Citation Nr: 21008447 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 14-25 285 DATE: February 17, 2021 REMANDED Entitlement to an initial rating higher than 10 percent for costochondritis (chest contusion) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from August 1984 to June 1987. He also served with the Reserves from June 1987 to March 1996 and the Army National Guard from July 1989 to July 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the matter in August 2018. Entitlement to an initial rating higher than 10 percent for costochondritis is remanded. The Board finds that remand is warranted for clarification of the finding in the October 2020 VA examination report that the Veteran’s costochondritis affects Muscle Group IV, for the reasons that follow. More specifically, the Veteran’s chest costochondritis has been rated by analogy to residuals of a muscle injury under Diagnostic Code (DC) 5231, which pertains to Muscle Group XXI, the muscles of respiration of the thoracic muscle group. 38 C.F.R. § 4.73; see 38 C.F.R. § 4.20 (providing that when an unlisted condition is encountered, it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous). In August 2008, the Veteran was in a motor vehicle accident in which he sustained an injury to his chest when it hit the steering wheel. He was assessed with a chest contusion, and was treated for chest pain. He has been diagnosed with a chest contusion or costochondritis, for which service connection has been awarded, and the evaluation of which is currently on appeal before the Board. Costochondritis is defined as an inflammation of the cartilaginous junction between a rib or ribs and the sternum. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY (32nd ed. 2012). The May 2011 VA examination report reflects findings of tenderness to palpation along the sternum from the manubrium to the inferior body of the sternum. There was also tenderness to palpation at the costochondral areas at the left and right of the sternum. In the October 2020 VA examination report, the examiner found that the muscle group involved is Group IV, the shoulder girdle muscles, whose function is to stabilization of the shoulder in abduction and rotation of the arm. The examiner checked the “no” box in the questionnaire in response to the question whether the Veteran had or ever had an injury to a muscle group in the torso and/or neck, which includes Muscle Group XXI. The examiner stated in the report that there had been no change in the service-connected diagnosis of costochondritis, and that no additional diagnoses have been rendered. The Board finds it unclear why an injury to the chest would involve the shoulder girdle muscles, and notes that this area is distinct from the areas of tenderness identified in the May 2011 VA examination, which were along the sternum and at the costochondral areas to the left and right of the sternum. Indeed, the October 2020 examiner found that Muscle Group XXI, the thoracic muscle group, was not affected; yet, that is the group which seems to most closely correspond to the areas of pain identified in the May 2011 examination report, and the Veteran’s costochondritis is currently rated under the diagnostic code pertaining to that group. Significantly, the record shows that the Veteran has a distinct right shoulder condition. For instance, a September 2017 VA treatment record reflects that he reported chronic right shoulder pain, and x-rays showed degenerative changes with large spurs. The diagnosis was impingement syndrome and post-traumatic arthritis. Such evidence raises the issue of whether the October 2020 examiner properly identified the area affected by the Veteran’s service-connected costochondritis, which resulted from an injury to the chest. On remand, the examiner who conducted the October 2020 VA examination should be asked to clarify the finding that the Veteran’s costochondritis affected the right shoulder girdle muscles, when it was his chest that was injured. The examiner should also be asked to reconcile that finding with the findings in the May 2011 VA examination report, which show areas of tenderness along the sternum and costochondral areas, and explain why one of the muscle groups of the torso, such as Muscle Group XXI, is not more applicable. The examiner must also account for the evidence showing a discrete right shoulder condition. The matter is REMANDED for the following action: Request the examiner who conducted the October 2020 VA examination to clarify the finding that the Veteran’s costochondritis affected the right shoulder girdle muscles, when it was his chest that was injured, and to reconcile that finding with the findings in the May 2011 VA examination report. Because the costochondritis involves the Veteran’s chest, the examiner should also explain why Muscle Group XXI, or one of the other muscle groups involving the torso, is not more applicable than Muscle Group IV. Finally, the examiner must account for the evidence showing that the Veteran has a discrete right shoulder condition, which in September 2017 was diagnosed as impingement syndrome and post-traumatic arthritis. If the examiner who conducted the October 2020 examination is not available, a different medical professional may render the requested opinion. If necessary for that purpose, another examination of the Veteran should be arranged. J. Rutkin Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Hughes 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.