RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00403
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Unit Supply Specialist, medically separated for chest pain with a disability rating of 0%.  

CI CONTENTION:  The CI contends he suffers from lower back pain, migraine headaches and sleep apnea.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20050214	VARD - 20050707	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chest Pain	5099-5003	0%	Hypertension & Chest Pain…	5003-7101	0%	20050404	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chest Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chest pain condition began in July 2002 during a PT run when he experienced a sudden onset of left sided chest pain associated with numbness and tingling of the left arm.  An extensive cardiovascular, pulmonary and neurology work-up did not reveal an etiology.  The chest pain condition could not be adequately treated to allow the CI to complete all of the tasks required of his military specialty and the MEB forwarded “chest pain, etiology unknown” for PEB adjudication.  

The 30 September 2004 MEB NARSUM examination, 9 months prior to separation, noted complaints of sharp, left-sided chest pain that was shooting and very brief.  It was usually associated with numbness and tingling of the left arm that occurred both with activity and at rest.  The physical examination showed a normal heart and lung evaluation as well as no tenderness with palpation of the chest.  

At the 4 April 2005 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported chest pain associated with shortness of breath, dizziness and left arm numbness that occurred up to once each week, usually when physically active but sometimes it did occur when he was sleeping.  The physical examination showed normal heart and lung evaluations.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chest pain condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the hypertension and chest pain condition 0%, analogously coded 5033-7101 (hypertensive vascular disease), based on the VA C&P examination and STR citing blood pressures that did not meet a compensable level and a lack of objective evidence of painful or limited motion of a major joint or group of minor joints, or multiple joint involvement.  The panel considered whether there was evidence for a higher than 0% rating for the atypical chest pain condition.  Chest pain is not a condition listed in the VASRD, rather the causes of the chest pain; since the cause of the CI’s chest pain was not determined, the panel considered analogous ratings based on the function affected, anatomical location, and symptomatology, IAW VASRD § 4.20 (analogous ratings).  The chest pain was not cardiac in origin; therefore, the panel chose not to apply cardiac codes.  The panel determined that VASRD code 5321 (Group XXI, thoracic muscles) most closely approximated the function and anatomic location.  VASRD code 5321 is rated based on severity of functional impact due to involvement of the thoracic muscles.  The panel noted that the chest pain was intermittent, relieved by cessation of the inciting physical activity, the CI was not on pain medication and running appeared to be the only activity that he was prevented from doing.  The panel concluded that the CI’s chest pain rose to the level of slight in functional impact due to it occurring approximately four times per week and for two hours each occasion for a total of eight hours out of the week.  The panel noted that this provided no rating advantage to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chest pain condition.  

BOARD FINDINGS:  In the matter of the chest pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150602, 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

10 Apr 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170004774 (PD-2015-00403)

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