RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00877
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Communications, Cable and Antenna Systems Apprentice, medically separated for “status post bilateral subcutaneous simple mastectomy causing bilateral chest pain” with a disability rating of 0%.  

CI CONTENTION:  His mastectomy caused loss of nerve feeling and strength and other conditions not within the panel’s scope of review.  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 – 20040329	VARD – 20040821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Bilateral Subcutaneous Simple Mastectomy Causing Bilateral Chest Pain	7626	0%	Bilateral Subcutaneous Mastectomy	7699-7626	0%	20040720 	
			S/P Mastectomy With Left Thoracic Intercostal Nerves Involvement	8599-8619	0%	20040707	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Chest Pain Status Post Bilateral Subcutaneous Simple Mastectomy.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-handed CI underwent a bilateral subcutaneous mastectomy for gynecomastia on 26 September 2003.  Postoperatively, the CI complained of bilateral pain on the chest wall particularly with contracting his pectoralis muscles or performing upper body exercises, as well as a sense of weakness.  
The 16 January 2004 [likely typo of 3 January 2003 source note] neurology evaluation was for bilateral chest pain that started following subcutaneous mastectomy.  The CI complained of persistent burning pain mainly lateral to the pectorals muscles and bellow the nipples, made worse by exercise.  Physical examination showed normal muscle bulk and “give way” 4+/5 deltoid weakness assessed by the neurologist as “subtle bilateral weakness in the deltoids and biceps most likely due to pain response.”  The CI was started on neuroactive medications and on 2 February 2004 underwent a nerve block.  Electrodiagnostic studies on 9 February 2004 were normal.  

The 10 February 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of “disabling bilateral chest wall neuropathy and possible myopathy.”  The examiner summarized the CI’s post-surgical course indicating that pain clinic physician evaluation “identified what sounds like almost reflex sympathetic dystrophy and a mild sensory neuropathy and hyperesthesia bilaterally.”  The CI was no longer taking oral medications because of side effects and loss of effectiveness.  Over multiple postoperative visits there was no evidence of pectoralis muscle atrophy, but also no improvement in his pain symptoms since his first post-operative visit and the CI was unable to lift heavy objects, perform physical therapy, or resume his duties.  The examiner indicated that wounds were well healed, and the diagnosis was chest wall neuropathy.  

At the 7 July 2004 peripheral nerves VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported numbness and tingling with no feeling in the left ribcage area around the nipple since 2 months following his surgery in September 2003.  Physical examination showed normal muscle mass, strength and tone in both upper extremities, with symmetric reflexes.  Sensory examination showed decreased pinprick in the left ribcage area involving intercostal nerves from T3 to T6 and around the left nipple.  Upper extremity sensory examination was normal.  The examiner diagnosed status post chest surgery with involvement of left thoracic intercostal nerves.  

At the 20 July 2004 general C&P evaluation, 3 months after separation, the CI reported chest surgery with left nerve damage.  Physical examination showed normal chest excursion and a well healed non-tender scar on the left upper chest.  There was normal musculature with full range of motion in all extremities, upper and lower.  There was no neurologic deficit.  Chest X-ray was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chest wall pain status post simple mastectomy condition 0%, coded 7626 (breast, surgery of).  The VA also rated the bilateral subcutaneous mastectomy condition 0%, coded 7699-7626, based on the C&P examination 3 months after separation, citing removal of a portion of breast tissue without significant alteration of the size or form of either breast.  The VA additionally rated the left thoracic intercostal nerve condition 0%, coded 8599-8619 (neuritis, long thoracic nerve), based on the same examination, citing mild incomplete paralysis.  

The CI’s surgery did not remove either nipple or muscles and did not result in significant alteration of size or form of the breast for any rating higher than a 0% rating under code 7626.  There was insufficient evidence of neuritis greater than the mild incomplete level, analogous to code 8619, for any rating higher than 0% for either the left or the right chest pain.  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 bilateral chest wall pain status post bilateral subcutaneous simple mastectomy.  

BOARD FINDINGS: In the matter of the bilateral chest wall pain status post bilateral simple mastectomy and IAW VASRD §4.116, 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 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00877.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings