RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-02826
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20150116
SEPARATION DATE:  20050601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-3 (Surface Warfare Officer) medically separated for testicular pain (testalgia).  This condition could not be adequately rehabilitated to meet the requirements of the Navy, so he was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The testicular condition, characterized as “unspecified disorder of male genital organs,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right chronic testalgia” as unfitting, rated 10%, with likely application of VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “The VA has never done a review which didn’t have errors.  I have limited mobility and take medications which limit my ability to drive, my employment, and quality of life.  The VA has been inconsistent in its evaluations, starting with the initial determination that my injury happened after the Navy performed the surgery to correct the injury.  I have requested a formal review board and have been denied for years.  I am not unemployable.  I have a good job.  But I have to continually spend time and money to compensate for the limitations for which I was involuntarily separated medically from the Navy.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service PEB – Dated 20050222	VA* - (3 Wks. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Testalgia	8730	10%	S/P Scrotal Exploration…	7599-7525	10%	20050622	
			Scar, Scrotal Region	7804	10%	20050622	
Other x 1	Other x 4	
RATING  10%	COMBINED RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20060221 (most proximate to date of separation (DOS)).
ANALYSIS SUMMARY:

Right Testicular Condition.  Review of the treatment record showed that the CI underwent bilateral orchiopexy (fixation of the testis in the scrotum) in 1997 to prevent recurrence of testicular torsion (twisting of the testis on its blood supply).  Post-operatively, the CI experienced chronic right testicular pain.  An ilioinguinal nerve block failed to resolve the pain, but medication for neurologically mediated pain was helpful.  The narrative summary dated 7 January 2005 (5 months prior to separation) reported that the CI could only perform desk work or mild activities and had been on a physical training waiver since 1997.  A physical exam was not performed.  The non-medical assessment on 28 January 2005 indicated that the CI lost work almost 2 days every 2 weeks due to “inability to concentrate brought on by spasms and pain.”  He could not sit for more than 90 minutes at a time without standing.  Medications prevented him from performing overnight watches.

At the VA Compensation and Pension exam performed a month after separation, the CI reported that medications used for the pain caused fatigue as a side effect.  He denied any recent time lost from work due to the condition.  Examination showed a centrally located, moderately tender scar and fibrotic changes within the scrotal sac region.  Tenderness or evidence of pain was not otherwise mentioned and gait was normal.  The neurologic exam was normal.

The Board directed attention to its rating recommendation based on the above evidence.  Under VASRD code 8730 (neuralgia of ilioinguinal nerve) the PEB assigned a 10% rating for severe to complete paralysis.  The VA’s 10% rating was based on analogous code 7525 (chronic epididymo-orchitis rated as urinary tract infection).  Board members agreed that the condition was best represented by chronic pain related to the ilio-inguinal nerve, and the 10% rating (the highest rating allowed under code 8730) was appropriate.  The Board could find no other clinically appropriate coding pathways.  The Board noted the additional rating by the VA on the basis of the residual surgical scar of the scrotum.  By precedent, the Board does not recommend separation rating for scars unless their presence imposes a direct limitation on fitness.  The Board agreed that the preponderance of the evidence in this case does not suggest that the scrotal scar was separately unfitting.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right chronic testalgia condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the right chronic testalgia condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends no re-characterization of the disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 16 Jun 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual's records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy' s Physical Evaluation Board:

-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USMC

XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)