RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  Pd-2016-00179
BRANCH OF SERVICE:  army	SEPARATION DATE:  20051004

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Administrative Specialist, medically separated for “chronic chest pain from median sternotomy…”, with a disability rating of 10%.   

CI CONTENTION:  “Wounded in theater.”  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 - 20050816	VARD - 20060412	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Chest Pain from Median Sternotomy	5099-5003	10%	Status Post Cardiothoracic Surgery for Removal of Teratoma with Residuals	5099-5003	10%	20060215	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Chest Pain from Median Sternotomy.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was diagnosed with a chest tumor that was removed in May 2000 through a median sternotomy.  Due to persistent chest pain, the median sternotomy was revised and rewired in August 2000.  He continued to experience severe frequent chest pain related to the surgical site.  Radiographic evaluations failed to show recurrence of the disease or an improperly healed sternotomy site.  

The 5 January 2005 MEB NARSUM examination, 9 months prior to separation, noted complaints of inability to run, and chest pains that occurred 2-3 times per week that impaired further activity for 2 hours.  Physical examination showed a firm but tender sternum, pain with abduction, and no signs of infection.  Radiographic evaluation (CT scan) in September 2004 documented a well healed sternum with no evidence of recurrent tumor.  During the 21 January 2005 MEB examination (recorded on DD Forms 2807 and 2808) 8 months prior to separation, the CI reported shortness of breath associated with physical activity.  There were no physical examination findings documented.  

At the 15 February 2006 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported upper sternum pain occurring 2 times per month and lasting 1-3 hours.  He reported missing 3 days of work during the past 12 months.  Physical examination showed a normal blood pressure and pulse, a nontender scar, and tenderness over the upper 1/3 sternum.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the chest pain condition, coded 5099-5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency pain policy.  The VA rated 10% for the residuals from surgical removal of a benign tumor, coded 5099-5003, based on the C&P examination 4 months after separation, citing residuals with musculoskeletal pain (painful motion).  

There was no evidence of X-ray involvement of 2 or more major joints of 2 or more minor joint groups with occasional incapacitating exacerbations for a higher rating.  There was no additional limitation with repetition of movement during the physical examination as related to pain, fatigue, incoordination, weakness, or lack of endurance to warrant a higher evaluation.  Alternative codes (muscle, nerve, and shoulder) were considered for rating, however none would provide a higher rating that would be of benefit to the CI.  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 from median sternotomy condition.  

BOARD FINDINGS:  In the matter of the chest pain from media sternotomy 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160404, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170014099, 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