RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05366
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “low back pain” and “bilateral testicular pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  “Discharged at 10%, now rated at 90% service connected…”  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 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 - 20060919	VARD - 20061101	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5242	10%	Thoracolumbar DDD	5242	10%	20061004	
Bilateral Testicular Pain	8799-8730	0%	Bilateral Epididymitis 	7525	0%	20061004	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in February 2006 without injury or trauma.  Radiographic studies showed “pars interarticularis defect at L4-5 and degenerative disc disease (DDD) at L5-S1.  During the 6 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, there was tenderness and painful motion despite having no limitation of motion.  Gait and bilateral lower extremity motor strength were normal.  The 21 July 2006 MEB NARSUM examination noted complaints of pain to the mid back and neck.  Physical examination showed tenderness and muscle spasm.  Motor strength and sensation were intact.  During the 7 August 2006 MEB range of motion (ROM) study by physical therapy (PT), 2 months prior to separation, there was 90 degrees of flexion (normal) and 240 degrees of combined ROM (normal).  Although there was no limitation of motion, the examiner noted “pain limits motion.”  At the 4 October 2006 VA Compensation and Pension (C&P) examination, one week before separation, the CI reported constant 2/10 back pain which increased to 6/10 with normal daily activity.  Physical examination showed thoracolumbar flexion of 90 degrees and 240 degrees of combined ROM with pain.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back condition 10%.  The PEB analogously coded the condition 5299-5242 (degenerative arthritis of the spine), citing “positive spasm” and “ROM limited by pain.”  The VA used code 5242, and based the rating on the C&P examination, citing “functional limitation as shown by the painful motion.”  Although there was no limitation of motion, the panel agreed a 10% rating was justified for the presence of painful motion as reported on the NARSUM and C&P examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 back condition.  

Bilateral Testicular Pain.  According to the STR and MEB NARSUM, the CI’s groin pain began in February 2006 without injury or trauma.  An ultrasound of the testicles in March 2006 revealed left-sided varicocele with no other abnormalities, and a CT scan showed no evidence of urinary calculi or hydronephrosis.  An abdominal wall ultrasound revealed no evidence of inguinal hernia on the right.  During the MEB examination the CI reported improvement in testicular pain that was mild to moderate with physical activity.  Physical examination revealed bilateral testicular tenderness, without redness or edema.  Varicocele was noted on the left.

The MEB NARSUM examination, 3 months prior to separation, noted complaints of left greater than right testicular pain that worsened with activity.  Physical examination showed a soft non-tender abdomen and no hernias.  The left testicle was tender and both epididymides were tender.  Spermatic cords were normal bilaterally.  Varicocele was not evident during physical examination.  At the VA C&P examination the CI reported pain twice a week with normal daily activities and usually lasting for a couple of hours.  Physical examination was unremarkable with the exception of bilateral epididymides tenderness and varicocele on the left.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the bilateral testicular pain 0%.  The PEB analogously coded the condition 8799-8730 (neuralgia of the ilio-inguinal nerve), citing “moderate” disability.  The VA used code 7525 (chronic epididymo-orchitis), based on the C&P examination, citing “no drug therapy or intensive management.”  Panel members agreed that STR entries did not support a rating higher than 0% under code 8730.  The CI reported pain twice a week that subsided within a couple of hours.  Therefore, severity was no more than moderate.  The panel also considered using the 7525 code, but couldn’t find evidence of long-term drug therapy, hospitalization, or intermittent intensive management to justify a 10% rating.  There were no other applicable codes to consider for this condition.  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 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 bilateral testicular 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.  

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX:

	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.