-2/10, sometimes up to 3-4/10 with standing for an hour or longer and 7/10 with heavy lifting.  Physical examination showed the left testicle was slightly larger than the right with no “bag of worms” type contour of the scrotum.  The examiner noted it was very difficult to do a thorough examination due to pain, but the testicles appeared to be within limits and smooth.  A hernia check was not accomplished.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left groin condition 10%, analogously coded 7599-7525 (epididymo-orchitis, chronic only).  The VA also rated the left groin condition 10%, analogously coded 7599-7525, based on the C&P evaluation, citing significant residual pain which affected the ability to perform physical labor.  Panel members noted that epididymo-orchitis is rated as a urinary tract infection and criteria for a 10% rating, which requires long-term drug therapy, one or two hospitalizations per year, or intermittent intensive management, and was not met in this case.  The panel considered using code 8730 (neuralgia) which correlated to the CI’s persistent symptomatology.  According to VASRD §4.124a, “Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis.”  Panel members acknowledged that the maximum rating level available for this specific code is 10% for complete paralysis.  Based upon the above, a logical deduction could be made that if measured in context of incomplete paralysis, such impairment would be less than 10%, or at least not greater than 10%.  Therefore, the maximum available rating under code 8730 offers of no additional 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 left groin condition.  

BOARD FINDINGS:  In the matter of the chronic left groin condition and IAW VASRD §4.115b, 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. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161114, 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