Citation Nr: 21062756 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 18-49 491 DATE: October 12, 2021 REMANDED Entitlement to a compensable disability rating for groin and bilateral testicle pain disorder is remanded. REASONS FOR REMAND The Veteran reported active duty in the United States Marine Corps from December 1993 to January 1994 and had documented active duty in the United States Navy from May 1995 to June 2000 with some additional service in the Naval Reserve. This matter comes before the Board of Veteran's Appeals (Board) from an April 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The claims file contains a copy of the hearing transcript. In July 2020, the Board remanded the claim for further development of the evidence; the Board finds that there has not been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Discussion The Veteran asserts that a noncompensable rating does not contemplate the severe pain of his service-connected bilateral testicle pain disorder. During the Board hearing, the Veteran testified that he has sought treatment from both a urologist and a pain management specialist to control the worsening symptoms of his pain disorder. The Veteran's testimony highlighted the "neural component" of this disorder. Moreover, the Veteran's lay complaints in both VA and private treatment records focus on "nerve" discomfort in the groin and testicle area. The ilio-inguinal nerve distributes to the skin of the scrotum or labia majora and the adjacent part of the thigh. See Dorland's Illustrated Medical Dictionary, 1123 (28th Ed. 1994). As such, the Veteran's complaints relate to his groin and, in its most general sense, scrotal region. Consequently, the Board found that the Veteran's groin and bilateral testicle pain disorder is best reflected and should be assessed under 38 C.F.R. § 4.124A, Diagnostic Code 8730 ilio-inguinal nerve neuralgia. The Board requested that the Veteran be provided with an examination by a clinician with expertise in nerve disorders to determine the severity of the groin and testicle pain disorder. The RO rated the Veteran's disorder under the criteria of 38 C.F.R. § 4.115b, Diagnostic Code 7599-7523 (which addresses the clinical status of atrophy of the testis/testes). The March 2021 VA clinician, a nurse practitioner with no indicated experience with nerve disorders performed a male reproductive organ conditions examination. The Veteran declined any physical examination but reported that he constantly has to switch sitting positions to relieve the throbbing and nagging pain emanating from his groin and testicles. He also reported that he could not sit or stand for extended time greater than 45 minutes and that he had been prescribed methadone for pain by a private practitioner. He reported interrupted sleep and an inability to exercise with reduced sexual activity. The NP assessed the disability as "moderately discomforting" but did not explain why medication such as methadone was consistent with the level of discomfort. Consequently, additional development is in order. The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file all outstanding VA treatment records. 2. After obtaining the necessary authorization from the Veteran and his representative, obtain any additional private treatment records for the Veteran's groin and bilateral testicle pain disorder including the records of care at the reported private facility for pain management and for his urologist. Should the Veteran identify private treatment records and such records not be obtained, the RO must (1) inform the Veteran that the records could not be obtained; (2) tell the Veteran what steps the RO took to obtain the records; and (3) tell the Veteran that the claim will be adjudicated without the records. See 38 U.S.C. § 5103A(b)(2)(A). Upon completion of the tasks above, the RO must arrange for a VA neurologic examination for ilio-inguinal nerve neuritis neuralgia The Board again requests that the examining clinician have expertise in nerve disorders, to include groin and bilateral testicle pain disorder. The clinician must review the claims file and indicate such review in the body of the examination report. The clinician must perform all necessary testing and evaluative protocols to assess the current severity of this disorder. The Veteran is competent to report his symptoms and history. However, the examiner is requested to assess the frequency, severity, and functional loss due to the reported pain and whether the pain is sufficiently severe and disability as to limit function and to warrant the methadone medication as reported by the Veteran or as shown in the file. Should the clinician reject the Veteran's reports, she/he must provide an explanation for such rejection, preferably with reference to specific evidence of record and applicable medical/neurological principles. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. J. Komins, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.