RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01897
BRANCH OF SERVICE:  Army	BOARD DATE:  20150122
SEPARATION DATE:  20040408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Army E-4 (M1 Armor Crewman) medically separated for chest pain condition.  The chest pain condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty although he was authorized to perform alternate physical fitness testing.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The chest pain condition, characterized as “atypical chest pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chest pain, atypical, non-cardiac” as unfitting, rated 0% with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

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 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:

Service IPEB – Dated 20040120	VA* - (2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chest Pain, Atypical, Non-Cardiac	5099-5003	0%	Atypical Chest Pain	5399-5321	NSC	20040419	
Other x 0  (Not in Scope)	Other x 2 (Not in Scope)	
Combined:  0%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20040419 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Chest Pain Condition.  The CI initially presented with chest pain in January 2001.  At that time he reported pulsating, non-radiating, sharp chest pain lasting 1-2 minutes.  Based on an electrocardiogram, functional capacity, cardiac risk factors, and physical examination the CI was diagnosed with atypical chest pain.  Despite activity modification and anti-inflammatory medications the CI continued to report chest pain.  In December 2002, the CI underwent cardiac tests (stress test, cardiac holter monitoring, and an echocardiogram) which were negative for a cardiac source.  A cardiology note dated 24 January 2003 documented stable cardiac status.  The cardiologist opined that the CI’s chest pain was non-cardiac in origin.  A chest ultrasound dated 3 April 2003 was negative for a chest wall mass.  A chest computed tomography study performed on 28 May 2003 revealed an anatomical chest wall deformity (pectus excavatum) which was determined not to be the source of the CI’s chest pain by thoracic surgery on 15 July 2003.  The narrative summary dated 23 December 2003 noted a history of chronic, persistent, atypical chest pain.  The examiner noted that pulmonary function tests on 21 October 2003 were normal.  The physical examination was normal.

At the VA Compensation and Pension (C&P) examination performed 2 months after separation, the CI reported sharp chest pain 2-3 times per week.  The CI reported that the pain occurred with activity, lasted five to 10 minutes, and was relieved with cessation of activity.  He reported that he was not on pain medications.  The cardiac examination was normal and there was no chest wall tenderness to palpation.  The examiner rendered a diagnosis of atypical chest pain and opined that there was insufficient clinical evidence to render “a diagnosis of any acute or chronic disorder or residual thereof.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the atypical chest pain condition as unfitting with a disability rating of 0% for slight, intermittent pain, IAW USAPDA pain policy; coded 5099-5003, analogous to degenerative arthritis.  The VA did not service-connect the atypical chest pain condition.  The Board considered whether there was evidence for a higher that 0% rating for the atypical chest pain condition.  Atypical chest pain is not a condition listed in the VASRD; therefore, the Board considered analogous ratings based on the function affected, anatomical location, and symptomatology, IAW VASRD § 4.20 (analogous ratings).  The chest pain was not cardiac in origin; therefore, the Board chose not to apply cardiac codes.  The Board determined that VASRD code 5321 (Group XXI, thoracic muscles) most closely approximated the function and anatomic location.  VASRD code 5321 is rated based on severity of functional impact due to involvement of the thoracic muscles.  The Board noted that the chest pain was intermittent, relieved by cessation of the inciting physical activity, and that the CI was no longer on pain medication at the time of the VA C&P examination.

The Board determined that the pain rose to the level of slight functional impact for a 0% rating.  The Board additionally considered application of VASRD §4.40 (functional loss) to achieve a compensable rating; but, members agreed that the §4.40 language was not satisfied.  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 atypical chest pain 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.  As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating atypical chest pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the atypical chest pain condition and IAW VASRD §4.71a, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130916, 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 XXXXXXXXXXXXXXX, AR20150010564 (PD201301897)

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			
						         
CF: 
(  ) DoD PDBR
(  ) DVA