RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01132
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050309

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a national guard E3, Infantryman, medically separated for “atypical exercise-related chest pain,” with a disability rating of 0%.  

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, Enclosure 3, paragraph 5.e. (2).  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/Naval 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 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 - 20041021	VARD - 20150401	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Atypical Exercise-Related Chest Pain	7099-7005	0%	Cardiac Syndrome X	7099-7005	30%	20150324	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Atypical Exercise-Related Chest Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s was first evaluated for chest pain in July 2004 when he reported a 1 year history of pain.  An exercise tolerance test showed excellent aerobic capacity obtaining 12 METs (metabolic equivalents), but did show some changes on the EKG (electrocardiogram).  He then underwent a cardiac catheterization which was normal.  Due to complaints of shortness of breath, pulmonary function testing was done.  It was normal also.  It was noted the CI smoked two packs of cigarettes per day.  He was placed on medications, but no restrictions in activity were placed by the examining cardiologist.  The Board noted one medication, to be taken daily, was prescribed over 7 months prior to separation.  A 6-month supply was dispensed without a refill or evidence that a second prescription was issued.  Another medication, nitroglycerin, was to be taken on an as needed basis.  He was diagnosed with atypical chest pain and referred by the MEB with this diagnosis for PEB adjudication.  The VA Compensation and Pension (C&P) evaluation was not performed until 10 years after separation and is not probative for rating at separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the atypical chest pain condition 0%, coded 7099-7005 (analogous to arteriosclerotic disease) noting a normal evaluation and exercise capacity of 12 METs.  The Board noted the code 5321, muscle group XXI (respiration) was an alternative code, but provided no rating advantage to the CI at the slight level of impairment present at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the atypical chest pain condition.  

BOARD FINDINGS:  In the matter of the atypical chest pain condition and IAW VASRD §4.73 and 4 §.104, 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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	
AR20170005807, XXXXXXXXXXXXXXXXXX. 

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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,