RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03227
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Infantryman, medically separated for “chest wall trauma, due to shrapnel wound,” with a disability rating of 20%.  

CI CONTENTION:  The applicant makes no specific contention in his application.  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 -  20080729	VARD - 20080918	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chest Wall Trauma, due to Shrapnel Wound	6843	20%	Restrictive Lung Disease, due to Shrapnel Injuries to Chest	6843	10%	20080904	
			Scar on the Back	7804	10%	20080904	
			Scars on the Chest	7804	10%	20080904	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chest Trauma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this CI was injured by shrapnel in 2004, while deployed overseas.  The shrapnel injury to his chest caused pneumothorax, and rib fractures.  After his return to the US, he was transferred to a recruiting detail.  During that time, he failed two physical fitness tests.  In 2007, he attempted to increase his level of physical activity, but he had problems with shortness of breath.  He especially had difficulty with running, ruck marching with full gear, and wearing a protective mask.  On 27 December 2007, pulmonary function tests (PFTs) were done.  The forced expiratory volume in the first (FEV-1) was 4.95 liters (111% of predicted).  The FEV-1 divided by forced vital capacity (FVC) was 87%.  These PFTs were normal. 

On 4 March 2008, the CI underwent a methacholine challenge test (MCT).  The MCT was negative, meaning that his respiratory symptoms were not due to asthma.  On 15 May 2008, repeat PFTs were done.  The FEV-1 was 4.53 liters (102% of predicted).  The FEV-1 divided by FVC was 88%.  He then had a pulmonary test called DLCO [diffusion capacity of the lungs, using carbon monoxide].  His DLCO result was 25.0, which was 69% of predicted.  On 6 June 2008, the CI underwent high resolution computed tomography (HRCT) of the chest. It showed destructive changes of some ribs, with pleural thickening and linear opacities.  These changes were consistent with his history of chest trauma, caused by shrapnel injury.  Due to the chronic nature of his chest wall condition, and since he was not able to meet the physical requirements of his military specialty, an MEB was initiated.

The MEB NARSUM was dated 20 June 2008.  The CI was using an albuterol inhaler (as needed) for his symptoms, which he felt helped a little.  On physical examination, he was in no apparent distress.  Respiratory rate was 16 breaths per minute.  His chest was symmetrical.  The lungs were clear to auscultation with good air movement throughout.  Cardiac exam showed regular rate and rhythm with normal heart sounds and no murmurs.  Extremities showed no clubbing, cyanosis, or edema.  There was no peripheral lymphadenopathy, skin rash, or joint abnormalities. The NARSUM diagnosis was: “Traumatic pneumothorax with residual ventilatory limitation, limiting performance of full duty.” 

In September 2008, 2 weeks before separation, the CI had a VA Compensation and Pension (C&P) exam.  He reported difficulty breathing and shortness of breath, especially when running.  On PE, he was alert and responsive.  Respiratory rate was 22 breaths per minute.  Examination of the lungs was normal.  He had normal inspiration and expiration, with no rales, rhonchi or wheezing noted.  There was no evidence of shortness of breath or dyspnea (difficulty breathing).  The C&P examiner wrote: “He cannot walk briskly secondary to difficulty with shortness of breath, but he is able to walk adequately without any difficulties.  I would say that his physical limitation is minimal today.”
  
The Board directed attention to its rating recommendation based on the evidence.  The PEB used VASRD code 6843 (Traumatic chest wall defect), and assigned a disability rating of 20%, citing Note (3) from the VASRD General Rating Formula (GRF) for Restrictive Lung Disease.  The referenced Note (3) states (in part): “Gunshot wounds of the pleural cavity with bullet or missile retained in lung, pain or discomfort on exertion, or with scattered rales or some limitation of excursion of the diaphragm or of lower chest expansion shall be rated at least 20% disabling.”

The Board found clear evidence in the STR that the CI did indeed have chest pain with exertion. The chest pain was described as sharp and stabbing.  The Board also surmised that the CI’s dyspnea with exertion was, more likely than not, caused by some limitation of lower chest expansion.  Therefore, the CI’s chest wall condition does meet the threshold as stated in Note (3), VASRD §4.97, GRF for Restrictive Lung Disease.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the chest wall condition.  

BOARD FINDINGS:  In the matter of the Chest wall trauma, due to shrapnel wound, and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140303, 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-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160011317 (PD201403227)

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:
Enclosure
CF:
( ) DoD PDBR
( ) DVA