RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03329
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070511

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “atypical chest pain” with a disability rating of 0%.  

CI CONTENTION:  Angina episodes still occur and negatively impact daily activities.  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’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070430	VARD - 20071016	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Atypical Chest Pain	7199-7120	0%	Transient Vasospasm	7099-7020	10%	20070808	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY

Atypical Chest Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI began to experience chest pain during his sixth week of basic training in September 2006 with no particular incident or trauma noted.  The 29 March 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of chest pain.  The CI described an episode of chest pain while shoveling snow and another when he had to admonish another Soldier.  The CI’s medications included aspirin, metoprolol, and isosorbide mononitrate.  Physical examination was unremarkable.  Cardiac examination showed regular rate and rhythm without murmur.  A 29 September 2006 echocardiogram revealed a normal left ventricular ejection fraction of 55-60% with no pericardial effusion or thrombus.  Mild to moderate tricuspid regurgitation and trace mitral regurgitation was noted.  A coronary arteriogram revealed normal coronary arteries.  During the procedure, he experienced a transient left anterior descending coronary vasospasm, which resolved spontaneously.  A stress test revealed no evidence of exercise induced ischemia, with a metabolic equivalent of task (METs) greater than 10.  

At the 8 August 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported chest pain.  Physical examination showed a normal rate and rhythm, without murmur, rubs, or gallops.  An echocardiogram revealed an ejection fraction of 55-60 percent and METs results were 10.  CI’s medication regimen included aspirin and metoprolol.  The examiner's assessment was status-post acute myocarditis with transient vasospasm of left anterior descending coronary artery and persistent intermittent palpitations.  X-rays of the chest revealed no active disease.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chest pain condition 0%, coded analogous to 7120 (varicose veins), citing 14.8 METs were achieved on exercise testing and an ejection fraction of 61%.  The VA rated the chest pain condition 10%, coded 7020 (cardiomyopathy), based on the C&P examination, citing prescribed continuous medication.  The panel considered the rating criteria for VASRD codes 7120 (PEB) and 7020 (VA).  Panel members agreed that the rating criteria for 7020 most closely approximated the CI’s chest pain and echocardiogram results. The panel noted a workload of 10 METS or greater on the VA C&P and the MEB examinations.  The ejection fraction was 55-60%.  There was no significant evidence of cardiac hypertrophy or dilatation on X-ray, electrocardiogram, or echocardiogram.  The CI’s condition was controlled with medications.  A 10% rating is supported by the evidence of a workload not greater than 10 METS with angina (chest pain) and continuous medications.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the chest pain condition, coded 7099-7020.  

BOARD FINDINGS:  In the matter of the chest pain condition, the panel recommends a disability rating of 10%, coded 7099-7020 IAW VASRD §4.104.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Atypical Chest Pain	7099-7020	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170510, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005919, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affaris.
Sincerely,					      
Enclosure