RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01400
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E5, Motor Transport Operator, medically separated for “atypical, non-cardiac chest pain” with a disability rating of 0%.   

CI CONTENTION:  “Had heart problems and contracted the Mursa virus and have rashes that continue to reappear on different spots of my body.  I continue to have painful growths of some kind in my nostrils like I had upon separation along with headaches, blurred vision and dizziness.  Also rashes that have crusty and puss, leaving my skin marked after dried.”  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 progression or complications of service-connected conditions after separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (VA), 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 - 20040517	VARD - 20130323	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Atypical, Non-Cardiac Chest Pain	5099-5003	0%	Atypical Chest Pains	7099-7005	NSC	20110928	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Atypical, Non-Cardiac Chest Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chest pain condition began in 23 January 2004 after awakening with chest pain shooting down the left upper extremity with tingling of the fingers of the left hand.  Pain was relieved after three doses of nitroglycerin (medication that treats chest pain due to coronary artery disease).  He was medically evacuated to the Kuwait Hospital where he underwent a cardiac evaluation, which was normal.  He was transferred to Landstuhl Medical Center.  
The 28 March 2004 Chest Pain Addendum noted a long history of exertional chest pain controlled by limiting activity and resting.  There was acute worsening prior to transfer.  An aching, stabbing sensation in the chest and fatigue lasting all weekend worsened on 24 March 2004.  He reported 10/10 chest pain with shortness of breath, dizziness and radiation to his neck, not relieved with rest but relieved with nitroglycerin.  He reported severe heartburn symptoms without recent exacerbation.  He was admitted to intensive care and cardiac enzymes were normal.  There was no resolution of the chest pain despite multiple medications.  He tested positive for methicillin-resistant staph aureu.  Chest X-ray was normal.  Electrocardiogram (EKG) showed sinus bradycardia (slowing) with T-wave inversion in lead 3, first degree atrial-ventricular block.  He was transferred to the medical ward and started on high dose proton pump inhibiters (PPI) due to his history of untreated gastroesophageal reflux.  Symptoms improved and he was transferred for interventional cardiac studies.

During the 22 and 26 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3months prior to separation, the CI reported chest pain and pressure regularly and sometime during and after exertion, palpitation, high blood pressure, shortness of breath during and after exertion or during onset of chest pains and pain in the left shoulder during the onset of chest pains.  Physical examination showed atypical chest pain and an abscess of the left breast and controlled hypertension.

The 26 April 2004 MEB NARSUM examination, 3 months prior to separation, noted the CI was transferred from Germany to Brooke Army Medical Center for further cardiac evaluation, including catheterization and angiogram.  He had an anomalous (of unusual origin) right coronary artery with high anterior take off.  There was no evidence of atherosclerotic artery disease.  The cardiologists noted the chest pain was of non-cardiac origins.  He was prescribed nitroglycerin, Lopressor (treats high blood pressure and chest pain due to cardiac illness) and ziac.  He had a history of smoking a pack and a half of cigarettes per day for 7-8 years.  

He had complaints of chest pain shooting down to the left upper extremity, lasting for 10-15 seconds.  He still took a nitroglycerin tablet about three times per week for chest pain.  He had stopped smoking for 3 weeks.  Lab studies were within normal limits.  The 24 March 2004 electrocardiogram showed marked sinus bradycardia of 43/minute and a prolonged PR interval of 24 seconds.  The CI was not working in his regular MOS and did not participate in physical training.  He did not play with his kids due to fear of a heart attack and due to the unknown etiology of the chest pain.  Physical examination showed a weight of 220 pounds, height 73 inches and normal blood pressure.  The cardio-pulmonary examination was normal.  There was a mass in the left breast about 1 inch in diameter, firm, slightly tender and probably an abscess.  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 chest pain condition 0%, analogously coded 5003 (arthritis, degenerative), citing rated as slight/intermittent and the US Army Physical Disability Agency pain policy.  The VA did not service-connected the chest pain condition, citing medical evidence of record failed to show disability as clinically diagnosed and normal heart examinations.  The NARSUM noted the non-cardiac chest pain lasted a few seconds and he took a nitroglycerin tablet 3 times a week for chest pain.  The pain did improve with treatment using the PPI.  The pain was rated slight/intermittent.  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 atypical, non-cardiac chest pain condition.  

BOARD FINDINGS:  In the matter of the atypical, non-cardiac chest pain 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.  Therefore, the panel recommends 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 20161004, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001578, 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