RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-00469
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060811

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Radar System Technician, medically separated for “right- sided thoracic outlet syndrome [TOS]” with a disability rating of 10%.

CI CONTENTION: Review requested of groin pain, back condition and thoracic outlet syndrome as well as 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 - 20060705	VARD - 20070409	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right-Sided TOS	8599-8513	10%	Right-Sided TOS with Neuralgia	8599-8513	20%	20061226	
L5-S1 Degenerative Disc Disease (DDD)	Cat III	
DDD, L5-S1	
5243-5242	
10%	
20061226	
Herniated Nucleus Pulposus (HNP), L5-S1	Cat III					
Neuralgia	Cat III	Chronic Orchalgia	7599-7525	0%	20061226	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Right-Sided TOS. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the right-dominant CI experienced an insidious onset of TOS beginning in 2004. The 8 May 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of paresthesias and hypoesthesias in both arms. Physical examination showed a well-nourished and

well-developed CI in no acute distress with a relaxed affect and a normal gait. An undated MEB orthopedic evaluation indicated a several month history of upper extremity, radial-sided digit numbness (right greater than left) with overhead activity. The CI denied any neck or shoulder trauma or any radiculopathy or symptoms consistent with a myelopathy. Physical examination of the upper extremities demonstrated normal bilateral motor strength, and sensation was intact except for the tips of the right first, second and third digits. Testing for carpal tunnel syndrome was negative, but Adson’s (loss of radial pulse) and Wright’s (hyperabduction maneuver) tests were positive for TOS on the right. Radial and ulnar pulses as well as capillary refill were normal. Cervical spine examination demonstrated full active range of motion without nerve root irritation.  Neck X-rays were within normal limits with no evidence of a cervical rib.

During the 26 May 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported losing his pulse if he held up his hands, and that while sleeping, he had to have his hands at his side or they would go “dead” (beyond numbness). He also noted “arms and hands with tingling, numbness, and pains.” All findings were marked as normal on the physical examination.

At the 26 December 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported not being able to sleep laying on his arms because of numbness and tingling in the right forearm and middle, ring and little fingers. Physical examination showed a normal radial pulse bilaterally in the upper extremities.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right-sided TOS 10%, analogously coded 8599-8513 (paralysis of all radicular groups). The VA rated the right-sided TOS 20%, analogously coded 8599-8513, based on the C&P examination, citing mild incomplete paralysis of the radicular muscles. Although the minimum rating for mild incomplete paralysis under 8513 is 20%, panel members did not find any evidence in the STR that the condition actually impaired performance of duties to any significant degree. Despite the PEB’s finding that this condition was unfitting, it was minimally disabling and only warranted a 0% rating IAW VASRD §4.31. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the right-sided TOS, coded 8599-8513.

Contended PEB Conditions: L5-S1 DDD, HNP L5-S1 and Neuralgia. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The PEB listed “neuralgia” as a Navy Category III condition (not separately unfitting and does not contribute to the unfitting condition), but was not specific as to whether it was connected to the right-sided TOS, lumbar DDD or secondary to groin pain (orchalgia). The panel agreed the neuralgia was associated with the orchalgia. Only the orchalgia was noted on limited duty forms, but both the back condition and orchalgia were implicated in the non-medical assessment.

L5-S1 DDD and HNP L5-S1. The CI developed an insidious onset of intermittent low back pain without radiculopathy, bowel or bladder symptoms or any gait symptoms. Although an MRI showed lumbar DDD, there were no hypoesthesias or paresthesias except related to the ilioinguinal nerve (see below). At the NARSUM orthopedic examination, the CI had a normal heel, toe, and tandem gait and a normal squat. He was nontender and had normal strength and sensation. There was no performance-based evidence from the record that the back condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the back condition, so no additional disability rating is recommended.

Neuralgia (Orchalgia). The CI underwent an ostensibly uneventful bilateral vasectomy in March 2005 and complained of chronic discomfort after the surgery, although there was no significant perioperative swelling, ecchymosis (black and blue discoloration of the skin) or major pain

associated with the procedure. Nonetheless postoperatively, he had groin pain rated at 3-8/10, with the right much worse than the left. Evaluation by urology in June 2005 revealed mild subjective congestive changes of the epididymis bilaterally without tenderness. He had granulomas bilaterally with the left being slightly greater than the right, and palpation of these seemed to reproduce the majority of his groin pain; he had no hernias. At pain management visits in August and October 2005, the provider noted no relief from a previous right genitofemoral nerve block, and prescribed a nerve pain medication and narcotic pain reliever which provided some improvement. A CT scan in December 2005 showed no evidence of a discrete inguinal hernia. Multiple medications for nerve pain and nonsteroidal anti-inflammatory drugs only provided modest improvement of the CI’s chronic orchalgia primarily in the right testicle. He also had paresthesias along the ilioinguinal nerve distribution on the right and reported severe spikes of pain that essentially incapacitated him. The NARSUM examination showed mild tenderness at the external inguinal area on the right, but he was distractible. Penile, scrotal, testes, epididymal and cords examinations were otherwise normal. At the VA C&P examination, the CI reported left testicle pain, rated at 3/10, that often radiated up the thigh and caused difficulties with lifting and carrying. There were varicoceles (collections of veins) on the left and the right areas of the scrotum. A scrotal ultrasound on 23 January 2007 showed bilateral congestion of the epididymis with mild enlargement of the epididymal head, ranging in diameter from 13-16 mm, and there were prominent varicoceles, left larger than right.

Panel members noted that the STR recorded both right and left post-vasectomy scrotal pain, and while the pain vacillated between the left and right sides, the right orchalgia was more painful. After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of right-sided orchalgia favors its recommendation as an additionally unfitting condition for disability rating. It is appropriately coded 8730-7525 (ilio-inguinal nerve neuralgia-chronic epididymo-orchitis) and meets the VASRD §§§4.124a, 4.115a and 4.115b criteria for a 10% rating.

BOARD FINDINGS: In the matter of the right-sided TOS, the panel recommends a disability rating of 0%, coded 8599-8513 IAW VASRD §4.124a. In the matter of the contended back condition, the panel recommends no change from the PEB determination as not unfitting. In the matter of the contended groin pain, the panel agrees it was unfitting and recommends a disability rating of 10%, dual coded 8730-7525 IAW VASRD §§§4.124a, 4.115a and 4.115b. There are no other conditions within the panel’s scope of review for consideration. As the proposed new combined disability ratings result in no change to the combined disability rating previously assigned, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 24 Oct 18

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.