RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX						            CASE:  PD-2014-01268
BRANCH OF SERVICE:  AIR FORCE 	 SEPARATION DATE:  20090223

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Network Infrastructure System) medically separated for a costochondritis (chest wall pain/inflammation).  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a temporary U4 profile and referred for a Medical Evaluation Board (MEB).  The “costochondritis” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated the costochondritis condition as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  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 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 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 20081028	VA* - (~3 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Costochondritis	5399-5321	10%	Costochondritis	5399-5321	0%	20081202	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 9 	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20090401 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Costochondritis Condition.  The narrative summary (NARSUM) and treatment record noted the CI had onset of chest pain symptoms after injury to his thorax in basic military training.  X-rays, CT scan and bone scans were normal.  Cardiac causes were ruled out.  Pain medications, injections, physical therapy and activity limitations were not completely effective and at the MEB exam, the CI reported chest pain with activities and had a diagnosis of chronic costrochondritis.  The MEB physical exam was essentially normal.  

At the VA Compensation and Pension (C&P) exam performed 3 months before separation, the CI reported recurring bilateral parasternal chest wall pain for 6 years.  The CI was not taking medications and had no breathing complaints.  Exam documented slight tenderness to palpation on the right and left parasternal areas with normal pulmonary and cardiovascular exams.  The VA rated this exam at 0%.  Remote from separation, the VA granted a 10% rating for costrochondritis (also claimed as Teitze's syndrome) effective the first day after separation based on a Board of Veterans Appeals decision dated July 9, 2014.  

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the costrochondritis condition analogously to 5321 (group XXI; function:  respiration.  Muscles of respiration:  thoracic muscle group) at 10%.  The CI had no evidence to penetrating chest wall injury, infection, debridement, hospitalization, scarring, and muscle atrophy or muscle loss.  IAW §4.73 (schedule of ratings–muscle injuries), §4.55 (principles of combined ratings for muscle injuries) §4.56 (evaluation of muscle disabilities) there was insufficient evidence to support any rating higher than the 10% (moderate) rating that the PEB awarded.  The Board considered alternative rating IAW VASRD §4.71a (Schedule of ratings–musculoskeletal system) and §4.59 (painful motion-collection of minor joints), but there were no incapacitating exacerbations for any rating higher than 10%.  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 costochondritis 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.  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 costochondritis condition and IAW VASRD §4.73, 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 20140311, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01268.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings