DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
·	.	WASHINGTON NAVY YARD DC 20374-5023

IN REPLY EFER TO
1850
CORB:003
27 Feb 20

From:
To:

Subj: Ref:

Director, Secretary of the Navy Council of Review  Boards
PD-2017-02662

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 29 Oct 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its
recommendation to the Department of the Navy for appropriate  action.

2.	On 21 February 2020, the Assistant General Counsel of the Navy (Manpower & Reserve Affairs) took action in your case by  accepting the recommendation of  the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 0% to 10% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02662 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090730

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Ground Communications Organizational Repairer, medically separated for “musculoskeletal chest wall pain” with a disability rating of 20%.

CI CONTENTION: “Condition persists without improving with no treatment available. Rating was initially 20% and reduced to 0% [by the VA].”  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 Medical Evaluation Board (MEB), but determined by the PEB 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. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20090511	VARD - 20090908	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Musculoskeletal Chest Wall Pain	5302	0%	Costochondritis	5399-5321	20%	20090908	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Musculoskeletal Chest Wall Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s musculoskeletal chest wall pain began insidiously in February 2008. After extensive specialty work-ups, the CI was diagnosed with costochrondritis (inflammation of the intercostal [rib area] of the chest wall). The 28 March 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of “chest pain.” His physical examination (PE) revealed tenderness about the lower aspect of his breast bone. Pain management encounters both before and after the NARSUM noted tenderness along the breastbone. At the 8 September 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported continued mid-breast bone pain associated with running or lifting heavy objects. His PE revealed severe tenderness over the right and left costochondral (rib area adjoining to the breast bone). All other components of the PE were normal. His diagnosis remained as costochondritis.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chest wall pain 0%, analogously coded 5399-5302 (Group II Function: extrinsic muscles of shoulder girdle). The VA rated the chest wall pain 20%, analogously coded 5399-5321 (Group XXI Function: muscles of respiration: thoracic muscle group), based on the C&P examination, citing a severe or moderately severe muscle disability.

Panel members first considered and agreed that utilization of a VASRD muscle code was an appropriate representation of the clinical pathology in this case. Additionally, per VASRD guidance, it is reasonable to analogize costochondritis to the 5321 code. Although the VA described the examination finding as “severe tenderness,” such a description was inconsistent with the totality of the record whereby no greater than “moderate” impairment was supported. Therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the chest wall pain.

BOARD FINDINGS: In the matter of the chest wall pain, the panel recommends a disability rating of 10%, coded 5321 IAW VASRD §4.73. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Musculoskeletal Chest Wall Pain	5321	10%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170322, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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