RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00149
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Electronic Warfare Intelligence Specialist, medically separated for “chest pain attributed to costochondritis” rated 0%.

CI CONTENTION:  The CI’s conditions continue to worsen.  The 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 – 20020513	VARD - 20020730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Costochondritis…	5099-5003	0%	Chronic Costochondritis	5399-5321	10%	20020225	
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

Chest Pains Attributed to Costochondritis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s costochondritis condition began in August 2001 while doing physical training.  She developed chest wall pain and shortness of breath (SOB) after running ¼ mile.  Treatment with steroids brought some relief but pain increased following fitness testing and muscle strengthening exercises.  Bone scans and X-rays were normal.  She was treated on several occasions for SOB and pain with exertional activities.  

At the 25 February 2002 VA Compensation and Pension (C&P) evaluation, performed 5 months before separation, the CI reported once a day she had at least some episode of SOB, particularly related to rate of walking.  On the best day the pain is not agonizing and on the worst day the pain is associated with difficult breathing sustained with increased aggravation due to any use of her arms.  She reported four bad days in the past 8 months.  At that time it takes up to 30 minutes to recover her breath.  
She was treated daily with over the counter medication.  Physical exam showed respirations 18, clear lungs but holding her arms straight aggravated pain in her chest, primarily in the anterior chest wall from about the third rib to the bottom of her rib cage and posteriorly on the top of her scapula to the bottom of her rib cage.  There was minimum pain in the lateral fields under her arms.  Chest compression was sensitive in the area of tenderness while lateral compression showed moderate discomfort.

At the 24 April 2002 MEB NARSUM examination, 3 months prior to separation, the CI noted the pain increased with physical activity and was unresponsive to various treatment modalities.  The pain did not allow her to lift or carry heavy objects or take a deep breath.  Pain varied through the day.  She reported she was taking a narcotic-like pain reliever with some relief but prescription orders were not documented.  The CI noted that since December 2001 the chest pain was relatively stable with only occasional flares of increased pain.  Physical examination showed findings that essentially mirrored the C&P examination.  Vital signs (pulse, respiration and blood pressure) were within normal limits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the costochondritis condition 0%, coded 5099-5003 (degenerative arthritis), citing pain rated as slight and intermittent.  The VA rated the costochondritis condition 10% coded 5399-5321(group XXI. respiration, moderate) based on the VA C&P examination 5 months before separation, citing moderate symptoms of pain with exertional activities and periods of exacerbation.  The panel agreed that the NARSUM examination was most proximal to separation and had the higher probative value.  The NARSUM noted the chest pain was stable with occasional flares of increased pain.  She was able to work doing nonphysical office duties.  The panel agreed the condition did not rise to a moderate level of disability to meet criteria for a 10% disability 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 costochondritis condition.  

BOARD FINDINGS:  
In the matter of the costochondritis condition and IAW VASRD §4.71a, 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160323, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014077, 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