RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02107
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20081129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Antitank Missile Gunner, medically separated for “chest pain” with a disability rating of 10%.   

CI CONTENTION:  “Review all conditions.”  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 - 20081009	VARD - 20090423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chest Pain	6799-6732	10%	Premature Non-Obstructive CAD	7005	0%	20090106	
Familial Hyperlipidemia	CAT IV	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY.

Chest Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first seen for chest pain in March 2008.  He presented with a 2 week history of pain which usually occurred at rest and had awoken him from his sleep.  An exercise tolerance test on 18 March 2008 was normal with excellent exercise capacity at 17 METS.  Due to persistent symptoms, he then had a cardiac catheterization which showed a fixed stenosis of one artery at 30% and an ejection fraction of 55% (normal).  He also had a nuclear medicine stress test which also showed good exercise tolerance at 14 METS.  The ejection fraction was 59%.  Obstructive cardiac disease was thought to be unlikely.  Pulmonary function testing on 23 July 2008 was normal.  

At the 21 August 2008 MEB NARSUM examination, 3 months prior to separation the CI reported continued pain.  His physical examination was unremarkable.  After the dictation, Toprol, a beta-blocker, was hand written into his prescriptions.  It is not clear why he was given this medication or by whom from the record.  The only indication that it was for the underlying cardiac condition is from the report by the CI to the VA examiner (below).  

At the 10 September 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported constant pressure.  His medications included Toprol.  The physical examination was unremarkable.  

At the VA Compensation and Pension (C&P) evaluation performed on 6 January 2009, 1 month after separation, the CI reported that he took a beta-blocker and aspirin for the coronary artery disease (CAD).  The physical examination was unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chest pain condition 10%, coded 6799-6732 (analogous to pleurisy, tuberculous, active or inactive).  The panel observed that the chest pain was not attributed to a cardiac condition and this code was consistent with that determination.  The VA rated the premature non-obstructive coronary artery disease condition 0%, coded 7005, (arteriosclerotic (atherosclerotic) heart disease (CAD)), based on the C&P examination 1 month after separation, citing normal blood pressure, peripheral edema or respiratory involvement without the use of continuous medication.  The panel observed that while the CI was on a medication (Toprol) used for treatment of cardiac disease and that CAD had been found on the cardiac catheterization, it was not clear if the chest pain was cardiac in origin from the records.  In fact, it appeared that this (cardiac chest pain) was not ever diagnosed while on active duty.  

The panel considered the evidence.  The CI was found to be unfit for chest pain, but not from CAD.  While the latter was present, it appeared to be an incidental finding during the evaluation of the atypical chest pain.  The code used by the PEB, 6799-6732, for pleuritic (related to breathing) chest pain, is rated IAW VASRD §4.88c and §4.89 which rate based on the residuals from tuberculosis, a serious disease.  The panel noted that the code 6845, chronic pleural effusion or fibrosis, better described the condition.  It supported a 0% rating.  Atypical chest pain can also be coded 5321, Group XXI muscles of respiration.  A 0% rating is supported by slight impairment and a 10% rating is supported by a moderate impairment.  While the CI did report ongoing discomfort, he achieved 17 and 14 METS on stress testing in the months prior to separation.  These values are not consistent with a moderate impairment.  The panel determined that while there were better coding options for the chest pain, none offered a higher rating than the 10% adjudicated by the PEB.  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 pain.  

Contended PEB Condition:  Familial Hyperlipidemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  Moreover, hyperlipidemia is a laboratory finding and not a ratable condition.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chest pain condition and IAW VASRD §4.73, 4.100, and 4.104, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended familial hyperlipidemia condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150725, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment 

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

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

	
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	     				  Acting