RECORD OF PROCEEDINGS
PHYSICAL DISABILITY PANEL OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00137
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Armor Crewman, medically separated for “chest wall 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 - 20060928	VARD - 20080116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tender Scar with Chest Wall Pain…	7804	10%	Residual Status Post Right Rib Cage …	5319	30%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Tender Scar with Chest Wall Pain Diagnosis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chest wall pain condition began in December 2005 after an IED exploded on the right side of a tank he was traveling in.  The CI sustained multiple shrapnel wounds on the right side with major injuries to the right arm pit, right arm, right chest wall, scalp, and hand.  The CI underwent surgery to remove the metallic fragments from his right hand with follow-on occupational therapy.  The CI continued to complain of right side chest and arm pit pain.  Fluoroscopy studies completed in May 2006 confirmed metallic fragments in the right chest and confirmed by computer tomography (CT) studies.  The CI underwent surgery; however, only one fragment was able to be removed.  Despite the surgery, the CI continued to have pain limiting his duty performance.  

The 26 July 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of dull pain that was present upon waking that improved throughout the day.  The CI reported he was unable to do pushups due to sharp pains on the right side of his body and he was unable to run due to chest cavity pain.  The CI also reported he was unable to do many of the tasks required of his MOS due to the same or similar symptoms.  Physical examination showed a 4cm X 2cm crater type scar in the right armpit that was painful with multiple other non-painful scars on his right arm and chest.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the tender scar with chest wall pain following shrapnel wound right chest condition 10%, coded 7804 (scar(s), unstable or painful).  The VA rated the residuals, status post right rib cage retained shrapnel fragments condition 30%, coded 5319 (muscle injury of group XIX, muscles that provide support and compression of abdominal wall and lower thorax, moderately severe), based on the STR.  

There were no examinations in evidence proximate to separation to be able to assess any level of muscle dysfunction to support a rating using code 5319.  The evidence does not corroborate difficulty breathing to endorse a rating using code 5321 (muscle injury of group XXI, muscles that support respiration).  The evidence does not show that any of the shrapnel fragments penetrated the lung to justify rating under the general rating formula for restrictive lung disease.  There were no unstable scars and there was no evidence of 3 or more painful scars to satisfy the requirements for the next higher rating using code 7804.  

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 tender scar with chest wall pain following shrapnel wound right chest condition.  

BOARD FINDINGS:  In the matter of the tender scar with chest wall pain following shrapnel wound right chest condition and IAW VASRD §4.118, the panel unanimously recommends no change in the PEB adjudication.  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 20160318, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014068, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure