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AF | PDBR | CY2012 | PD2012 00965
Original file (PD2012 00965.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1200965
BRANCH OF SERVICE: Army  BOARD DATE: 20130507
SEPARATION DATE: 20031208


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (67T20/UH-60 Helicopter Repair) medically separated for a testicular pain condition, first noted in 1996. This condition was not relieved by conservative measured or by surgery, and could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or to satisfy physical fitness standards. The Medical Evaluation Board (MEB) forwarded chronic left testicular pain status post (s/p) left varicocele and left cord stripping procedure; left knee pain; and history of toxoplasmosis of the eyes to the Physical Evaluation Board (PEB) IAW AR 40-501. The PEB adjudicated chronic left testicular pain as unfitting, rated 0%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI did not concur with the PEB’s findings, but waived a formal hearing. The case was reviewed by the US Army Physical Disability Agency (USAPDA), which affirmed the PEB findings and recommendations and the CI was medically separated with a 0% rating.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 testicular pain condition is addressed below. The left knee and toxoplasmosis conditions were not contested and thus are not within the DoDI 6040.44 defined purview of the Board. These, and any other conditions or contention not requested in this application, remain eligible for future consideration by the respective Service Board for Correction of Military Records. 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 VASRD standards, based on ratable severity at the time of separation.



RATING COMPARISON:

Service FPEB – Dated 20030822
 VA* - (~13.8 Mos. Post-Separation) and Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Testicular Pain...
 8799-8730 0% Varicocele, Left Hemiscrotum, S/P Varicocelectomy… 7599-7525 10% 20050124
Residuals Scars, S/P Varicocele… 7805 0% 20050124
Left Knee Pain
 Not Unfitting Left Knee Condition 5257 NSC 20050124
History, Toxoplasmosis both Eyes
 Not Unfitting Toxoplasmosis 6399-6320 NSC STR
No Additional MEB/PEB Entries
 Other x 6 20050124
Combined: 0%
 Combined: 30%
* Derived from VA Rating Decision (VA RD ) , d ated 200 50314 (most proximate to date of separation)


ANALYSIS SUMMARY:

Chronic Left Testicular Pain Condition. The CI first reported left testicular pain in April 1996. Initially treated for epididymitis, he underwent a left spermatic vein ligation in April 1996. In April 2000, he underwent elective vasectomy, and noted testicular pain again 6 months later. Despite treatment for chronic epididymitis, he continued to experience left testicular pain. A spermatic cord block in March 2002 resulted in relief of pain and left spermatic cord stripping was completed in April 2002. However, despite initial good results, his pain recurred with lifting and exercise, and he reported right testicular pain in July 2002. He was issued a permanent profile and referred for an MOS Medical Retention Board (MMRB) in October 2002. The MMRB concurred with the commander’s recommendation and referred the CI for MEB. An ultrasound in February 2003 noted chronic inflammatory changes consistent with chronic epididymitis. The CI reasonably decided against an additional surgery, removal of the testicle, which was not guaranteed to relieve his symptoms. No further treatment was recommended. The MEB narrative summary (NARSUM), in June 2003, 6 months prior to separation, noted that the CI continued to suffer from pain, and developed “incapacitating pain in the left testicle” secondary to any exertional activity, which the CI believed prohibited his ability to maintain fitness standards. The NARSUM notes a normal examination except for bilateral scrotal tenderness to palpation, greater on the left than on the right, with normal testicular size, without masses or edema.

At the VA Genitourinary Compensation and Pension (C&P) examination, 13 months after separation, on 24 January 2005, noted the same clinical history reported above. The CI noted continuous left testicular swelling and pain, 5 out of 10, with activity, walking, lifting, and sex. He had discontinued impact exercises and weight lifting. He continued to note swelling and denied any urinary symptoms. The examiner noted the CI was very tender on exam and the presence of a large left varicocele. A General Medical C&P examination was performed the same day and it noted a normal neurologic examination with normal reflexes, strength, and sensation to touch and pinprick. The initial VA Rating Decision noted that there was no documentation of treatment for this condition after his separation from service or for lost time from work due to this condition. A subsequent C&P examination in February 2010 documented the CI had been evaluated for an orchiectomy to treat his continued pain; however, the CI had ultimately decided not to pursue the procedure even though he continued to have significant problems with pain. Moderate tenderness was present on examination.

The Board directs attention to its rating recommendation based on the above evidence. The PEB coded the chronic left testicular pain condition analogous to 8730 (neuralgia of the ilio-inguinal nerve), rated at 0% for moderate symptoms. The VA coded the condition analogous to 7525 (Epididymo-orchitis), chronic only, and applied a rating of 10%. The VASRD instructs that diagnoses rated under this code be rated as urinary tract infections, for which 10% is awarded when there is “long-term drug therapy, 1–2 hospitalizations per year and/or requiring intermittent intensive management.” There is no evidence in the record of treatment during the 13 months after separation. While neither code completely characterizes the CI’s condition, the Board determined that the ilioinguinal nerve code more closely reflected not only the functions affected, but also the anatomical localization and symptomatology of the CI’s condition. The record does not include any evidence of severe symptoms. 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 testicular pain 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. 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 testicular pain 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 that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Left Testicular Pain
 8799-8730 0%
COMBINED
 0%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120625, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130011455 (PD201200965)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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