RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00674
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “bilateral mastodynia,” with a disability rating of 0%.  

CI CONTENTION:  The CI contends she was given an unfair rating and not all issues were addressed.  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 – 20081110	VARD – 20090526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Mastodynia	7699-7626	0%	Bilateral Mastodynia	7699-7626	0%	20090507	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Mastodynia.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left breast pain began in April 2001.  She underwent multiple excisional biopsies (2001 and 2005) which were benign, and had fibrocystic breast disease bilaterally.  She continued to have pain in her left breast and persistent bilateral breast tenderness.  The MEB forwarded bilateral mastodynia for PEB adjudication.  

The MEB NARSUM examination on 22 October 2008, 2 months prior to separation, noted complaints of constant bilateral breast pain increased with wear of field gear or significant activity.  The CI denied current nipple discharge, skin dimpling, nipple changes or retractions or lymph node enlargement.  There was a reported lump in the left breast.  Ultrasound and mammography noted benign-appearing calcifications bilaterally and a mass correlating with the left breast excision site.  Physical examination showed the breasts were visually symmetric with no nipple discharge, retraction, skin changes, or lymphadenopathy.  Both breasts had diffuse rubbery freely-mobile lumps appreciated throughout the breast tissue, and there was a conglomeration of lumps appreciated at the lateral upper quadrant of the left breast.  The right breast was tender at and surrounding the nipple.  The left breast was tender throughout with a 0.75 cm linear scar at the areolar margin at approximately the 2-3 o'clock position.  The final diagnosis was “bilateral mastodynia, left greater than right.”  

At the 7 May 2009 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported having been diagnosed with fibrocystic breast disease with several biopsies that were negative for cancer.  The CI indicated there was no effect on occupational or activities of daily living, but that she was scheduled to have bilateral mastectomies due to genetic testing (BRCA mutation).  Physical exam showed diffusely nodular breasts without any focal masses, lesions, or lymphadenopathy.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral mastodynia condition 0%, coded 7699-7626 (breast, surgery of), citing wide local excision without significant alteration of size or form.  The VA also rated the bilateral breast mastodynia condition 0% coded 7699-7626, based on the VA C&P examination 5 months after separation, citing wide local excision without significant alteration of size or form.  There was no diagnosis of cancer, no asymmetry of the breasts, or significant alteration of size or form of the breasts, or impairment in function of the skin for any rating higher than awarded by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral breast mastodynia condition.  

BOARD FINDINGS:  In the matter of the bilateral breast mastodynia condition and IAW VASRD §4.116, 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 20150528, 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 XXXXXXXXXXXXXXXXXXXXX, AR20170001037 (PD201500674)

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