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AF | PDBR | CY2012 | PD2012 01345
Original file (PD2012 01345.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XX         BRANCH OF SERVICE: NAVY
CASE NUMBER: PD1201345   SEPARATION DATE: 20020606
BOARD DATE: 20130416


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, HM3/E-4, (8408/Hospital Corpsman), medically separated for testalgia, right greater than left. The CI developed right sided testicular torsion in 1999 and underwent a bilateral orchiopexy. Due to continued pain, he underwent surgical exploration where his cremasteric muscle was stripped from the cord on the right and a small hydrocele was removed. He continued with post operative pain, right greater than the left. He failed both surgical and conservative treatment and was unable to meet the physical requirements of his rating or satisfy physical fitness standards and was referred for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the right greater than left persistent testalgia condition as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated.


CI CONTENTION: “I had severe depression, anxiety that was severe was bipolar wich at that time was undiagnoses. Dr’s never went to any depth on my mental problems violent outburst was told I didn’t have an choice to dibate on the %. My total health was disregarded after my fisrt surgery I was given little pain meds and not treated for any other issues at that time wich were servere depression anxiety PTSD [posttraumatic stress disorder] all of wich trigerd violent oburst throwing stuff and breaking equipment wasn’t given treatment for my severe pain just told to deal with it and not allowed to properly heal told I was a melingarer.”


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The other requested conditions (depression/anxiety/bipolar and PTSD) are not within the Board’s purview. 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 Naval Records.


 RATING COMPARISON :

Service IPEB – Dated 20020426
 VA (14 Mos. Post-Separation) – All Effective Date 20020607
Condition
 Code Rating Condition Code Rating Exam
R>L testalgia 8730 10% B Testalgia s/p orchiopexy 7599-7525 10% 20030812
No Additional MEB/PEB Entries
 Other X 2 / Not Service-Connected x 4 20030812
Rating: 10%
 Combined: 40%



ANALYSIS SUMMARY:

Bilateral Testalgia, Right Greater Than Left. In 1999, the CI presented with an acute onset of right testicular pain and swelling. He was diagnosed with right testicular torsion and underwent bilateral orchiopexy. He continued to report post-surgical testicular pain bilaterally with prolonged standing, walking, and running. A second surgical procedure (right hydrocelectomy and spermatic cord stripping) was performed in 2001 for persistent right greater than left testicular swelling and pain. The narrative summary (NARSUM), 4 months prior to separation notes persistent right greater than left testicular pain. The NARSUM examination was significant for right testicle and epididymis tenderness to palpation and no left testicular findings. At the VA Compensation and Pension examination 10 months after separation, the CI reported daily, right greater than left, testicular pain with swelling; worse with activity and sitting. The CI reported no use of pain medications for the testicular pain. The examiner noted bilateral moderate testicular and cord tenderness to palpation with cord thickening.

The Board directs attention to its rating recommendation based on the above evidence. The PEB adjudicated the bilateral testalgia condition as unfitting and rated it analogous to neuralgia of the ilio-inguinal nerve, VASRD code 8730. The VASRD defines neuralgia as dull, intermittent pain along a typical nerve distribution. Although the VA conferred a similar disability rating of 10%, the coding pathway, 7599-7525, was analogous to chronic epididymo-orchitis. The Board considered both coding options as reflective of the functional impact of activity dependent bilateral testalgia not responsive to surgical and conservative management; however, Board members agreed that the PEB’s neuralgia coding more accurately characterized the testalgia condition. IAW VASRD §4.124, the maximum rating for neuralgia is equal to moderate incomplete paralysis of the involved nerve, thus there is no route a higher rating under VASRD code 8730. The Board then considered whether a higher of rating could be conferred using the VA’s 7299-7525 coding option, but there was no evidence of “continuous intensive therapy” for a higher rating of 30%. 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 bilateral testalgia condition. The Board concluded therefore that this condition could not be recommended for additional disability 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 bilateral 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 that there be no recharacterization of the CI’s disability and separation determination, as follows:
UNFITTING CONDITION
 VASRD CODE RATING
Bilateral Testalgia 8730 10%
RATING 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120610, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         XX
         Director of Operations
         Physical Disability Board of Review


 MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 31 May 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandum, 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:
- X former USMC
- X former USN
- X former USMC
- X former USN
- X former USN
- X former USN



                                                     
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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