RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01814
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050304

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Fire Support Specialist, medically separated for “chronic left orchialgia” 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 – 20050119 	VARD - 20050318	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Orchialgia	8799-8730	0%	Left Orchialgia 	8799-8730	0%	20050224	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Orchialgia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a left varicocelectomy (removal of excess veins in the scrotum) on 31 August 2004.  Due to recurrent pain, the CI underwent a left groin exploration on 2 November 2004.  There was no abnormal findings, no varicocele and no injured, scarred or entrapped nerves and the spermatic cord was free from surrounding scar tissue.  There was no improvement of his left inner thigh pain and orchialgia (testicular pain).  

During the 3 December 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported pain in the left inner thigh, left lower abdomen and groin.  Physical examination showed tenderness to palpation of the left testicle with a slightly prominent vein and left inner thigh.  A urinalysis on 3 December 2004 was negative.

At a urology clinic visit on 7 December 2004, the CI described “sharp pain,” exacerbated by prolonged standing or sitting in a certain fashion.  No lower urinary tract symptoms (urinary frequency, urgency, dysuria, or urinary incontinence) were reported.  Examination revealed a healing scar in the left groin without drainage, erythema or induration.  There was diffuse tenderness in the area of the incision and mild allodynia (increased pain following normally non-painful stimulation) over the medial left thigh.  He underwent a genitofemoral block and was noted to have immediate diminution of his pain.  

The 29 December 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of left inner thigh pain with numbness and a pinching sensation over his left inner thigh as well as some left groin and left scrotal pain with some mild left orchialgia.  Physical examination showed no abnormalities of his penis.  His testes were descended bilaterally with no masses.  His left inguinal incision was well-healed.  On examination, there was numbness and a pinching sensation of the left inner thigh.  No varicocele of the left scrotum was present.  

At the 24 February 2005 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported left orchialgia with intermittent tightness, stiffness with a dull ache and intensity of 6/10.  He limped while walking and was not able to walk more than 1 hour or stand for more than 10 minutes.  Physical examination showed a well‑healed non-tender scar on the left groin.  There was tenderness on the inner left thigh; however, there was no objective evidence of sensory loss on the medial aspect of the left thigh and no muscle wasting.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left orchialgia condition 0%, coded 8799-8730 (neuralgia), citing mild incomplete paralysis.  The VA also rated the left orchialgia condition 0%, coded 8799-8730, based on the C&P examination, citing incomplete paralysis of the ilio-inguinal nerve, which was mild or moderate.  Panel members noted that using code 8730 requires the equivalent of severe to complete paralysis of the ilio-inguinal nerve for a 10% rating.  Since the CI’s pain improved with a genitofemoral block and he was prescribed Ultram, panel members determined that the neuralgia did not rise to a severe or complete level.  Therefore, there was no applicable higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left orchialgia.  

BOARD FINDINGS:  In the matter of the left orchialgia 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. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008179, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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 been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure