RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:                                                          BRANCH     OF
SERVICE:  Army
CASE  NUMBER:   PD1100233                                         SEPARATION
DATE:  20061229
BOARD DATE:  20120329


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/Infantryman), medically separated  for  chronic  left  sided  scrotal
pain.  The CI developed left scrotal pain, without  history  of  trauma,  in
September 2004.  He was treated with  pain  medications,  nerve  blocks  and
surgery,  without  improvement  in  his  pain.   The  CI  did  not   respond
adequately to treatment and  was  unable  to  perform  within  his  Military
Occupational Specialty (MOS) or meet physical  fitness  standards.   He  was
issued a permanent P3/H2 profile and underwent a  Medical  Evaluation  Board
(MEB).  Chronic Left Orchialgia, was forwarded to  the  Physical  Evaluation
Board  (PEB)  as  medically  unacceptable  IAW  AR  40-501.    Three   other
conditions, as identified in the rating chart below, were forwarded  on  the
MEB submission as meeting retention  standards.   The  PEB  adjudicated  the
chronic left sided scrotal pain  condition  as  unfitting,  rated  0%,  with
application of the Veterans Administration Schedule for Rating  Disabilities
(VASRD).    Additionally,   moderate   obstructive   sleep   apnea    (OSA),
retropatellar  pain  syndrome  and  left  sensorineural  hearing  loss  were
adjudicated as not unfitting.  The CI made no  appeals,  and  was  medically
separated with a 0% combined disability rating.


CI CONTENTION:  “Because I ended up having to have my left testical  removed
do to extreme pain.  I am now can not have any  kids  now  due  to  problems
that I have had.  And my second condition is obstructive  sleep  apnea  with
use of a CPAP machine.  My VA rating is under the appeal process  right  now
for the removal of my testie.”


RATING COMPARISON:

|Service PEB – Dated 20061002   |VA (1 Day After Separation) – All        |
|                               |Effective Date 20061230                  |
|Condition                      |Code                            |Rating  |
|Combined:  0%                  |Combined:  80%*                          |


*Added Right Ankle s/p reconstructive surgery, 5271-5010, at  10%  effective
20061230 (20070424 surgery), temporary 100%  20070424-to-20070801;  combined
90% effective 20081125

ANALYSIS SUMMARY:  The Board acknowledges the  sentiment  expressed  in  the
CI’s  application  regarding  the  significant  impairment  with  which  his
service-incurred condition continues to burden him.   The  Board  wishes  to
clarify that  it  is  subject  to  the  same  laws  for  service  disability
entitlements as those under which the  Disability  Evaluation  System  (DES)
operates.  The DES has neither the role  nor  the  authority  to  compensate
service members for anticipated future severity or  potential  complications
of conditions resulting in medical separation.  That role and  authority  is
granted by Congress to the Department of Veterans’ Affairs (DVA),  operating
under a different set of laws (Title 38, United  States  Code).   The  Board
evaluates  DVA  evidence  proximal  to  separation  in   arriving   at   its
recommendations, but its authority resides in  evaluating  the  fairness  of
DES fitness decisions and rating determinations for disability at  the  time
of separation.  The Board also acknowledges the CI's  contention  suggesting
that service  ratings  should  have  been  conferred  for  other  conditions
documented at the time of separation and for conditions not diagnosed  while
in the service (but later determined to be service-connected  by  the  DVA).
While the DES considers all of  the  service  member's  medical  conditions,
compensation can only be offered  for  those  medical  conditions  that  cut
short a service member’s career, and then only to  the  degree  of  severity
present at the time of final disposition.  The DVA,  however,  is  empowered
to compensate service-connected conditions and to  periodically  re-evaluate
said conditions for  the  purpose  of  adjusting  the  Veteran’s  disability
rating should the degree of impairment vary over time.

Chronic Left Sided Scrotal Pain Condition.  The  CI  had  gradual  onset  of
left sided scrotal pain on  September  26,  2004.   Evaluation,  to  include
urinarlysis, scrotal ultrasound and cystoscopy, was  unremarkable.   The  CI
was diagnosed and treated for epididymitis  and  recovered  sufficiently  to
deploy to Iraq with his unit.  In  December  2005,  his  left  scrotal  pain
symptoms  worsened  and  were  not  relieved   with   pain   medication   or
ilioinguinal nerve blocks.  The CI was evacuated from  theater  for  further
evaluation in January 2005.  Urologic work-up did not determine an  etiology
of his pain; however, the CI’s  civilian  urologist  suspected  intermittent
torsion and performed a high ligation of the spermatic  vein  and  bilateral
orchiopexy in February 2005.  The CI  recovered  well  post-operatively  and
was returned  to  Iraq  in  February  2005.   In  March  2005  he  developed
worsening of his pain following blunt trauma to the left scrotum.  The  pain
did not improve with conservative treatment, rest  and  non-steroidal  anti-
inflammatory medication, and the CI was once again  evacuated  from  theater
for futher evaluation and treatment.  Upon  return  to  CONUS,  the  CI  was
evaluated by urology and the pain clinic.  Urology initiated an MEB for  the
left scrotal pain condition.  Pain  clinic  evaluation  was  not  consistent
with neuropathic testicular pain and  the  examiner  opined  that  the  CI’s
surgery and traumatic  injuries  were  too  recent  to  recommend  permanent
separation.  The MEB was terminated and the CI was  placed  on  a  temporary
profile.  The CI had  transient  improvement  with  decreased/resolved  pain
symptoms in August 2005, and the CI was returned  to  full  duty.   Symptoms
recurred and the CI was referred for MEB.

At the time of the narrative  summary  (NARSUM)  exam,  7  months  prior  to
separation, the CI was continuing to experience left scrotal pain  that  was
worsened by activity and physical exertion.  It was noted that  the  CI  had
been  counseled  on  options  for  further  treatment  (cord   block,   cord
stripping, epididymectomy and/or  orchiectomy),  but  had  declined  further
surgery  (considered  reasonable).   The  exam  revealed   normal   external
genitalia and a well healed left inguinal incision.  The left  testicle  and
epididymis were mildly tender to palpation.  Both testes were descended  and
there was no evidence of varicocele or mass.   The  MEB  examiner  concluded
“Given the patient suffers from severe left-sided scrotal  pain  with  heavy
exertion,  this  would  severely  impact  his  ability  to   serve   as   an
infantryman.”

The VA Compensation and Pension (C&P)  exam,  (28  November  2006)  1  month
prior to separation, documented complaints of continous pain since  surgery,
worsened with walking,  jumping,  or  other  motion.   The  CI  additionally
complained of impotence due to pain with intercourse.  He denied  difficulty
initiating urination  and  denied  symptoms  of  urinary  incontinence.   He
stated that he had undergone a vasectomy in October 2006, without relief  of
pain symptoms.  The VA physical exam was remarkable for tenderness  of  both
testes and both epididymides, without  nodules  or  masses.   A  March  2005
testicular ultrasound found no testicular hematoma or mass.

The PEB and the VA used different coding for the condition  but  arrived  at
the same rating determination.  The PEB coded as analogous  to  ilioinguinal
neuralgia,  moderate  (8799-8730),  and  rated  at  0%.   The  VA  coded  as
analogous to removal of one testis  (7599-7523)  and  also  rated  0%.   The
Board noted  that  both  ratings  represented  the  maximum  that  could  be
assigned under either code for the condition.  Per  the  VASRD  §4.124,  the
maximum rating  allowed  for  neuralgia  is  equal  to  moderate  incomplete
paralysis (0% for the ilioinguinal nerve).  The record of evidence  did  not
support a diagnosis of neuritis IAW VASRD §4.123, and there were no  organic
changes.   There  was  no  documentation  of  voiding  dysfunction,  urinary
frequency or recurrent urinary tract infection to justify alternate  coding.
 There is no route to a rating higher than 0% under any applicable code  and
no coexistent pathology which would merit additional rating for the  chronic
left  scrotal  pain  condition  under  a  separate   code.    All   evidence
considered, there is not reasonable doubt in the  CI’s  favor  supporting  a
change from the PEB’s coding or rating decision for the chronic  left  sided
scrotal pain condition.

Other PEB Conditions.   The  other  conditions  forwarded  by  the  MEB  and
adjudicated as not unfitting by the PEB  were  moderate  OSA,  retropatellar
pain syndrome (knee) and  left  sensorineural  hearing  loss.   The  CI  was
diagnosed with moderate OSA in August 2006 and treatment was initiated  with
continuous positive airway pressure  (CPAP)  therapy.   This  condition  was
documented  on  the  permanent  profile  with  the  notation,   “must   have
electrical outlet for CPAP machine.”  There  was  no  documentation  of  any
unfitting symptoms which were  not  corrected  by  CPAP.   In  October  2006
(after the PEB), the CI underwent  a  uvulopalatopharyngoplasty  (UPPP)  and
tonsillectomy due to a desire to discontinue CPAP  therapy.   The  available
STRs did not document the CI’s post surgical course;  however,  the  VA  C&P
exam noted that the CI had had little improvement in his OSA  following  the
surgery.  As a result, he had resumed treatment with  CPAP  and  denied  any
symptoms  as  long  as  his  CPAP  mask  remained  in  place  during  sleep.
Routinely OSA is not considered unfitting solely on the basis of  field  and
operational impediments to the use of CPAP.  There is no  evidence  in  this
case that OSA was associated with any unfitting  impairments  not  corrected
by  CPAP.   The  PEB’s  fitness  adjudication  was  therefore  expected  and
reasonable.  All evidence considered, there is not reasonable doubt  in  the
CI’s favor supporting recharacterization of  the  PEB  fitness  adjudication
for the OSA condition.

The CI underwent orthopedic evaluation for  chronic  right  knee  pain  that
worsened during a February 2006 road march.   The  orthopedic  MEB  examiner
noted that the CI had not had any treatment  with  medications  or  physical
therapy for the knee pain condition.  The  examiner  stated  that  the  CI’s
“prognosis overall is  good,”  noting  that  the  condition  was  likely  to
improve with proper treatment.  The condition of  right  knee  retropatellar
pain syndrome did not result in any specific profile  limitations,  was  not
implicated in the commander’s statment and was found to meet Army  retention
standards.  Although it is possible that the profile for the unfitting  left
sided  scrotal  pain  condition  could  have  provided   shelter   for   the
limitations caused by the right knee condition, that possibility  is  unduly
speculative as the basis for a Board fitness recommendation.

The CI was placed on a permanent H2 profile for left  sensorineural  hearing
loss.  The profile limitations  specified,  “no  duty  assignment  to  noise
levels in excess of 85 dBA or weapon  firing  (not  to  include  firing  for
preparation of replacements for overseas  movement  (POR)  qualification  or
annual weapons qualification with proper ear  protection.”   This  condition
was not implicated in the commander’s statement and was found to  meet  Army
retention standards.

All three conditions were reviewed by the action officer and  considered  by
the Board.  There was no indication  from  the  record  that  any  of  these
conditions significantly  interfered  with  satisfactory  duty  performance.
All evidence considered, there is not reasonable doubt  in  the  CI’s  favor
supporting recharacterization of the PEB fitness adjudications for the  OSA,
right knee and hearing loss conditions.

Remaining Conditions.  Other conditions identified in the DES file  and  the
VA rating decision within 12  months  of  separation  were  anxiety,  Bell’s
Palsy, bilateral tinnitus, right  shoulder  pain,  and  hiatal  hernia  with
gastroesophageal reflux disease.  The STRs documented  treatment  for  post-
deployment anger  management  problems,  anxiety  attacks,  impulse  control
problems and marital relationship  problems.   The  CI  was  diagnosed  with
adjustment disorder with  mixed  emotional  features,  as  well  as  impulse
control disorder and a personality disorder.  IAW  DoDI  1332.38  adjustment
disorder and personality disorder are conditions that do  not  constitute  a
physical  disability.   There  was  no  diagnosis  of  posttraumatic  stress
disorder (PTSD).  The MEB examiner documented that  the  “post-OIF”  anxiety
problems were “almost resolved.”  There was no indication  from  the  record
that the CI’s mental health  conditions  were  significantly  clinically  or
occupationally  active  during  the  MEB  period,  and  no   mental   health
conditions were profiled or implicated in the commander’s statement.

Several additional non-acute conditions  or  medical  complaints  were  also
documented in the MEB history and physical.  None of these  conditions  were
significantly clinically or occupationally active  during  the  MEB  period,
none carried attached profiles, and none were implicated in the  commander’s
statement.  These  conditions  were  reviewed  by  the  action  officer  and
considered by the Board.  It was determined that none  could  be  argued  as
unfitting and subject to separation rating.  Additionally the conditions  of
PTSD and ankle sprain were noted in the VA proximal to separation, but  were
not documented in the DES file.  The  Board  does  not  have  the  authority
under DoDI 6040.44 to render  fitness  or  rating  recommendations  for  any
conditions  not  considered  by  the  DES.   The  Board  therefore  has   no
reasonable basis for recommending any additional  unfitting  conditions  for
separation rating.


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 sided scrotal  pain  condition
and IAW VASRD §4.124a, the Board unanimously recommends  no  change  in  the
PEB adjudication at separation.  In the matter of the  moderate  OSA,  right
knee  retropatellar  pain  syndrome  and  left  sensorineural  hearing  loss
conditions,  the  Board  unanimously  recommends  no  change  from  the  PEB
adjudications as not unfitting.   In  the  matter  of  the  anxiety,  Bell’s
Palsy, bilateral tinnitus, right  shoulder  pain,  and  hiatal  hernia  with
gastroesophageal reflux disease conditions or any other  medical  conditions
eligible for Board consideration,  the  Board  unanimously  agrees  that  it
cannot recommend any findings of unfit for additional rating at  separation.



RECOMMENDATION:   The  Board,  therefore,  recommends  that  there   be   no
recharacterization of the CI’s disability and separation  determination,  as
follows:

|UNFITTING CONDITION                             |VASRD CODE  |RATING  |
|Chronic Left Sided Scrotal Pain                 |8799-8730   |0%      |
|COMBINED    |0%      |


The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20110325, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record



                 President
                 Physical Disability Board of Review
SFMR-RB


MEMORANDUM FOR Commander, US Army Physical Disability Agency

SUBJECT:   Department  of  Defense  Physical  Disability  Board  of   Review
Recommendation

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
                 Deputy Assistant Secretary
                     (Army Review Boards)