RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04223
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090729

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Communication Signals Intelligence Journeyman, medically separated for “atypical chest pain” with a disability rating of 10%.

CI CONTENTION:  “Reason for separation did not match actual diagnosis.  Discharge with atypical chest pain, diagnosed with chronic bilateral pleurisy.”  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 - 20090506	VARD - 20100303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Atypical Chest Pain	5299-5321	10%	Chronic Bilateral Pleurisy	6899-6845	60%	20100217	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Atypical Chest Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s chest pain began in 2004 after a viral respiratory illness.  The STR documented various diagnoses such as bronchitis, dyspnea (difficulty breathing) and pleurisy (chest pain with deep inspiration).  Despite an extensive multi-disciplinary medical work-up being found normal, her diagnosis remained as pleurisy and was determined to be of a chronic nature.  The chest pain consistently occurred with an increase in activity; specifically, the CI endorsed symptom initiation when running more than 100 yards.  An initial PFT performed on 7 October 2005 was completely normal.  The 26 January 2009 MEB NARSUM examination, 6 months prior to separation, noted complaints of chest pain and coughing when running short distances.  Her physical examination (PE) was normal.    

At the 17 February 2010 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported chest pain and shortness of breath while exercising.  Her PE revealed an abnormal lung sound that was described as a “friction rub” (a sound similar to rubbing a balloon with a finger).  There was no further description noted under the lung examination.  A repeat PFT performed revealed a significant decrease in the predicted values for FEV1, FVC and FEV1/FVC after bronchodilator treatment.  Pre-bronchodilator treatment results per the PFT were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the atypical chest pain at 10%, analogously coded 5399-5321 (muscle group XXI). The VA rated the atypical chest pain at 60%, analogously coded 6899-6845 (chronic pleural effusion or fibrosis) based on the C&P examination, citing abnormal PFT parameters.  

Panel members first acknowledged that the coding schemes utilized by the PEB and VA were vastly different in equating the CI’s condition to a body system.  The PEB based its rating on a muscle code, but the VA based their rating on a respiratory code.  Panel members agreed that the STR and pre-separation PE’s held greater probative value than the post-separation VA examination.  Additionally, panel members agreed that despite poor PFT results found on the post-separation VA examination, its documented post-bronchodilator results were poorer than pre-bronchodilation measurements; therefore, per VASRD guidelines, the pre-medication parameters were to be utilized for impairment rating.  Under such guidance, the CI’s PFT results performed by the VA were normal, noting 105% and 90% predicted of FEV1 and FEV1/FVC, respectively.      

The VASRD specifically states that the diagnosis of “atypical chest pain” be analogized to code 5321 with rating options of “slight 0%,” “moderate 10%” or “severe or moderately severe 20%.”  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel agreed that the CI’s symptoms did not more nearly approximate the “severe” level of impairment and thus the impairment was best described as moderate.  The panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the atypical chest pain.  

BOARD FINDINGS:  In the matter of the atypical chest pain and IAW VASRD §4.73, the panel 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:

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

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04223.

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.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have 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.  Accordingly, I accept their recommendation that your application be denied.