RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04001
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20020812

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-3, Personnel Administration, medically separated by the Informal Physical Evaluation Board (IPEB) for “chronic sternal pain, s/p thymectomy” with a disability rating of 0%. 

CI’s CONTENTION:  The CI requested all conditions be considered.  The applicant’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 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 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 - 20020614	VARD - 20020910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Sternal Pain, s/p Thymectomy	5099-5003	0%	Residuals of Thymectomy & Sternotomy	7804	10%	20020502	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Sternal Pain.  In May 2001, the CI had surgery for removal of her thymus.  After the surgery, she developed chronic sternal pain at the surgical site.  The pain was aggravated by sit-ups, push-ups, running or heavy lifting.  In December 2001, computerized tomography (CT) imaging of the chest showed complete healing of the sternal fracture, with sternal wires intact.  Physical therapy (PT) and other conservative therapeutic measures were tried in an attempt to alleviate her symptoms.  In spite of all treatment efforts, the chest pain persisted and a Medical Evaluation Board (MEB) was initiated.  The MEB narrative summary (NARSUM) was dated 29 April 2002.  The CI reported that she was unable to do weight training, which she had previously enjoyed.  She was careful when moving furniture or doing household chores.  Any lifting over 25 pounds would increase her chest pain.  On physical examination (PE), the surgical site was well healed.  A keloid had formed at the site of the skin incision.  There was tenderness to palpation at the anterior portion of the sternum.  The PE was otherwise unremarkable.  The NARSUM examiner’s diagnosis was “chronic chest pain, status post thymectomy.”  The CI was medically separated from service on 12 August 2002.  On 2 May 2002, 3 months before the date of separation (DOS), she had a VA Compensation and Pension (C&P) exam.  She reported that she was taking pain medication on an “as needed” basis.  On PE of the chest, the surgical scars were non-tender, but there was tenderness at the sternocostal junction bilaterally.

The Board directed attention to its rating recommendation based on the evidence.  The PEB and the VA chose different coding and rating options for the chronic pain condition.  Unfortunately, there is no specific VASRD diagnostic code for chronic post-operative sternal pain.  The Army PEB used the code 5099-5003 (analogous to degenerative arthritis), and rated it 0%.  The VA chose the code 7804 (scars, unstable or painful) and assigned a 10% rating.  The Board determined that IAW VASRD §4.10 (functional impairment) and VASRD §4.40 (functional loss), a part of the musculoskeletal system that is painful on use must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional impairment and functional loss due to pain.  Therefore, the Board members agreed that a disability rating of 10% was appropriate in this case.

BOARD FINDINGS: In the matter of the chronic sternal pain, the Board unanimously recommends a disability rating of 10%, IAW VASRD §4.10 and §4.40.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Sternal Pain, s/p Thymectomy	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140910, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160005165 (PD201404001)

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