RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

                              BRANCH OF SERVICE:  ARMY  
           SEPARATION DATE:  20020115 

 
NAME:  XXXXXXXXXXXXXXXXX                 
CASE NUMBER:  PD1200499                             
BOARD DATE:  20121113  
 
 
SUMMARY  OF  CASE:  Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SPC/E-4  (63W,  Heavy  Wheel  Mechanic)  medically 
separated for non-cardiac chest pain.  He suffered an episode of acute viral pericarditis in 2000 
with a somewhat complicated course.  Although the primary condition resolved, he continued 
to experience persistent episodes of chest pain which could not be adequately controlled  to 
meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical 
fitness  standards.    He  was  consequently  issued  a  permanent  P3  profile  and  referred  for  a 
Medical  Evaluation  Board  (MEB).    The  chest  pain  condition  (and  the  associated  diagnosis  of 
“viral pericarditis, resolved”) was forwarded to the Physical Evaluation Board (PEB) as medically 
unacceptable  IAW  AR  40-501.    Two  additional  conditions  (as  designated  in  the  rating  chart 
below) were addressed by the MEB, and also forwarded as medically unacceptable.  The PEB 
adjudicated  the  non-cardiac  chest  pain  condition  (appropriately  combined  with  the  resolved 
pericarditis condition) as unfitting, rated 0%, citing criteria of the US Army Physical Disability 
Agency (USAPDA) pain policy.  The other conditions were determined to be not unfitting.  The 
CI made no appeals, and was medically separated with a 0% disability rating. 
 
 
CI  CONTENTION:  The  application  states  simply,  “PTSD  [post-traumatic  stress  disorder], 
depression [sic], chronic parcaditos [sic], and knee pain.”  The CI does not elaborate further or 
specify a request for Board consideration of any additional conditions.  
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of Defense Instruction (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  rating  for  the  unfitting  non-cardiac  chest  pain 
condition is addressed below; as is the knee condition (determined to be not unfitting) referred 
to in the application.  The PEB-adjudicated left carpal tunnel syndrome was not alluded to in 
the application, and thus does not satisfy scope requirements.  The two psychiatric conditions 
named  in  the  application  were  not  identified  by  the  PEB,  and  thus  are  not  within  the  DoDI 
6040.44  defined  purview  of  the  Board.    Those,  and  any  other  conditions  or  contention  not 
requested  in this  application, remain  eligible  for  future  consideration by  the  Army  Board  for 
Correction of Military Records.     
 
 
 

 

RATING COMPARISON:  
 

Service PEB – Dated 20011120 
Code 

Condition 

Rating 

Condition 

VA (2 Wks. Pre-Separation) – Effective 20020116 

Noncardiac Chest Pain, Post Viral 
Pericarditis 
Healed Tibal  Plateau Fracture, Left Knee 
Carpal Tunnel Syndrome,  Left Wrist 

5099-5003 

0% 
Not Unfitting 
Not Unfitting 

Residuals, Pericarditis  
Residuals, Left Tibial Plateau...  
CTS, Left Wrist 

No Additional MEB/PEB Entries 

Combined:  0% 

Not Service-Connected (NSC) X 4 Additional 

Combined: 20% 

Code 
7002-
5321 
5260 
8515 

Rating 
10% 
10% 
NSC 

Exam 

20011228 
20011228 
20011228 
20011228 

 

 

ANALYSIS SUMMARY:  
 
Non-Cardiac Chest Pain Condition.  The CI was diagnosed with viral pericarditis in June 2000, 
which progressed to cardiac tamponade requiring pericardiocentesis (build up of fluid around 
the  heart  requiring  emergency  needle  drainage). 
  Although  he  suffered  no  further 
hemodynamic compromise from this event, he continued to complain of episodes of chest pain.  
Subsequent  echocardiography  and  magnetic  resonance  imaging  confirmed  the  lack  of  any 
residual cardiac pathology.  A stress test performed in July 2001, 6 months prior to separation, 
confirmed a normal exercise tolerance (> 10 METs) with “fleeting episodes of chest discomfort 
[<  2  seconds]  ...  [which]  ...  had  no  bearing  on  his  exercise  tolerance.”    The  cardiologist’s 
narrative  summary  (NARSUM)  described  the  initial  clinical  course,  and  proceeded  with  the 
following excerpts. 

The patient did not follow up for approximately 10 months and returned because he "could not 
perform his duties" and described atypical chest pains.  His chest pains are currently described 
as sharp, lasting seconds and are fleeting in nature. They are sometimes related to exertion and 
sometimes not.  They seem to be positional although not reproducible. 
[Present  Condition]  By  all  objective  evidence,  this  soldier  has  resolved  his  episode  of  viral 
pericarditis and has no evidence of either chronic pericarditis or constrictive pericarditis by all 
objective  tests.    He  does  have  a  chest  pain  syndrome,  that  does  not  fit  any  clinical  cardiac 
etiology, but the servicemember cannot perform his duties as a soldier. 

The  VA  Compensation  and  Pension  (C&P)  examiner  (on  the  eve  of  separation)  documented 
“continued chest pain with activity sometimes at rest ... aggravated by running and excessive 
exertional activities.” 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB’s  determination  for  a  0%  rating  cited,  “Rated,  for  pain,  moderate/intermittent.”    This  is 
clearly  derived  from  the  USAPDA  pain  policy;  and,  the  PEB’s  analogous  coding  to  5003 
(degenerative  arthritis)  is  also  difficult  to  justify  under  VASRD  §4.71a.    The  VA’s  rating  was 
under the hyphenated code 7002-5321 (pericarditis rated for thoracic muscle disability), and 
conferred  a  10%  rating  for  “moderate”  muscle  disability.    The  Board’s  choice  of  coding  as  a 
basis for its rating recommendation in this case is confounded by the fact that no applicable 
code is to be found in the VASRD; nor, is there any analogous candidate which is truly aligned 
with the clinical and functional disability in evidence.  The 7002 (pericarditis) code attaches to a 
condition  which  clearly  was  no  longer  active;  and,  that  notwithstanding,  the  minimal 
compensable  rating  would  require  an  exercise  tolerance  under  10  METs.    No  other  code 
available  in  VASRD  §4.104  (cardiovascular  rating  schedule)  is  relevant.    The  muscle  disability 
code  5321  (thoracic  group)  is  a  common  analogous  choice  for  atypical  chest  pain,  although 
there is nothing in the evidence supporting thoracic wall pathology (muscle or musculoskeletal) 

in  this  case.    As  an  analogous  characterization  of  the  disability,  not  the  etiology,  the  only 
applicable  criteria  are  those  encompassing  the  VASRD  §4.56  “cardinal  signs”  of  muscle 
disability; i.e., “loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment 
of  coordination  and  uncertainty  of  movement.”    A  10%  rating  under  5321  for  “moderate” 
disability  requires,  “Record  of  consistent  complaint of  one  or  more  of the  cardinal  signs and 
symptoms of muscle disability ... particularly lowered threshold of fatigue after average use.”  
The evidence clearly demonstrates the absence of any of the enumerated cardinal signs, with 
the possible exceptions of lowered threshold of fatigue and fatigue-pain; and, those not linked 
to “average use.”  The 0% rating for “slight” muscle disability, however, requires “no cardinal 
signs  or  symptoms  of  muscle  disability.”    Members  agreed  that  neither  of  the  defined 
thresholds was unequivocally met, and thus deliberated which characterization was the best fit 
with the functional limitations in evidence at separation (if defaulting to analogous rating under 
5321).  With due deference to VASRD §4.3 (reasonable doubt), the members agreed that the 
fleeting  chest  pains  (correlated  somewhat  with  significant  exertion)  did  not  meet  the 
compensable  threshold  under  5321.    The  Board  concluded  that  the  preponderance  of  the 
evidence provided insufficient cause to recommend a change in the PEB’s rating determination 
for the non-cardiac chest pain condition. Since the PEB’s coding choice was not germane to the 
Board’s  rating  recommendation  and  since  there  was  no  clearly  superior  choice  available, 
members concurred with retaining the code designation. 
 
Contended Left Knee Condition.  The CI was diagnosed by bone scan with a stress fracture of 
the medial tibial plateau in 1997.  It was managed conservatively, never profiled, and was not 
clinically active in the service treatment record for the extended period preceding separation.  
The NARSUM specified that no profile was indicated for the condition, and that it met retention 
standards.    The  VA  C&P  examiner  described  “episodic  discomfort,  especially  with  weather 
changes.”    The  Board’s  main  charge  with  respect  to  this  condition  is  an  assessment  of  the 
fairness  of  the  PEB’s  determination  that  it  was  not  unfitting.    The  Board’s  threshold  for 
countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard 
used  for  its  rating  recommendations,  but  remains  adherent  to  the  DoDI  6040.44  “fair  and 
equitable” standard.  The condition was not profiled; it was not implicated in the commander’s 
statement; and, it was not judged to fail retention standards.  There was no performance based 
evidence  from  the  record  that  it  significantly  interfered  with  satisfactory  duty  performance.  
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  fitness 
determination  for  the  left  knee  condition;  thus  no  additional  disability  rating  can  be 
recommended.  
 
 
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 chest pain condition was operant in this case 
and it was adjudicated independently of that policy by the Board.  In the matter of the non-
cardiac chest pain condition and IAW VASRD §4.104, the Board unanimously recommends no 
change in the PEB adjudication.  In the matter of the contended left knee condition, the Board 
unanimously recommends no change from the PEB determination as not unfitting.  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, as follows: 
 

Non-Cardiac Chest Pain, Residual of Viral Pericarditis 

UNFITTING CONDITION 

VASRD CODE  RATING 
5099-5003 
COMBINED 

0% 
0% 

 
 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120601, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXX, AR20120021218 (PD201200499) 
 
 
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 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)