RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00703
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20060415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Organizational Automotive Mechanic, medically separated for “chronic left chest wall pain,” with a disability rating of 10%.

CI CONTENTION:  “Review 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 - 20060217	VARD - 20070920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Chest Wall Pain	5299-5297-5003	10%	Healed Fractures of Left Ribs	8718	0%	20070723	
Status Post Multiple Costochondral Junction Fractures	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Left Chest Wall Pain.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left chest wall pain began in July 2004 after falling 8-10 feet out of a building onto broken concrete while deployed to Afghanistan.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chest pain” and “closed fractures of multiple ribs, unspecified” for PEB adjudication.  Rib X-rays performed on 18 November 2005 showed healing (but not yet healed) fractures involving the left 7th, 8th and 9th ribs.  The MEB NARSUM examination on 19 January 2006, 3 months prior to separation, noted complaints of difficulty lying down, taking deep breaths and doing abdominal exercises.  Physical examination showed a left lower anterior chest wall bulge that was tender to palpation.

Pulmonary function tests performed by the VA on 1 March 2007, 10 months after separation, showed mild airway obstruction with diffusion capacity also mildly reduced at 77% of predicted.  At the 23 July 2007 VA Compensation and Pension (C&P) evaluation, performed 15 months after separation, the CI reported chest pain that was not well controlled, the pain interfered with sleep so much that he was using sleep medications and he devised new ways of moving to avoid hurting his ribs.  Physical examination showed bony enlargement of the left lower anterior ribs with no tenderness on examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chest wall pain condition 10%, analogously coded 5299-5297-5003 (ribs, removal of-arthritis, degenerative).  The PEB additionally adjudicated “status post multiple costochondral junction fractures as a Category II condition (contributes to the unfitting condition but is not separately ratable).  Members agreed that this condition was intrinsic to the rated condition and not associated with any findings that could be separately rated without violation of VASRD §4.14 (avoidance of pyramiding); thus, it was appropriately subsumed in the same rating recommendation as that for the primary condition.  The VA rated the fractures of the left rib 0%, coded 8718 (neuralgia, circumflex nerve) based on the VA C&P examination 15 months after separation.  The Board noted the opinion of thoracic surgeon that the anterior fractures of the ribs near the cartilage margins are very slow to heal and nothing speeds the process.  The CI continued to have pain with activities and with deep breaths.  There were no ribs resected; therefore, a higher rating cannot be assigned under code 5297.  The Board noted that the VA performed pulmonary function tests proximate to separation that showed restrictive lung disease secondary to pain and decreased diffusion capacity (77% of predicted) which supports a 10% rating under VASRD code 6843 (traumatic chest wall defect, pneumothorax, hernia, etc.), but this rating provides no rating advantage to the CI.  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 left chest wall pain condition.

BOARD FINDINGS:  In the matter of the left chest wall pain condition and IAW VASRD §4.71a, 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 20150604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 16 Nov 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)