RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201055 SEPARATION DATE: 20020606 

BOARD DATE: 20130320 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (92A/Automated Logistical Specialist), 
medically separated for chronic bilateral breast pain, status post (s/p) reduction mammoplasty. 
Despite bilateral breast reduction surgery, medication, follow-up with General Surgery, and a 
Pain Management evaluation, the CI failed to meet the physical requirements of her Military 
Occupational Specialty (MOS) or satisfy physical fitness standards. She was issued a permanent 
P3 profile and was initially referred for a MOS/Medical Retention Board (MMRB) in January 
2002. However, the MMRB directed that she be referred for a Medical Evaluation Board (MEB). 
The MEB forwarded “Bilateral Chronic Breast Pain” to the Physical Evaluation Board (PEB). The 
MEB forwarded no other conditions for PEB adjudication. The PEB adjudicated “Chronic 
Bilateral Breast Pain S/P Reduction Mammoplasty” condition as unfitting, rated 10% for 
moderate/frequent pain with application of the US Army Physical Disability Agency (USAPDA) 
pain policy. The CI made no appeals, and she was medically separated with a 10% disability 
rating. 

 

 

CI CONTENTION: “I have steady pain during heavy periods, also fever and cramping. Still 
unable to conceive. Left shoulder has lost of range of motion. Had to change jobs due to the 
inability of % 100 percent of use of left and right shoulder. I’ve revived an injection of Lanacane 
& steroid in left shoulder that increased pain. From PM & RS musculosketetal office at VA in 
Houston, TX Debakey. Room 2B-301, 2nd floor.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings 
for unfitting conditions will be reviewed in all cases. The condition of chronic bilateral breast 
pain, as requested for consideration, meets the criteria prescribed in DoDI 6040.44 for Board 
purview and is addressed below. The other requested conditions are not within the Board’s 
purview. 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 Army Board 
for Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20020514 

VA (3 Mos. Pre-Separation) – All Effective Date 20020606 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Bilateral Breast 
Pain, status post 
reduction mammoplasty 

5099-5003 

10% 

Residual Painful Scar from status 
post Bilateral Reduction 
Mammoplasties 

7626-7804 

10% 

20020318 

.No Additional MEB/PEB Entries. 

Status Post Bilateral 
Salpingectomy 

7614 

30% 

20020318 

Right Shoulder Strain 

5203-5014 

10% 

20020318 

0% X 2 / Not Service-Connected x 3 

20020318 

Combined: 10% 

Combined: 40% 




ANALYSIS SUMMARY: The Board’s authority as defined in DoDI 6040.44, resides in evaluating 
the fairness of Disability Evaluation System (DES) fitness determinations and rating decisions for 
disability at the time of separation. The Board utilizes service and VA evidence proximal to 
separation in arriving at its recommendations and DoDI 6040.44 defines a 12-month interval for 
special consideration of post-separation evidence. Post-separation evidence is probative only 
to the extent that it reasonably reflects the disability and fitness implications at the time of 
separation. 

 

Chronic Bilateral Breast Pain, S/P Reduction Mammoplasty Condition. The CI started with 
complaints of swollen breasts and soreness that caused back pain during running in February 
1999. The breast complaints were unrelated to her menstrual cycle but instead were attributed 
to the breast size of an estimated 40D. At that time, a potential breast reduction was first 
considered and the CI underwent a bilateral breast reduction mammoplasty in September 
1999. The CI’s post-operative history of breast pain and tenderness in the scar area bilaterally 
is well documented in the service treatment record (STR). The CI was given a sick slip in April 
2000 for complaints of unbearable pain and soreness under the left breast, along the incision 
scars with tenderness to palpation, and around the nipples after running with activity 
restrictions for a week. There was more soreness in the left breast and the surgeon ordered an 
ultrasound to rule out a fluid collection or mass lesion; however, the ultrasound was negative. 
Pain management evaluated the CI in June 2000 for chronic bilateral mastalgia and 
recommended a medication for neuropathic pain (Neurontin). The CI was issued a permanent 
P3 Profile in January 2001 for bilateral breast pain with limitations of no running or high impact 
aerobic activities. Because of continued bilateral breast pain, the CI was again seen by General 
Surgery and the P3 Profile was continued. The MEB narrative summary (NARSUM) examination 
2 months prior to separation indicated that the CI had moderate and frequent pain made worse 
by lifting overhead and bending over as well as an inability to run or perform greater than 
twenty five pushups, all due to pain. The physical examination findings were scars under both 
breasts and bilateral breast tenderness to palpation in the outer aspects of her breasts. The 
commander’s statement opined that the CI’s condition was worse that her profile stated and 
that she was unable to lift more than twenty pounds or raise her arms above shoulder level 
without severe discomfort which rendered her “totally incapable” of performing her MOS 
duties in a combat environment. The VA Compensation and Pension (C&P) examination 3 
months prior to separation documented pain, bruising, and itching at the level of the breast 
scars especially with activities. The physical exam findings were a right breast inferior scar 
measuring 20cm x 0.3cm and a left breast inferior scar measuring 20cm x 0.3 cm, linear in 
shape, dark color with disfigurement, and tenderness. The examiner opined that there was 
chronic tenderness overlying the disfiguring scars. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB coded the chronic bilateral breast pain, s/p reduction mammoplasty condition analogous to 
5003 Arthritis, degenerative (hypertrophic or osteoarthritis) rated 10% with application of the 
USAPDA pain policy. The VA coded the residual painful scar from reduction mammoplasties 
7626 Breast, surgery of with 7804 Scars, unstable or painful rated 10% for one or two scars that 
are unstable or painful. All exams throughout the STR documented painful scars and 
tenderness to palpation over the scars under both breasts. The NARSUM and C&P exams 
indicated that there was bilateral breast tenderness to palpation in the outer aspects and 
chronic tenderness overlying the disfiguring scars. The Board agreed that the CI clearly met the 
criteria for 7626 Breast, surgery of with 7804 Scars, unstable or painful: One or two scars that 
are unstable or painful. After due deliberation, considering all of the evidence and mindful of 
VASRD §4.3 Reasonable doubt, the Board concluded that there was insufficient cause to 
recommend a change in the PEB adjudication for the chronic bilateral breast pain, s/p reduction 
mammoplasty 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. As discussed above, PEB 
reliance on the USAPDA pain policy for rating the chronic bilateral breast pain, s/p reduction 
mammoplasty condition was operant in this case and the condition was adjudicated 
independently of that policy by the Board. In the matter of the chronic bilateral breast pain, 
s/p reduction mammoplasty condition and IAW VASRD §4.116, 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: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic Bilateral Breast Pain, status post Reduction Mammoplasty 

5099-5003 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120706, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


FMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxxxx, AR20130007448 (PD201201055) 

 

 

I have reviewed the enclosed Department of Defense Physical Disability Board of 
Review (DoD PDBR) recommendation and record of proceedings pertaining to the 
subject individual. Under the authority of Title 10, United States Code, section 1554a, 
I accept the Board’s recommendation and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of 
Congress who have shown interest in this application have been notified of this decision 
by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)