RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02727
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20070616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1, Wheeled Vehicle Mechanic medically separated for chronic chest pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “costochondritis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic chest pain movement due to costochondritis secondary to chest injury” as unfitting, rated 0% with likely 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.”  

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 20070516	VA* - (~14 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Chest Pain…	5099-5024	0%	Costochondritis	5399-5321	NSC	**STR	
Other x 0 (Not In Scope)	Other x 2	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20090731 (most proximate to date of separation (DOS)).  **CI failed to report for C&P dated 20090710.  

ANALYSIS SUMMARY:  

Costochondritis Condition.  The service treatment record (STR) has limited primary source material related to the CI’s condition, costochondritis, which is marked by inflammation of the cartilage that connects a rib to the breastbone (sternum).  The MEB narrative summary (NARSUM) dated 14 February 2007 noted the CI was involved in a motor vehicle accident (MVA) on 15 June 2006 at which time an air bag deployed while he was a belted front seat passenger.  Discharge documentation from the emergency room indicated that “blunt trauma could result in bruised ribs, although minor rib fractures may not be seen on initial X-rays.” Since the time of injury he had sternum “popping” resulting in chest pain, which was aggravated by exertion such as running, push-ups, and lifting weights and heavy items as well as direct pressure on the sternum (breast bone), deep inspiration or coughing.  He had no pain in the absence of the aforementioned activities or at rest.  A memorandum dated 27 September 2006 found the CI’s injuries to be “in line of duty.”  Examination on 16 October 2006 noted “rib bruised” still with pain, but revealed no chest tenderness and no point tenderness of the ribs.  Pulmonary and cardiac physical examinations were normal.  A chest X-ray series on 16 October 2006 demonstrated the bony thorax and soft tissues were unremarkable and there was no evidence of active disease of the heart or lungs.  In spite of several directed physical therapy sessions over a two months for his sternal pain and the medications, ibuprofen and naproxen (nonsteroidal anti-inflammatory drugs) and Tylenol (acetaminophen-a pain medication), the chest pain persisted, although it was relieved with Percocet (acetaminophen and oxycodone a narcotic), which was prescribed for wisdom teeth extraction.  A follow-up chest X-ray series in January 2007 was read as negative with an unremarkable bony thorax.

At the MEB examination dated 23 January 2007, the CI reported (DD Form 2807-1) pain or pressure in the chest “due to accident.” The MEB physical examination (DD Form 2808) was normal with costochondritis listed as the disqualifying diagnosis.  A permanent P3 profile was issued on 12 January 2007 for costochondritis, status post motor vehicle accident, with physical fitness limitations of running and push-ups and no alternate physical fitness testing as well as limitations of military activities including moving with a fighting load and constructing a fighting position.  The commander’s statement dated 19 March 2007 indicated the CI’s “chest ailment” prevented him from participating in both field duty and deployments and he could not wear his personal protective equipment.

The CI failed to report for a VA Compensation and Pension (C&P) examination and no further clinical information is available for review.

The Board directed its attention to its rating recommendation based on the above evidence.  The IPEB assigned a 0% rating using code 5099-5024 (Tenosynovitis) for chronic chest pain with chest movement due to costochondritis.  The VA indicated the costochondritis was not service connected, assigned no rating, but did use code 5399-5321 (Group XX: Thoracic muscle group) for the disability.  The Board sought a route to a higher rating.  Since a VA code for costochondritis does not exist, an analogous code alternative most closely related to costochondritis manifesting sternal or rib pain is 5299-5297 (Ribs, removal).  However, the CI did not have any ribs removed, but did have “bruising” and tenderness of the sternum. Therefore, a 10% rating analogous to one or resection of two or more ribs without regeneration is not unreasonable.  A 20% rating requires removal two ribs, which is not in concert with the clinical presentation.  Alternatively using analogous code 5399-5321, moderate thoracic muscle group involvement in respiration warrants a 10% rating, but slight involvement only rates 0%, which is more consistent with the CI’s symptoms that are present when performing strenuous physical activity, but are otherwise quiescent.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% 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, the Board unanimously recommends a disability rating of 10%, coded 5299-5297 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Costochondritis	5299-5297 	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140606, 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, AR20160003752 (PD201402727)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA