RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00295
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Motor Transport Operator, medically separated for “chronic chest wall pain due to costochondritis” with a disability rating of 0%.  

CI CONTENTION:  The CI’s condition has worsened over the years.  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 - 20060314	VARD - 20080602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Chest Wall Pain Due to Costochondritis	5099-5003	0%	Costochondritis	6899-6843	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Chest Wall Pain Due to Costochondritis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s “chronic chest wall pain due to costochondritis” condition began in July 2005 without specific injury.  

The 31 October 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of chest wall pain, especially with exertion.  Cardiac and rheumatology evaluations ruled out heart or systemic rheumatology disorders and the chest pain was consistent with costochondritis.  Chest X-ray was normal.  The physical examination showed a normal lung and cardiac findings.  The anterior chest wall was tender to palpation with pain in the area of the 4th, 5th, and 6th ribs.  Pain was “sharp and very tense,” aggravated with taking deep breaths and relieved when sitting and breathing quietly.  

At the 27 April 2006 VA treatment clinic evaluation, within 1 month after separation, the CI complained of chest pain.  The denied cardiovascular chest pain, pulmonary symptoms, or shortness of breath.  On physical examination, lungs were clear to auscultation and percussion.  The 2 May 2006 cardiology consult performed exercise stress testing that showed good functional capacity with no signs of cardiac ischemia.  There was no VA Compensation and Pension (C&P) evaluation in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  

The PEB rated the “chronic chest wall pain due to costochondritis” condition 0%, coded 5099-5003 (analogous to arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the costochondritis condition “not service connected” coded 6899-6843 (analogous to “traumatic chest wall defect, pneumothorax, hernia, etc.”), based on the STR, VA medical center records, and a missed scheduled VA examination, citing there was no evidence showing costochondritis had continued since discharge from military service.  

There was no evidence of cardiac or pulmonary disability with no abnormal pulmonary function testing in evidence for any non-zero rating under code 6845 or under the general rating formula for restrictive lung disease.  There was no fracture of the ribs or surgery for any higher analogous rating under codes of VASRD §4.71a (schedule of ratings—musculoskeletal system).  Analogous rating to muscle injury (5321 - group XXI.  Function:  Respiration.  Muscles of respiration:  Thoracic) would rate no higher than slight (0%) IAW VASRD §4.73 (schedule of ratings–muscle injuries), §4.55 and §4.56.  There was therefore no mechanism for any rating higher than that awarded 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 “chronic chest wall pain due to costochondritis” condition.  

BOARD FINDINGS:  In the matter of the “chronic chest wall pain due to 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160513, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 
Treatment Record

	

AR20170015255,  XXXXXXXXXXXXXXXXXX. 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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