RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02580
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20041122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Tactical Aircraft Maintenance Journeyman, medically separated for “recurrent pubic pain status post penile vein thrombophlebitis” with a disability rating of 10%.   

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 - 20041013	VARD - 20050622	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Pubic Pain 	7121-7199	10%	Recurrent Pubic Pain 	7121-7522	10%	20050212	
Obesity 	Cat III	No VA placement	
History of Tobacco Abuse	Cat III		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Recurrent Pubic Pain Status Post Penile Vein Thrombophlebitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s recurrent pubic pain began in January 2003 in the absence of an accident or injury.  Initial examination revealed a tender cord on the left side of the penis, which was felt to be a blood clot in a superficial vein (left dorsal vein).  A note dated 11 February 2003 indicated the dorsal penis vein thrombosis was almost totally resolved; however, a small tender nodule remained at the base of the penis.  The May 2003 examination revealed tenderness at the base of the penis on the left side, which was felt to be the vas deferens, the duct from the testicle to the urethra.  Urologic examination on 27 October 2003 was unremarkable with no lesions present.  Computerized tomography (CT) on 5 November 2003 showed mild splenomegaly, but was otherwise unremarkable.  A repeat CT of the abdomen and pelvis on 9 January 2004 showed mild splenomegaly and a “slight prominence of gonadal veins most like represents congenital variation but no evidence for internal venous thrombosis or adenopathy.”  An April 2004 urology examination showed a small, hardened lesion within the skin at the left base of the penis that was tender, but was unlike the previous lesion that was on the right shaft.  The CI was diagnosed with Mondor’s phlebitis (thrombosis of the dorsal vein of the penis), which was treated with NSAIDs and warm compresses.  The April 2004 urology examination showed “no active disease.”  
  
The 18 August 2004 MEB NARSUM examination, 3 months prior to separation, showed a soft, non-tender abdomen without hepatosplenomegaly or masses.  The penis was without lesions, but there was mild tenderness at the base of the penis bilaterally.  The testes were normal and non-tender.  The examiner noted the CI had been evaluated by four urologists and two hematologists and despite extensive evaluation there was a paucity of objective findings with the exception of the initial presentation.  Because of pain, the CI was unable to perform his primary duties.

At the 12 February 2005 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported constant deep-seated pelvic pain, worse with erections.  Physical examination showed no evidence of any phlebitis.  His penis was normal, circumcised and without masses.  Testicles were down bilaterally and were normal size and consistency with no palpable masses.  The abdomen was soft, slightly obese, non-tender and non-distended.  Additionally, he was neurovascularly intact.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the pubic pain 10%, coded analogously as 7121-7199 (post-phlebitic syndrome of any etiology).  The VA also rated the pubic pain 10%, dual coded 7121-7522, (post-phlebitic syndrome of any etiology-penis, deformity, with loss of erectile power), citing significant residual pain.   

Panel members noted the analogous code used by the PEB (7121) was a poor choice for rating the CI’s condition because a 10% rating requires “intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery.”  However, the VA’s coding was more appropriate, but the CI neither had a penile deformity proximate to separation nor did he have loss of erectile power, although he did have pain with erections.  Therefore, although the CI had significant pain as a result of the post-phlebitic process, a higher rating (in the absence of persistent edema or penis deformity with loss of erectile power) cannot be achieved.  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 pubic pain.  

Contended PEB Conditions:  Obesity and History of Tobacco Abuse.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither condition was profiled or implicated in the commander’s statement nor is either condition considered a physical disability.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended condition; and so, no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the pubic pain and IAW VASRD §4.104, the panel recommends no change in the PEB adjudication.  In the matter of the contended obesity and history of tobacco abuse, 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.  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 20170226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02580.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings