DEPARTMENT  OF THE  NAVY 

BOARD  FOR  CORRECTION  OF  NAVAL  RECORDS 

2  NAVY  ANNEX 

WASHINGTON  DC  20370-5100 

JRE 
Docket No:  5648-01 
13 January 2003 

This is in  reference to your  application for correction of  your  naval record pursuant to the 
provisions of  title  10 of  the United  States Code, section  1552. 

A  three-member panel of  the Board  for Correction of  Naval Records, sitting in  executive 
session, considered your application on  9 January 2003.  Your  allegations of  error and 
injustice were reviewed  in  accordance with  administrative regulations and procedures 
applicable to the proceedings of  this Board.  Documentary material considered by  the Board 
consisted of  your application, together with  all material submitted in  support thereof, your 
naval record and  applicable statutes, regulations and policies.  In  addition, the Board 
considered the advisory opinion  furnished by  a specialist in  urology  dated  3 June 2002, a 
copy of  which  is attached. 

' 

After careful and  conscientious consideration of  the entire record, the Board  found that  the 
evidence submitted was insufficient to establish the existence of  probable material error or 
injustice.\ In  this connection, the Board  substantially concurred with  the comments contained 
in  the adyisory opinion.  Accordingly, your  application has heen denied.  The names and 
votes of  the members of  the panel  will be  furnished upon  request. 

It is regretted that the circumstances of  your  case are such that  favorable action cannot be 
taken.  You  are entitled to  have the Board  reconsider its decision upon  submission of  new  and 
mqterial evidence or other matter not  previously considered by  the Board.  In this regard, it is 
important to keep in  mind  that a presumption of  regularity attaches to aLl official records. 

Consequently, when applying for a correction of an official naval record, the burden is on the 
applicant to demonstrate the existence of probable niaterial error or injustice. 

Sincerely, 

W.  DEAN PFEIFFER 
Executive Director 

Enclosure 

6150 
267A 
3 Jun 02 

From:  Chief, Urology Service, National Naval Medical Center 
To : 

Chairman, Board for Correction of Naval Records, 2 Navy 
Annex, Washington, DC 20370-5100 
Director, Restorative Care Directorate 

Via: 

Sub j :  COMMENTS AND REC 

Ref: 

(a)10 U.S.C.  1552 

-. 

Encl:  (1) Bibliography 

(2) BCNR File, Service Record Microfiche, VA 

Records/Medical Records, Docket No.  05648-01 

response to the request to review the 

(hereinafter referred to as SNM). 

1.  After review of medical records it has been assumed that SNM 
was diagnosed with Stage IIIB Mixed Germ Cell Cancer  (90% 
embryonal and 10% Seminoma) on 24 June 2000.  After a pre- 
operative work up he underwent a right radical orchiectomy 
followed by four cycles of a chemotherapy regimen commonly 
referred to as "PEB." 

on physical exam perfo;med  4 june 1998 by-, 
who at that time was a Lieutenant Commander in the 

.. 

tates Navy Medical Corps. 

2.After review of medical records it has also been assumed that 

SNM was found to have an "atro~hic riaht testicle."  on 

4. If we assume that - did truly distinguish 

3. The question which will be addressed in further paragraphs is: 
"Was the right testis cancer present at the time of separation 
physical of SNM?"  This question will never be able to be 
answered definitively.  Therefore, a "best opinion," will be 
offered with an explanation of logic supported by the evidence 
available in the medical record. 

between a "testis mass," and an "atrophic testis,"  (also known 
as small testis), then we are lead to believe that there was 
no evidence of testis cancer, or at least no need for further 

: *-  TIONS ICO FORMER 

military.  Additionally, there is no evidence that SNM 
experienced any debilitating illness or injury, which would cause 
right testicular atrophy during his time of active service in the 
Navy.  Therefore, the assumptions may be:  (1) the presence of 
right testicular atrophy was missed on physical exam prior to 
entrance to the Navy or (2) SNM  experienced an accident or 
debilitating ilhess during his active service in the Navy which 
was not documented in his medical record and resulted in the 
right testicle "atrophying," or shrinking, in size. 

5 .   Because of the inability to distinguish the timeline for 
onset of the testicular atrophy, it is also impossible to 
determine whether this was an "acute" or "chronic" disease 
process.  With the lack of findings in either the medical record 
or on physical exam, this reviewer is led to believe that the 
condition was more likely chronic and reflected a condition of 
childhood events.  Medical records from birth to the time of 
physical exam prior to entry to the service may further 
illuminate this issue. 

6.  Per reference  (1) in the enclosed bibliography, authors 
Oliver and Mead agree that the presence of testicular atrophy 
does indeed increase the likelihood that a testis cancer will 
develop in the future. 

7.  The pathology specimen report dated 28 June 2000, 18:27, 
supports that the right testis was no longer atrophic.  In fact, 
the testicular size was measured and found to be, 7x10~9 
centimeters in size.  This is approximately 2-5 times the size of 
a normal testicle depending on the individual. 

8.  Radiological report of SNM in the form of computerized 
tomography scans of the chest, abdomen, and pelvis dated 27 June 
which would 
2000, 18 :43, s u p p ~ r t s  ati-.*m:!l 
classify SNM as a Stage IIIB by the M.D. Anderson staging system 
for testicular cancer, (bibliography reference 2). 

.  , I   and T I I ~ . I . ~ S ~ L ~ ~  

i  8 .  r-,i~.~e~- 

9.  When the above information is taken into consideration, 
including the assumptions of the timeline and etiology of the 
initial testicular atrophy and the potential pre-disposition to 
testis cancer, it is this reviewer's opinion that the condition 
of testis cancer DID NOT EXIST at the time of separation physical 
examination.  The fact that the testis was noted to be small in 
1998 and found to be severely enlarged after removal in 2000 
supports the pathologic process as one of rapid growth over time. 

ICO FORMER 0 

10.  A  testicular malignancy consisting of 90% embryonal and 10% 
seminomatous germ cell components could spread to the level of 
metastasis equivalent to Stage IIIB in less than two years.  In 
fact, the time it takes for a germ cell tumor to double in size, 
"doubling time," is felt to be as short as 10-30 days in the case 
of embryonal cell car~inoma.~ Even when SNM is given the longest 
possible doubling time, it can be assumed that he had an 
approximate 4-6 month period from no tumor to one of the size 
stipulated on the pathology report referenced in paragraph 8 of 
this memo.  A  4-6 month retrospective period would not make it 
likely that a tumor existed in the right testis at the time of 
separation physical examination. 

11.  It is the reviewer's hope that the logic applied to the 
information submitted is within the confines of a reasonable 
conclusion.  If however, further questions exist please do not 
hesitate to contact me for further explanation. 

LCDR -MC USNR 

BIBLIOGRAPHY 

1. Curr  Opin  Oncol  1993 May;5 (3) :559-67. 

2 .   The M .  D .   Anderson  S u r g i c a l   Oncology  Handbook  , second edition; 

Feig BW, et  al; Lippincott Williams and Wilkins; pg.  374: 
1999. 

3. Campbell's  Urology,  seventh edition; Walsh,  et  al.; WB 

Saunders; pp. 2411-2425: 1998. 

Enclosure (1)