RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-02893
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Infantryman, medically separated for “chronic lumbosacral spine pain” and “chronic right scrotal pain,” rated 10% and 0%, respectively, with a combined 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 – 20071226	VARD - 20080425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lumbosacral Spine Pain	5299-5243	10%	DDD, Lumbar Spine	5241	10%	20080131	
Chronic Right Scrotal Pain	8799-8730	0%	Neuralgia, Right Scrotum 	8799-8730	0%	20080131	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Lumbosacral Spine Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent an L5-S1 spinal fusion in March 2007.   The 16 October 2007 MEB NARSUM examination, 4 months prior to separation, noted continued complaints of low back pain.  The physical examination (PE) revealed full, but painful lumbar range of motion (ROM).  Spasms without tenderness were present about the lumbosacral spine.  Bilateral lower extremity strength was slightly weakened and the Achilles reflex was absent, bilaterally, but sensation was normal.  On 3 December 2007, physical therapy (PT) measured thoracolumbar ROM with forward flexion of 60 degrees (normal 90) and combined ROM of 175 degrees (normal 240).  The examiner also noted that “lumbar stiffness” was the mechanical factor (not pain) that limited the CI’s ROM.  There was no evidence of tenderness, spasms, guarding or abnormal spinal contour.  

The 31 January 2008 VA Compensation and Pension (C&P) examination, 10 days prior to separation revealed no antalgic gait or abnormal spinal contour, but spasms were present.   Spinal ROM was normal, with pain.  “There [was] no evidence of radiculopathy of both lower extremities.”  The examiner stated:  “During the PE, this [CI] exhibited mild manifestation of pain and stiffness on his lumbosacral spine.  It is my estimate that this [CI] will have mild functional loss limited to forward flexion of 80 degrees, and will have mild physical impairment during flare-ups.”   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5243 (intervertebral disc syndrome), citing mechanical limitation of motion and muscle spasm without deformity or altered gait.  The VA also rated the back condition 10%, coded 5241 (spinal fusion), based on the C&P examination, citing limitation of motion.  Panel members first agreed that the greatest degree of probative value be apportioned to the VA examination due to it close reference to separation.  Members then agreed that sufficient evidence of painful motion was present to justify the Service’s 10% rating, as well as the presence of localized spasms not resulting in abnormal gait or spinal contour IAW §4.71a.  There were no available alternative or analogous coding options which were applicable and or advantageous to the CI’s current 10% rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the back condition was appropriately adjudicated in this case.  

Chronic Right Scrotal Pain.  According to the STR and MEB NARSUM, the CI’s right scrotal pain began following a right sided hernia repair performed in August 2006.  Secondary to persistent right-sided scrotal pain, he underwent spermatic cord injections which failed to provide a complete resolution of pain.  His pain was “somewhat” controlled by medication.   A urology clinical encounter on 28 September 2007, 4 months prior to separation, revealed a normal genitourinary (GU) examination, noting no scrotal tenderness or swelling.  The MEB NARSUM examination, noted complaints of high-riding right sided scrotal pain.  His GU examination was detailed and completely normal except for tenderness about the right epididymis (which sits atop the testicle).  At the VA C&P examination, the CI reported pain in the right groin.  There was no comment of any complaints within the scrotum.  The detailed GU examination revealed right-sided scrotal tenderness. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right scrotal pain 0%, analogously coded 8799-8730 (neuralgia), citing moderate disability.  The VA also rated the right scrotal pain 0%, analogously coded 8799-8730, based on the C&P examination, citing mild or moderate incomplete paralysis of the ilio-inguinal nerve.  Panel members deliberated on the most appropriate and beneficial coding scheme in representing the CI’s condition.  The CI’s clinical condition, surgical intervention and resultant persistent painful symptoms clearly indicated anatomical involvement of the right Ilio-inguinal nerve and therefore, VASRD codes of either 8530 (paralysis of Ilio-inguinal nerve) or 8730 (neuralgia of ilio-inguinal nerve) were considered.  VASRD §4.124a has only two possible ratings for impairment of this nerve; 0% (mild or moderate) or 10% (severe to complete paralysis), which equates to the maximum rating if the condition was coded as neuralgia of the same nerve.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that as long as medication provided pain relief, the “severe” or “10%”  level was not supported.  Therefore, there was insufficient cause to recommend a change in the PEB’s adjudication for the right scrotal pain. 
BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right scrotal pain 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 20170406, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

PD-2017-02893

AR20190009873, XXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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.

				PD-2017-02893