RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00897
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070330

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “atypical chest right-sided pain,” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  The 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 - 20070125	VARD - 20071105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Atypical Chest Right-Sided Pain	5099-5003	0%	Pulmonary Nodules with Atypical Chest Pain	6834	NSC	20070821	
Calcified Pulmonary Nodules	Not Unfitting					
Osgood Schlatter’s Disease of the Lower Extremities, Bilateral		Osgood Schlatter Disease, Left Knee	5260			
		Osgood Schlatter Disease, Right Knee				
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Atypical Chest Right-Sided Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s atypical chest pain condition began in April 2005 without any specific injury or trauma.  The CI had multiple specialty evaluations (cardiology, pulmonary, gastrointestinal, infectious disease, and pain management) and specialty examinations for right-sided chest pain and shortness of breath.  The only significant findings were multiple calcified right hilar lymph nodes (pulmonary nodules) that were assessed as benign (consistent with histoplasmosis).  Pulmonary function tests (PFTs) were normal.  The CI had slight improvement of his right-sided chest pain with medication (Gabapentin).  There was no surgical indication and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “atypical chest pain associated with shortness of breath, of uncertain etiology after extensive evaluation, unresponsive to all available and appropriate treatment modalities” (as not meeting retention standards) and “calcified pulmonary nodules unchanged over 18 months most consistent with prior histoplasmosis infection” (as meeting retention standards).  

The 27 December 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of right-sided chest pain and shortness of breath related to physical activity.  The constant 3-4/10 chest pain cold be as bad as 7-8/10, lasting 15 minutes, and required the CI to stop what he was doing.  There was a normal cardiopulmonary examination, and diagnostic imaging showed pulmonary nodules as noted above.  

At the 21 August 2007 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported continuing chest pain on the right side, worsened with “strenuous activity (carrying his son upstairs), dyspnea with sharp pain.”  There was no cough or hemoptysis or wheezing.  The physical examination showed a normal pulmonary examination with clear breath sounds and a normal cardiovascular examination with normal auscultation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the atypical chest pain condition 0%, under the analogous code 5003 (arthritis, degenerative), indicating no etiology, no use of medication, and a normal physical examination with rating for pain citing the U.S. Army Physical Disability Agency Pain Policy.  The VA combined the chest pain and pulmonary nodule conditions as “pulmonary nodules with atypical chest pain” as a “not service connected” condition coded 6834 (histoplasmosis of lung), based on the VA C&P examination 5 months after separation.  The VA cited “service connection is denied because pulmonary nodules with atypical chest pain is not considered an actually disabling condition.  Symptoms, in the absence of a diagnosed underlying disability are not subject to VA compensation.”  

There were no abnormal chest wall findings, no abnormal PFTs, and no abnormal cardiovascular or gastrointestinal findings for rating under the respiratory, musculoskeletal, muscle injury, digestive, cardiovascular, or neurological systems.  The Board noted that table of analogous coding recommendation for atypical chest pain under code 5321 (Group XXI muscle function) would be no higher than slight (0%).  There was therefore no pathway to warrant any rating higher than that assigned 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 atypical chest pain condition.  

Contended PEB Conditions:  Calcified Pulmonary Nodules and Osgood Schlatter’s Disease of the Lower Extremities, Bilateral.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The contended conditions were not profiled or implicated in the commander’s statement or judged to fail retention standards. Any contribution of the pulmonary nodules on the CI’s unfitting atypical chest pain was considered above.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determinations for the contended conditions and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the atypical chest pain condition and IAW VASRD §4.71a, §4.73, §4.97, §4.104, §4.114a, and/or §4.124a; the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended calcified pulmonary nodules and Osgood Schlatter’s disease of the bilateral lower extremities conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011761, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,