RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-00509
BRANCH OF SERVICE:  Army	BOARD DATE:  20141121
Separation Date:  20070426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11B20/Parachute Infantryman) medically separated for chronic left scrotal pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent P3/L3 profile and referred for a Medical Evaluation Board (MEB).  The scrotum condition, characterized as “chronic left scrotal pain Status Post (s/p) multiple surgeries” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (hypertension and non-radicular lower back pain [LBP]) for PEB adjudication.  The Informal PEB adjudicated “chronic left scrotal pain” as unfitting, rated at 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to meet medical retention standards.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I received 0% compensation for the conditions which rendered me unfit.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left scrotal condition is addressed below.  There is a vague reference by the CI to other conditions that may include the non-disqualifying MEB conditions hypertension and non-radicular LBP, which were determined to be not unfitting by the PEB, and are likewise addressed below.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20070306	VA - (2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Scrotal Pain	8730	10%	Left Scrotal Pain, s/p Orchiectomy	7524	0%	20070626	
Hypertension	Non-disqualifying	Accelerated Hypertension	7101	10%	20070626	
Non-radicular LBP	Non-disqualifying	Spondylosis L-Spine	5003	0%	20070626	
Other x 0	Other x 3 	
Rating:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20070827 (most proximate to date of separation)

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to the VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.
Chronic Left Scrotal Pain Condition.  The CI developed severe left groin and scrotum pain during a combat airborne assault behind enemy lines in April 2003.  After completing his mission, he sought care in a Combat Aid Station and was treated conservatively with non-steroidal anti-inflammatory drugs and activity limitations.  The CI’s symptoms continued to significantly worsen and on 10 April 2004, he was seen in the emergency room, diagnosed with testicular torsion and underwent emergency surgery.  Post-operatively, the CI continued with hemi scrotal pain; especially after prolonged physical exercise.  In January 2005, a testicular ultrasound demonstrated a left testis suspicious for a malignancy versus an inflammation.  The urologist noted that the left testicle was exquisitely tender to palpation and was tender along the cord to the inguinal canal.  He diagnosed left orchalgia (testicular pain) and possible nerve entrapment.  A repeat testicular ultrasound demonstrated a possible left testicular infarct versus a neoplasm.  The CI underwent a left orchiectomy and prosthesis placement on 28 June 2005.  The urologist indicated that the CI still had left inguinal pain that extended from his left lower abdomen to the posterior aspect of the scrotum.  Because of the chronic left testicular pain, the CI underwent an excision of the prosthetic testicle on 6 January 2006.  Despite removal, the CI continued to have persistent painful soft tissue on the left hemi scrotum.  On 13 March 2006, the CI underwent a scrotal and inguinal exploration with removal of scar tissue.  The urologist noted that the CI continued with left scrotal pain; however, he had no further therapy available to resolve his pain.  

The urology special care consult for the MEB (10 months prior to separation), noted that the CI’s persistent pain prevented him from performing his MOS duties.  The focused physical exam finding was significant tenderness to palpation at the scrotal inguinal junction.  The examiner diagnosed left scrotal/pelvic pain and opined that although the condition was stable, the CI was still unable to perform his duties adequately.  The pain management specialist documented chronic pain in the groin and scrotal area despite the four surgeries on the left testicle and scrotum.  On physical exam, there was slight tenderness and no discharge.  The examiner recommended pulsed radiofrequency denervation of the ilioinguinal and genitofemoral nerves.

The MEB narrative summary exam (approximately 9 months prior to separation), documented chronic left scrotal pain refractory to multiple surgeries, multiple narcotic and non–narcotic pain medications and various other strategies.  There were physical exam findings of tenderness to palpation of the left scrotum and inguinal canal.  The examiner opined that despite the CI’s best efforts, he failed to meet retention standards.  The CI underwent pulsed radiofrequency ablation of the left ilioinguinal nerve on 3 October 2006.  The pain management specialist noted that despite the ablation, the CI continued to have left scrotal pain.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the chronic left scrotal pain condition as 8730 (neuralgia) and rated at 10% (severe to complete).  The VA coded the left scrotal pain, s/p orchiectomy condition as 7524 (removal testis), and rated at 0% for “one testicle.”  The Board reviewed the criteria for §4.124 (neuralgia characterized usually by a dull and intermittent pain, of typical distribution) so as to identify the nerve versus §4.123 (neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating).  The Board agreed that the evidence was more closely aligned with §4.124 neuralgia.  All exams proximate to separation documented persistent left scrotal pain.  The Board considered alternate rating schema and agreed that none would result in a higher rating.  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 chronic left scrotal pain condition.

Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB were hypertension and non-radicular LBP.  The Board’s first charge with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness adjudications.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  None of these conditions were profiled; none were implicated in the commander’s statement and, none were judged to fail retention standards.  All were reviewed and considered by the Board.  There was no indication from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the hypertension and non-radicular LBP contended conditions and, therefore, no additional disability ratings can be recommended.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chronic left scrotal pain condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the hypertension and non-radicular LBP contended conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

			
XXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20150007043 (PD201400509)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA