RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01290
BRANCH OF SERVICE:  Army	BOARD DATE:  20151216
SEPARATION DATE:  20040821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve 0-3 (Chemical, Biological, Radiological, and Nuclear (CBRN) Officer) medically separated for chest pain, knee pain, and plantar fasciitis.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent P3L3 profile and referred for a Medical Evaluation Board (MEB).  The “persistent chest pain and shortness of breath of uncertain etiology,” “sleep disorder with snoring and leg jerks with arousals,” “bilateral patellofemoral syndrome” (PFS), and “plantar fasciitis” conditions were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded four other conditions that met retention standards (see rating chart below) for PEB adjudication.  The Informal PEB adjudicated “chest pain”, “patellofemoral pain syndrome” (PFPS) and “plantar fasciitis” as unfitting, rated 0%, 0% and 0%.

CI CONTENTION:  The applicant asks that all his service connected conditions be considered.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

IPEB - Dated 20040628	VA* ~3 Yrs. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chest Pain	5099-5003	0%	Chest Pain and Shortness of Breath	7099-7000	NSC	NA	
			Vasovagal Episode	8099-8000	NSC	NA	
PFPS	5099-5003	0%	Patellofemoral Syndrome, Left Knee	5299-5260	0%	NA	
			Patellofemoral Syndrome, Right Knee	5299-5260	0%	NA	
Plantar Fasciitis	5399-5310	0%	History of Plantar Fasciitis, Bilateral	5299-5284	0%	NA	
Sleep Disorder	Not Unfitting	Obstructive Sleep Apnea	6847	50%	NA	
Hypertension	Not Unfitting	Hypertension	7101	10%	NA	
Hyperlipidemia	Not Unfitting	Hyperlipidemia	7599-7500	NSC	NA	
Bilateral Wrist Pain	Not Unfitting	Carpal Tunnel Syndrome Left Wrist	8515	10%	NA	
		Carpal Tunnel Syndrome Right Wrist	8515	10%	NA	
Pericarditis	Not Unfitting	History of Pericarditis	7002	NSC	NA	
Other MEB/PEB Conditions x 0	Other x 20	
RATING:  0%	RATING:  80%	
*Derived from Decision Review Officer Decision dated 20070521.    

ANALYSIS SUMMARY:  

Chest Pain.  The record shows that the CI was evaluated for chest pain initially on 22 May 2003, 15 months prior to separation.  He was diagnosed with pericarditis (an inflammation of the tissue sac around the heart, the pericardium) and treated with aspirin.  A pericardial friction rub (a sign of pericarditis) resolved, but his chest pain and shortness of breath (SOB) persisted.  He was started on an inhaler for asthma, but a subsequent evaluation for asthma did not confirm the diagnosis.  The CI also reported an inability to meet physical fitness standards and had shortness of breath (SOB) with rapid walking (dyspnea on exertion [DOE]).  A chest X-ray was normal.  A cardiac stress test on 29 October 2003 was normal.  A pulmonary evaluation noted mild small airway disease, but he did not meet the criteria for asthma.  An addendum to the narrative summary (NARSUM) dated 7 May 2004 noted a normal cardiac and pulmonary examination.  His diagnosis was changed to persistent chest pain and shortness of breath of uncertain etiology.  He was also noted to have a history of pericarditis.  He was on medications for hypertension and hyperlipidemia, but no other cardiac or pulmonary medicines.  Following separation, he reported that his chest pain improved on medications for gastro-esophageal reflux (GERD).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chest pain (and dyspnea) on exertion at 0%, coded 5099-5003 (analogous to degenerative arthritis).  The VA determined that the chest pain, SOB, and asthma conditions were not service connected (NSC) as there were no findings (on examination) on which to make a diagnosis (at separation).  The Board observed that the VA determination was upheld on subsequent reviews.  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 chest pain (and dyspnea) on exertion condition.  

Patellofemoral Pain Syndrome (PFPS).  The NARSUM, dated 27 October 2003, noted that the CI had a history of bilateral knee pain which had been treated with physical therapy and duty restrictions without resolution.  On examination, he had normal range-of-motion (ROM) with abnormal tracking of the kneecap and testing consistent with PFPS.  The knees were stable.  It was recorded that bilateral knee X-rays done the previous May were normal as were X-rays of the kneecaps.  Neither painful motion nor incapacitation was documented.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral PFPS at 0%, coded 5099-5003 (analogous to degenerative arthritis), noting full ROM and normal X-ray studies.  The VA rated each knee separately, but also at 0%, coded 5299-5260 (analogous to limitation in motion).  The Board noted that the VA ratings were upheld on subsequent reviews.  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 knee pain condition.  

Plantar Fasciitis.  The CI was also treated for left heel pain diagnosed as plantar fasciitis.  He was treated with an arch support, heel cup, and a steroid burst.  His pain was controlled by limiting his activity level.  He was tender at the insertion of the plantar fascia into the heel bone.  An X-ray on 22 May 2003 had shown a heel spur consistent with the diagnosis of plantar fasciitis.  He reported intermittent flares when seen on 7 May 2004, 3 months prior to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left plantar fasciitis condition at 0%, coded 5399-5310 (analogous to Muscle Group X impairment) at the slight level of impairment.  The VA also rated the plantar fasciitis condition at 0%, but coded it 5299-5284 (analogous to other foot injuries) at less than the moderate level.  The VA rating was upheld on subsequent reviews.  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 (left foot) plantar fasciitis condition.  

Contended PEB Conditions.  The contended conditions in the scope of the Board include a sleep disorder, hypertension, hyperlipidemia, bilateral wrist pain, and a history of pericarditis.  The pericarditis was considered with the chest pain condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that these conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Only the sleep disorder was judged to fail retention standards, implicated in the commander’s statement, and issued a profile.  However, a sleep study did not show sleep apnea which had been suspected and no significant oxygen desaturations (a sign of abnormal breathing while asleep).  All conditions were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at the time of separation.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.

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 chest pain and bilateral patello-femoral pain conditions and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the plantar fasciitis conditions and IAW VASRD §4.73, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended sleep disorder, hypertension, hyperlipidemia, bilateral wrist pain, and history of pericarditis conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130910, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160000807 (PD201301290)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA