RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX                                                                                CASE:  PD-2013-02121
BRANCH OF SERVICE:  MARINE CORPS                                                           BOARD DATE:  20140731
SEPARATION DATE:  20051130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve SGT/E-5 (0121, Administrative Clerk) medically separated for left chest wall pain.  The muscle pain could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was placed on light duty and referred for a Medical Evaluation Board (MEB).  The muscle conditions, characterized as “chest pain,” “other disorders of muscle, ligament, and fascia” and “late effect of sprain and strain without mention of tendon injury,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “left chest wall pain and weakness, status post (s/p) repair of left pectoralis major rupture” as unfitting, and rated 20% with likely application of Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “The Physical Evaluation Board only took into account my torn pectoralis major.  Other medical problems caused as a direct result of my service were not considered (gastro-intestinal, Gulf War and Post Traumatic Stress)” 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left chest wall pain condition is addressed below; and, the gastro-intestinal and Posttraumatic Stress Disorder (PTSD) conditions are not within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20050907 | VA - 6 Yrs., 4 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Left Chest Wall Pain, s/p Pectoralis Major Repair | 5303 | 20% | Left Pectoral Muscle and Tendon Tear (Minor) | 5303 | 20% | 20120312
No Other Conditions in Scope | Other x 3
Rated:  20% | Combined:  40%
Derived from VA Rating Decision (VARD) dated 20130201 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  The Board notes that the presence of a diagnosis, in and of itself, is not sufficient to render a condition unfitting and ratable.  While the DES considers all of the service member's medical conditions, compensation can only be offered for those medical conditions that cut short a service member's career, and then only to the degree of severity present at the time of final disposition.  However, the Department of Veterans Affairs, operating under a different set of laws (Title 38, United States Code), is empowered to periodically re-evaluate veterans for the purpose of adjusting the disability rating should his degree of impairment vary over time.

Left Chest Wall Pain, S/P Pectoralis Major Repair Condition.  The CI is right handed and sustained an injury to the non-dominant left upper extremity while doing heavy bench pressing in February 2003.  At the time of his injury, he had bruising that extended from the elbow to the shoulder; however, he received clearance and deployed while on light duty.  He was seen in Medical Clinic for a 2-month history of bruising and left shoulder pain with left biceps pain on internal rotation and flexion.  The examiner diagnosed biceps tear/contusion and prescribed a non-steroidal anti-inflammatory drug (NSAID), and PT restrictions for 8 weeks.  The CI was reevaluated for an 8-month history of limited left shoulder movement, pain tingling sensation with physical exam findings of tenderness to palpation (TTP) at outer upper left side of chest.  The examiner diagnosed left pectoralis major tightness versus strain; however no X-rays were done at this time.  The Physical Therapist (PT) noted a palpable defect on pectoralis major and TTP at the defect.  The PT referred the CI to Orthopedics for a suspected pectoralis muscle tear.  The Orthopedist noted a left pectoralis major deformity which was consistent with a tear and ordered an MRI for confirmation.  An MRI of the chest showed a left side tear with a 5cm medial retraction of the pectoralis major tendon/muscle complex.  The CI underwent a left pectoralis tear repair on 4 May 2004.  The CI was seen in PT post operatively for complaints of left anterior chest muscle pain, tightness and occasional tingling in the left arm and chest muscle.  The Orthopedic surgeon sent a letter and indicated that the CI had been on light duty for initial conservative management since his surgery and would require a recovery period of 3 to 6 months.  The CI was followed by PT and Orthopedics on a regular basis and continued to report tightness and limited use of the left upper extremity. The CI sustained a re-injury to the left shoulder during sporting activities when he was running and fell onto his left arm and had onset of pain to the left pectoralis major area in December 2004.  The CI was reevaluated by Orthopedics and reported pain which woke him up from sleep, required strong narcotic two to three nights per week to recue pain.  The examiner noted TTP in the lateral superior chest and ordered a repeat MRI.  The MRI demonstrated a high grade tear in the distal aspect of the pectoralis major tendon.  The Orthopedic MEB Addendum noted that the CI was 80% recovered from his chronic injury/pain and that he received maximum benefit from his surgery.  The Non-Medical Assessment (NMA) documented that the CI experienced significant physical limitation and because of this, he was unable to attend Inactive Duty Training and even if he were to attend, he would not be able to adequately perform his administrative duties.  The MEB Narrative Summary (NARSUM) exam, approximately 4 months prior to separation, documented that the CI continued to have significant pain and problems with his left chest wall and pectoralis tendon. He had occasional mild pain in the left pectoralis tendon region, which increased to intermittent to moderate pain with activity; and a significant strength loss in the left shoulder, left pectoralis and chest area.  The CI had functional limitations in an inability to perform any heavy lifting, forceful gripping and grasping, light gripping and grasping, pushing and pulling, and reaching at or above shoulder level or heavy lifting at or above shoulder level.  The MEB NARSUM physical exam findings are summarized in the chart below.  The VA Compensation and Pension (C&P) exam approximately 6.5 years after separation documented that the CI continued to have pain, weakness, muscle fatigue and pain when using a left pectoral muscle.  The pain was at a level two to three out of ten on a daily basis.  The VA C&P physical exam findings are summarized in the chart below.

There were two goniometric range of motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Left Shoulder ROM Degrees | MEB Exam 6 Mos. Pre-Sep | NARSUM 4 Mos. Pre-Sep | VA C&P 6.5 yrs. Post-Sep
Flexion (0-180) | “FROM” | 175 | 180
Abduction (0-180) | | 175 | 165

Comments
Right handed

No defect or deformity; No weakness

Pos. tenderness pectoralis tendon; Well healed incision; No defects or retraction; Pos. weakness shoulder & grip

Decreased movement; Pos weakness and tenderness

§4.71a Rating | 20% | 20% | 20%

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the left chest wall pain, post pectoralis major repair condition and rated at 20% (moderate).  The VA also coded the left pectoral muscle and tendon tear (minor) 5303 and rated at 20%.  All documents proximate to the date of separation noted pain and tenderness in the chest wall and left upper extremity with non-compensable ROM measurements.  There was no shoulder specific injury or impairment that would allow a specific shoulder code to be applied.  Board members agree that the 20% (moderate) rating as applied by the PEB and the VA was appropriate.  The CI’s After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the left chest wall pain, post pectoralis major repair condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left chest wall pain, post pectoralis major repair condition and IAW VASRD §4.73a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131029, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 12 Feb 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)

PD-2013-02121