RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-04312 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070213

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “atraumatic onset of bilateral testicular pain” with a disability rating of 0%.

CI CONTENTION:  Review of all conditions requested.  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 – 20061208	VARD - 20070630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Testicular Pain	8699-8630	0%	Bilateral Testicular Hydroceles and Epididymal Cysts	7529-7525	0%	20070502	
Left Leg Pain, Numbness and Tingling	Not Unfitting	Ilioinguinal-Genitofemoral Neuritis, Left Lower Extremity	8699-8630	0%	20070502	
Hypercholesterolemia	Not Unfitting	No VA Placement	

Elevated Blood Pressure	
Not Unfitting	
Elevated Blood Pressure	
7101	
NSC	
20070502	
Overweight	Not Unfitting	No VA Placement	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Bilateral Testicular Pain. The PEB combined the right and left testicle conditions under a single disability  rating,  analogously  coded  8699-8630  (neuritis  of  the  ilio-inguinal  nerve;  mild   to

moderate) and rated 0%. This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications. The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings. When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s scrotal condition began in March 2006 with pain occurring 2 weeks after a 25-mile road march. There was no direct scrotal trauma or pain during the march. Initially diagnosed with epididymitis (inflammation of the top portion of the testicle), the CI was treated with medication and activity restrictions. A urology consultation on 21 April 2006 noted that the CI’s testicular pain was worse on the left than on the right side. A scrotal ultrasound performed on 27 April 2006, provided an overall impression of ‘normal testicles’; however, the actual findings noted the presence of bilateral epididymal cysts as well as hydroceles (fluid-filled sac around the testicle). A follow-up scrotal ultrasound performed 3 months later continued to show the bilateral epididymal cysts, but the hydrocele was present only about the left testicle.

Secondary to persistent painful symptoms in light of minimal abnormal findings ultrasonically within the scrotum, the CI was diagnosed with a nerve-related etiology and thus underwent pulsed radiofrequency treatments to various inguinal (groin) nerves on 16 August 2006. Despite such treatments, the CI continued to have ‘significant pain’ in the left testicle and ‘intermittent pain’ in the right testicle. Additionally, due to the radiofrequency treatments, the CI developed the not-so-uncommon side effects of intermittent pain in his left thigh and intermittent numbness in his left foot.

At the 31 October 2006 MEB NARSUM examination, 3 months prior to separation, the CI endorsed bilateral testicular pain with increased activity. He endorsed a constant baseline pain in the left testicle and no baseline pain in the right testicle. His physical examination (PE) revealed marked tenderness about the left testicle. The CI was taking prescription pain medicine on a daily basis. At the 2 May 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant and mild bilateral testicular pain that worsened with exercise. His PE revealed “…very mild tenderness to both testicles. There are no testicular or scrotal masses.”  The documentation under current medications was “none.”

The panel directed attention to its rating recommendation based on the above evidence. As noted above, the PEB bundled the right and left testicles and applied a single 0% rating, coded 8699-8630, citing ‘moderate’. The VA also rated the bilateral testicle condition 0%, analogously coded 7529-7525 (benign neoplasms of the genitourinary system-epididymo-orchitis), based on the C&P examination.

The evidence makes clear that the left testicle was associated with more disability than the right one in this case as noted by baseline pain and pre-separation of “marked” tenderness of only the left testicle. The disparity was such that the question is raised of whether the right testicle was reasonably justified as separately unfitting. Shortly after separation, there again was tenderness to both testicles at a “mild” degree of intensity. The panel considered it was speculative to conclude that the disability confined to either testicle alone would have rendered the CI incapable of performing his military occupational specialty; but, it also found it reasonable to surmise that it was the combined effect of both testicles which rendered him unfit.

Although the PEB and VA chose different coding options for this condition, panel members agreed that the initial diagnosis of epididymitis coupled with ultrasonic evidence of  epididymal

cysts in the context of scrotal pain was most clinically consistent with the overall condition of epididymo-orchitis as listed under VASRD code 7525. VASRD code 7525 defaults to rating under the criteria for urinary tract infections. Under the default condition, there are two possible impairment rating levels; 10% requiring ‘long-term drug therapy, 1-2 hospitalizations per year and/or requiring intermittent intensive management’ or 30% requiring continuous intensive management. Panel members extensively deliberated over any level of impairment and concluded that the CI’s long-term use of prescription pain medicine in evidence at 3 months prior to separation was no longer being taken at 3 months after separation. Therefore, near the time of separation the CI’s prior long-term medication was either decreasing or totally discontinued and thus does not support a positive rating. Additionally, the CI was not hospitalized for the testicular condition. There were no additional or alternate codes available that more accurately reflected the clinical picture, impairment, or would result in a higher rating than the 7525 genitourinary system code. Therefore, after due deliberation, considering all 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 bilateral testicular condition.

Contended PEB Conditions: Intermittent Left Upper Leg Pain and Lower Leg Numbness and Tingling; Hypercholesterolemia, Elevated Blood Pressure; Overweight. The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting. None of the conditions were profiled and they did not fail retention standards. The commander’s statement however commented on severe pain in the left leg which prevented the CI from performing infantry-type duties. The panel specifically considered the left leg pain as possibly a separate ratable condition and concluded that it being of an intermittent nature and thus not in evidence within 3 months either side of separation, did not support the condition as significantly interfering with satisfactory duty performance at or near separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the bilateral testicular condition and IAW VASRD §4.14a, the panel recommends no change in the PEB adjudication. In the matter of the contended intermittent left upper leg pain and lower leg numbness and tingling, hypercholesterolemia, elevated blood pressure, and overweight 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. Therefore, the panel recommends no modification or re- characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

PD-2017-04312 

AR20190012252, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

	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.