RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03153
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Heavy Wheeled Vehicle Mechanic, medically separated for “chronic right rib pain,” with a disability rating of 0%.

CI CONTENTION:  “Please consider all conditions.” The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 based on 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 PEB - 20040413	VARD – 20080520 (Original Unavailable) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Rib Pain	5099-5003	0%	Status-Post Rib Fracture Right Side, Chest Wall with Costochondritis	5299-5297	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Right Rib Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained multiple right-sided rib fractures in September 2000.  The injury was historically reported for the earliest clinical records within the case file began in November 2000 (2 months after the reported injury).  Despite extensive evaluation and non-surgical treatment, the right-sided chest wall (rib) pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “chronic pain of a thoracic rib origin” for PEB adjudication.
At the MEB examination dated 22 March 2004, 5 months prior to separation, the CI’s historical chronology was reviewed.  His physical examination (PE) was reported as normal with a pain assessment of ‘slight’ and ‘occasional’.  The STR contained numerous clinical encounters that indicated various diagnoses of chest wall pain, sternal pain, or costochondritis.  There was no VA Compensation and Pension (C&P) examination contained in the case file that was near separation and therefore, only the STR and MEB-derived documents were utilized in determining an impairment rating.   

The Board directed attention to its rating recommendation based on the above evidence.  Although utilizing different VASRD codes, both the PEB and VA rated the rib (chest) pain condition at 0%.  The PEB cited pain assessment for its rating using the analogous code of 5003 (degenerative arthritis); whereas the VA analogized code 5297 (rib removal) for its rating.  Board members first considered the best coding approach in this case and determined that neither analogized code used by the PEB or VA were consistent with the overall pathology of the case whereby there was an absence of surgical rib removal or imaging evidence of local degenerative bone.  The frequency of clinical assessments throughout the STR noted that a residual costochondritis condition was the etiology of the CI’s chronic pain and therefore, was the most appropriate diagnosis to be considered for an impairment rating.  According to VASRD §4.73 guidelines, it is reasonable to analogize costochondritis to VASRD muscle code of 5321 (Group XXI, muscles of respiration; thoracic muscle group).  This code has three levels of impairment of 0% (slight), 10% (moderate), and 20% (severe).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that the ‘normal’ PE coupled with the ‘slight’ pain assessment did not reach a level of impairment above ‘slight’ at 0%.  Therefore, the Board concluded that there was insufficient cause to recommend a change in the PEB’s level of impairment rating, but does recommend a coding change (5321) to reflect appropriate VASRD diagnostic identification.   

BOARD FINDINGS:  In the matter of the chronic right rib pain condition and IAW VASRD §4.73, the Board recommends that the CI’s prior determination not be modified.  

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140630, 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 XXX, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017161 (PD201403153)

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: