RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00696
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20070703

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Wheeled Vehicle Mechanic, medically separated for “chronic right testicular pain” with a disability rating of 0%.  

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 - 20070323	VARD - 20071003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Testicular Pain	8799-8730	0%	Left Spermatocelectomy with Chronic Right Orchalgia	8730-7525	10%	20070917	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY.  

Chronic Right Testicular Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right testicular condition was subsequent to a straddle injury to the right testis in 2004.  Right testicular pain began in the fall of 2005 after completing a physical fitness test.  An ultrasound and multiple urologist’s evaluations were essentially normal regarding the genitalia.  The CI underwent repair of a right inguinal hernia (March 2006) and right testicular pain (orchalgia) worsened.  

During the 18 October 2006 MEB urology consultation, the CI complained of lower urinary tract symptoms manifested by intermittent decreased force of stream, increased urgency, difficulty initiating the stream, frequency and nocturia up to 3 times a night.  Physical examination showed a well-healed right inguinal incision.  There was pain with palpation of the right testicle, mostly localized to the mid testicle.  The right head of the epididymis was slightly enlarged and non-tender to palpation.  The examination was otherwise noncontributory.  

The 20 December 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of chronic right testicular pain.  Records review indicated civilian provider diagnoses of right epididymitis (December 2005), right testicular torsion (January 2006), and right testicular dysfunction and pain (February 2006).  Physical examination summarized the urology consultation above.  

At the 17 September 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported a painful right testicle with swelling once a week.  Physical examination showed a tender hernia scar with no hernia present.  There was pain and tenderness with touching the entire scrotal area, and the testicles, epididymis, spermatic cord and scrotum were otherwise normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the CI’s right testicular pain 0%, coded 8799-8730 (neuralgia, ilio-inguinal nerve), citing right testicular tenderness causing moderate partial paralysis of the ilioinguinal nerve.  The VA rated the right testicular pain 10%, dual coded 8730-7525, (ilio-inguinal neuralgia - chronic epididymo-orchitis), citing well documented chronic testicular pain.  

The panel noted 0% for moderate incomplete neuralgia was the highest rating under code 8730.  The panel next considered alternate coding under 7525 (epididymo-orchitis, chronic only).  Given the CI’s diagnosis of chronic right orchalgia, multiple evaluations and treatment notes, as well as use of narcotic pain medication, and additional non-specific lower urinary tract symptoms, the panel adjudged the CI disability picture at separation more closely approximated the 10% rating under code 7525 than the zero percent evaluation permitted by VASRD §4.31.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right testicular pain, coded 8730-7525.  

Contended PEB Conditions:  Lower Urinary Tract Symptoms, Bilateral Knee Pain, Lower Back Pain (LBP) and Hypertension.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The lower urinary tract symptoms and hypertension conditions were not profiled, implicated in the commander’s statement or judged to fail retention standards.  Additionally, the lower urinary tract symptoms were considered in the rating for the unfitting chronic right testicular pain condition above.  Although the bilateral knee pain and LBP conditions were mentioned on the profile, they were judged to meet retention standards.  The 14 June 2006 MEB consultation on the CI’s LBP and bilateral knee pain stated that “with respect to his orthopedic issues, he does not need to undergo MEB as he can complete his MOS and really has no limiting factors with respect to his back and knee problems.”  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right testicular pain, the panel recommends a disability rating of 10%, dual coded 8730-7525 IAW VASRD §4.124a and §4.115a.  In the matter of the contended lower urinary tract symptoms, bilateral knee pain, LBP and hypertension conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Testicular Pain	8730-7525	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170214, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004744, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure