RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX					           CASE:  PD-2014-01837
BRANCH OF SERVICE:  AIR FORCE  	SEPARATION DATE:  20070623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Security Forces Helper) medically separated for chronic costochondritis.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was placed on restricted duty and referred for a Medical Evaluation Board (MEB).  The condition characterized as “chronic costochondritis” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic costochondritis” 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:  “Please consider all conditions”.  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 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 20070515	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Costochondritis	5299-5022	10%	Chronic Costo-Sternal Joint ,and Intercostal Muscle Strain	5297-5020	10%	20070826	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080229 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY: 

Chronic Costochondritis Condition.  Absent direct trauma, the CI developed right-sided chest pain after performing physical activities while in basic training.  He underwent a complete medical work-up and eventually was cleared by cardiology and received a diagnosis of chronic costochondritis.  Despite aggressive physical therapy and trials of medication (to include narcotics, his chest pain remained fairly constant and was worsened with movements.  He was placed on multiple temporary physical profiles and eventually was referred to a MEB.  At the narrative summary examination performed on 4 April 2007, 3 months prior to separation), the CI reported chest pain with tenderness when touched.  His physical examination (PE) was complete and normal.  Despite documenting a normal examination, the provider summed up the exam as follows: “[The CI] continues to experience pain, impaired mobility and an inability to complete Technical training due to pain associated with his chronic costochondritis.”  At the VA Compensation and Pension (C&P) examination (26 September 2007; 3 months after separation), the CI reported “persistent chest pain, worsened by extremes of cold and heat, pulling, lifting more than 20 pounds, aerobic exercises involving elevated respiratory rate and depth and sudden impacts in the arm and chest, such as when firing a rifle.”  The VA PE was detailed and complete.  All exam parameters were normal excepting right-sided chest guarding with tenderness.  There was no specific documentation of painful motion upon chest motion with normal respirations.  His diagnosis remained as chronic costo-sternal joint and intercostal muscle strain.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the CI’s costochondritis analogously under 5022 (periostitis) at 10% whereas the VA rated 5297 (rib removal) and 5020 (synovitis) for a 10% rating.  Board members first acknowledged that the coding scheme as utilized by the PEB and VA were not ideal in this case as there was no radiographic evidence of rib, joint, or bone abnormality.  Board members considered and agreed that a more appropriate representation of the clinical pathology in this case was muscular in origin, anatomically encircling the chest wall.  Therefore, a better fit for impairment is coding under §4.73 (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 deliberated and agreed that the totality of evidence does not support the 20% (severe) impairment level.  Therefore, all evidence considered, there is no reasonable doubt in the CI’s favor supporting a change from the PEB’s 10% rating decision for the chest pain/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 costochrondritis 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 20140428, 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

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01837.

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,

XXXXXXXXXXXXXXX 
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings