RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01599
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060201

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

CI CONTENTION:  His back problems have worsened and he has developed 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 - 20051214	VARD - 20061127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cheat Pain and Muscle Weakness status post Atrial Septal Defect (ASD) Repair	7020-5099-5022	10%	Sternotomy	5399-5321	10%	20060822	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Pectoralis Muscle Pain and Weakness Status Post Atrial Septal Defect (ASD) Repair.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), an asymptomatic congenital ASD was found during a routine examination in April 2004, 2 years after entry.  Surgical repair was performed for cardiac enlargement and pulmonary hypertension, in April 2004.  Radiographic ultrasound (echocardiogram) in March 2005 was normal with resolution of the previously noted cardiac enlargement and pulmonary hypertension.  The CI developed post-operative bilateral chronic muscle pain and weakness which caused difficulty with overhead activities; however, he reported the ability to “do 90% of his job without problems” at a primary care visit in April 2005.  

The 22 September 2005 commander’s statement noted that the condition affected the CI’s ability to satisfy some duty requirements with weight restrictions; however “return to duty with restrictions” and “cross training” into a less physically demanding field was recommended.  At a 6 October 2005 physical medicine and rehabilitation visit, 4 months prior to separation, the physical examination showed decreased (4/5) strength of the shoulder (anterior and middle deltoid) and chest (pectoralis major and minor) muscles with evidence of pain during muscle contraction.  At a 10 November 2005 physical therapy evaluation, 3 months prior to separation, the CI reported discomfort with pushing, pulling and overhead lifting.  The physical examination showed bilateral decreased (4/5) strength of shoulder abduction, adduction (pectoralis major and minor muscles), flexion, extension, and internal and external rotation.  The 17 November 2005 MEB NARSUM examination noted complaints of chest wall pain with certain activities, and chest muscle weakness that limited his ability to push and pull heavy objects.  The CI reported extensive physical therapy had resulted in “some decreased discomfort as well as increased strength,” with inability to make further gains.  The physical examination showed a normal, nontender chest wall with protrusion of the sternum (pectus carinatum deformity).  The December 2005 physical profile delineated “no crawling, no push-ups, no sit-ups, and no activities requiring repetitive or high impact actions of [the] arms.”  

At the 22 August 2006 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported intermittent sternal pain and denied significant effect on his occupation as a car salesman.  The physical examination showed a normal chest shape.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the chest pain and muscle weakness condition, analogously coded 7020-5099-5022 (cardiomyopathy; periostitis) citing no deduction for the original cardiac condition (atrial septal defect) which had existed prior to service (EPTS).  The VA also rated 10% for the “sternotomy-residuals of open heart surgery” condition, analogously coded 5399-5321 (muscle group XXI) based on the C&P examination 6 months after separation, citing mild to moderate weakness of the pectoral musculature.  

Ratings using VASRD diagnostic codes for muscle group II and III function (codes 5302 and 5303, respectively) define ‘slight’, ‘moderate’, moderately severe’ and ‘severe’ muscle disability based on the ‘cardinal signs and symptoms’ described in VASRD §4.56 (which include loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement).  A 20% rating under 5302 and 5303 for ‘moderate’ disability requires, a “record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability...particularly lowered threshold of fatigue after average use.”  Although there was consistent report of inability to push and pull heavy objects and difficulty with performing upper extremity duties and exercises (physical fitness testing), the CI reported being able to perform 90% of his job.  Panel members agreed that the weakness described did not approach a ‘moderate’ muscle disability for the higher rating, and therefore alternative coding afforded no benefit to the CI.  There was, likewise, no evidence of loss of deep fascia, muscle substance, or impairment of muscle tonus, or atrophy to support a higher rating.  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 wall pain condition.  

BOARD FINDINGS:  In the matter of the bilateral pectoralis muscle pain and weakness condition, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended a disability rating of 50% and did not elect to submit a minority opinion.  There were no other conditions within the panel’s scope of review for consideration.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150625, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01599.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings