Citation Nr: 20005910 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 19-19 451 DATE: January 23, 2020 ORDER Entitlement to an initial 10 percent, but no higher, rating for costochondritis is granted, subject to the regulations governing the payment of monetary awards. FINDING OF FACT Throughout the appeal period, the Veteran’s costochondritis has been manifested by intermittent sharp, radiating chest pain that occurs mid-sternum. CONCLUSION OF LAW The criteria for an initial 10 percent, but no higher, rating for costochondritis are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.20, 4.21, 4.40, 4.56, 4.73, Diagnostic Code (DC) 5321. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 2008 to February 2015. This matter is on appeal from a September 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Increased Rating for Costochondritis The Veteran contends he is entitled to an initial compensable rating for his service-connected costochondritis. The Veteran is currently assigned a noncompensable rating under Diagnostic Code 5297 by analogy for removal of the ribs. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When an unlisted condition is encountered, such as in this case, it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but also the anatomical localization and symptomatology, are closely analogous. 38 C.F.R. § 4.20. Here, the Board finds that the evidence of record does not document symptoms more closely approximating removal of the ribs. Given the findings on examination, the Board finds that 38 C.F.R. § 4.73, DC 5321, which relates to disabilities of the muscles of respiration, more appropriately captures the nature of the Veteran’s costochondritis due to the location and symptoms of the condition. See Read v. Shinseki, 651 F.3d 1296 (Fed. Cir. 2011); see also Butts v. Brown, 5 Vet. App. 532, 539 (1993) (the assignment of a particular diagnostic code is “completely dependent on the facts of a particular case”). Under DC 5321, disabilities resulting from injuries to the thoracic muscle group (Group XXI) are classified as slight, moderate, moderately severe, or severe. 38 C.F.R. §§ 4.56(d), 4.73. A noncompensable rating is warranted for slight muscle injury. A 10 percent rating is warranted for moderate muscle injury. A 20 percent rating is warranted for moderately severe or severe muscle injury. For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. 38 C.F.R. § 4.56(c). A slight disability of muscles comprises simple wound of muscle without debridement or infection. There should be service department record of superficial wound with brief treatment and return to duty. Healing with good functional results. No cardinal signs or symptoms of muscle disability. Objective findings include minimal scar; no evidence of fascial defect, atrophy, or impaired tonus; and no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56(d)(1). A moderate muscle disability comprises a through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. There should be evidence of in-service treatment for the wound and a 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, affecting the particular functions controlled by the injured muscles. Objective findings should include entrance and (if present) exit scars; small or linear, indicating short track of missile through muscle tissue; some loss of deep fascia or muscle substance or impairment of muscle tonus; and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56(d)(2). A moderately severe muscle disability comprises a through-and-through or deep open penetrating wound by a small high-velocity missile or a large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. There should be a history of hospitalization for a prolonged period for treatment of the wound, with a record of consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating track of missile through one or more muscle groups; and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56(d)(3). A severe muscle disability contemplates through-and-through or deep penetrating wounds due to high-velocity missile, or large or multiple low-velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. There should be a history of hospitalization for a prolonged period for treatment of the wound, with consistent complaints of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings should include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpable loss of deep fascia or muscle substance, or soft flabby muscles in wound area; and abnormal muscle swelling and hardening in contraction; tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. 38 C.F.R. § 4.56(d)(4). A Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In this case, April 2015 VA treatment records note “chest pain or discomfort.” September 2015 VA treatment records reflect that the Veteran reported frequent chest pain radiating to the left jaw. He stated that the symptoms occur daily 2 to 3 times a day. He described the feeling in his chest as sharp and stated it can last up to 2 minutes. He stated that he sometimes experienced a little trouble breathing and denied nausea or diaphoresis. He stated that the pain can be 7.5/10 and at times tolerable and can talk with it. During an August 2016 VA Gulf War General Medical Examination, the examiner noted that the etiology of the Veteran’s costochondritis is costo-sternal inflammation, a biomechanically-caused condition. During an August 2016 VA Heart Condition Examination, the Veteran reported that he continued to experience the chest pain intermittently. He described it as a sharp pain that occurs in the mid sternum and goes to the back. He said it lasts for two minutes and then goes away. He reported that he was prescribed ranitidine and omeprazole, but that did not help. During an August 2016 VA Respiratory Condition Examination, the examiner described the Veteran’s costochondritis as a respiratory condition and noted that the Veteran’s lung fields were clear and without wheezing, rales, or rhonchi. She noted that imaging studies had been performed and an August 2016 chest x-ray showed bilateral nipples markers, normal heart size, and pulmonary vascularity with no pneumothorax, focal consolidation, or pleural effusions, and a negative chest impression. She also noted that this disability did not impact his ability to work. During a September 2016 VA examination, the examiner noted that the Veteran’s costochondritis manifests in chest pain due to inflammation around the ribs. She noted that it is not a respiratory condition and that the Veteran’s muscle examination is presumed normal. In a September 2017 affidavit, the Veteran described symptoms of “really bad chest pains.” In an October 2018 Notice of Disagreement, the Veteran stated through his representative that the Veteran’s costochondritis manifests with sharp, radiating chest pain that occurs mid-sternum and goes through the back and is not relieved by prescription medication. Upon review of the record, the Board finds that the Veteran’s symptoms more nearly approximate the criteria contemplated for moderate muscle impairment due to sharp, intermittent pain, lasting a few minutes, two to three times a day that is not relieved by prescription medication. A preponderance of the evidence is against a finding that the Veteran’s symptoms are more analogous to a moderately-severe disability of the respiratory muscles. 38 C.F.R. § 4.73, DC 5321. There has been no objective evidence of loss of deep fascia, muscle substance, or normal firm resistance of muscles, positive impairment of strength and endurance, or other signs or symptoms of similar severity to those listed in the findings for a moderately severe muscle injury. Other than the sharp, intermittent pain described above, there were no other objective abnormalities indicated on the VA examinations or in the treatment records. The Board therefore finds that the overall disability picture for the Veteran’s costochondritis does not more closely approximate a 20 percent rating for moderately severe or severe muscle injury under the applicable DC. While the Board has also considered other potentially applicable Diagnostic Codes, the Veteran’s disability is not shown to involve other body systems. Therefore, this disability does not warrant an evaluation under any other provisions of the rating schedule. Accordingly, the Board finds that an initial 10 percent rating, but no higher, is warranted for the entire period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.20, 4.21, 4.40, 4.56, 4.73, DC 5321. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. H. White, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.