RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00154
BRANCH OF SERVICE:  ArmY	BOARD DATE:  20150128
SEPARATION DATE:  20070820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Military Police) medically separated for chest/rib pain.  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The chest/rib pain condition, characterized as “rib pain-chronic bilateral chest wall pain from costochondritis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “chest wall/rib pain from costochondritis…” as unfitting, rated 10% 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 simply stated “PDBR Review.”

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 20070724	VA - (~1 Mo. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chest Wall/Rib Pain From Costochondritis…	5099-5003	10%	Costochondritis w/Chest Wall 
Pain Due to Right Fifth Rib Fracture	5015-5297	0%*	20070803	
Other x 0 (Not In Scope)	Other x 5	
Rating:  10%	Combined Rating:  30%	
Derived from VA Rating Decision (VARD) dated 20070901 (most proximate to date of separation [DOS]).
*VARD dated 20080124 rating increased to 10% as of 20070821 

ANALYSIS SUMMARY:

Chest Wall Pain Due to Costochondritis.  The treatment record noted that while deployed the CI fell forward in a gun turret and struck his upper chest against a 50 caliber machine gun.  Initially, thought to be a rib fracture, he was treated with medication and restrictions.  Further tests confirmed the absence of a rib fracture and the CI was diagnosed and treated for costochondritis.  He underwent aggressive physical therapy to include intercostal (between the rib) injections with no relief of symptoms.  There was no evidence of cardiac or pulmonary pathology as a result of the initial incident.  His chest pain remained fairly constant and was worsened with movements.  He received a permanent profile in March 2007 and was referred for an MEB.  At the narrative summary examination (2 months prior to separation), the CI reported chest pain with the wearing of military gear and when exerting muscles of the chest.  The physical examination (PE) revealed bilateral and consistent reproducible tenderness to the sternal-costal margins (area connecting ribs to the breastbone).  His pain was characterized as “moderate” and “intermittent.”  His diagnosis remained “rib pain-chronic bilateral chest wall pain from costochondritis.”  The commander’s statement specifically noted the CI’s inability to wear Army gear as a main factor for not meeting MOS requirements.  At the VA Compensation and Pension examination (2 weeks prior to separation), the CI reported daily chest wall pain, worsened with activity and relieved with rest and medications.  The VA PE was detailed and complete.  All exam parameters were normal excepting right-sided sternal-costal tenderness.  There was no documentation of painful motion.  His diagnosis remained unchanged.  Based on this exam, the VA initially rated it at 0%.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the CI’s costochondritis analogously under the 5003 (degenerative arthritis) at 10% whereas the VA rated VASRD codes 5015-5297 analogous to “new bone growth; benign” (5015) and removal of ribs (5297) for 0% rating.  Board members first acknowledged that the coding scheme as utilized by the PEB and VA were not ideal in this case as there were no radiographic evidence of rib/joint abnormality, pursuant to 5003; or, history of rib removal, pursuant to 5297.  Board members considered and agreed that a more appropriate representation of the clinical pathology in this case was muscular in origin that anatomically encircles the chest wall.  Therefore, a better fit for impairment is coding under §4.73 (schedule of ratings–muscle injuries), analogous to Group XXI (function:  muscles of respiration: thoracic muscle group) as code 5321.  Under this code, there exist three rating levels of 0%, 10% and 20% corresponding to “slight,” “moderate,” and “severe,” respectively.  Members agreed that the totality of evidence does not support the 20% (severe) impairment level.  IAW DoDI 6040.44, the Board may not recommend a rating lower than that received prior to this application.  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 of the chest pain/costrochondritis condition.

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 costochondritis was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the costochondritis condition, 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 20131230, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

President
DoD Physical Disability Board of Review

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, AR20150008500 (PD201400154)

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		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA