RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  		CASE:  PD1300131
BRANCH OF SERVICE:  ARMY		BOARD DATE:  20130716
SEPARATION DATE:  200701

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (15T20/UH-60 Helicopter Repairer) medically separated for chronic right shoulder pain status post (s/p) arthroscopic subacromial decompression and distal clavicle excision.  The CI’s right shoulder pain began sometime in mid-2003 without injury.  Conservative treatment did not relieve his pain and magnetic resonance imaging (MRI) revealed degenerative arthritis of the acromioclavicular (AC) joint.  He was referred to orthopedics for further evaluation and treatment and he underwent arthroscopy surgery in January 2006.  While he had some improvement, the right shoulder condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3/L2 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded right shoulder pain s/p arthroscopic subacromial decompression and distal clavicle excision to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded left ankle pain as medically acceptable.  The PEB adjudicated the chronic right shoulder pain as unfitting, rated 0% with specified application of the US Army Physical Disability Agency (USAPDA) pain policy.  The left ankle pain condition was determined to meet retention standards and therefore was not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “There is a discrepancy between my Army separation disability rating (0%) and what the VA awarded me, which is a combined rating of 30%.”

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 chronic right shoulder pain condition is addressed below.  The left ankle condition (adjudicated as not unfitting by the IPEB and rated by the VA) was judged to be sufficiently inferred in the CI’s contention to meet the DoDI 6040.44 scope requirements and is also addressed below.  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 Military Records.

RATING COMPARISON:

Service IPEB – Dated 20061127	VA - (2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	0%	Impingement Syndrome, Right Shoulder	8599-8519	10%	20070312	
Left Ankle Pain	Not Unfitting	Left Ankle Sprain	5299-5271	20%	20070312	
No Additional MEB/PEB Entries	No Other Conditions	20070312	
Combined:  0%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20070324 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Chronic Right Shoulder Pain Condition.  In July 2004, the CI complained of greater than a year of right shoulder pain.  There was no history of trauma and the CI was right hand dominant.  He was treated by his primary care provider for over 15 months without response.  In October 2005, a right shoulder MRI arthrogram revealed degenerative arthritis of the AC joint, tendinitis and a partial tear of the rotator cuff.  He was then referred to physical therapy and an orthopedic surgeon who performed the arthroscopic subacromial decompression and distal clavicle excision in January 2006.  The narrative summary (NARSUM) prepared 3 months prior to separation noted the CI was unable to return to full duty due to right shoulder pain and that he still had pain mostly with reaching forward, with overhead heavy lifting and with pulling activities.  Post-surgical radiographic study revealed that the CI was s/p surgical excision of the distal end of the right clavicle.  Physical exam revealed no tenderness over the right AC joint, positive tests for shoulder impingement and no evidence of instability.  Range-of-motion (ROM) testing was accomplished by physical therapy 2 months prior to separation and revealed a right shoulder flexion of 160 degrees (180 degrees normal) with slight decrease in strength and abduction of 160 degrees (180 degrees normal) again with a slight decrease in strength.  There was pain at the AC joint.  At the VA Compensation and Pension exam performed 2 months after separation, the CI reported no specific injury but noticed clicking and grinding.  He reported a decrease in strength and pain at the AC joint.  He denied any episodes of instability and was unable to perform overhead work activities.  Physical exam revealed no muscle atrophy, AC joint pain or crepitence.  There was mild pain over the sub-acromial area anteriorly and there was normal strength and deep tendon reflex testing.  The ROM was 175 degrees of shoulder flexion and 170 degrees of abduction with no Deluca criteria present.

The Board directs attention to its rating recommendation based on the above evidence.  The IPEB adjudicated the right shoulder by applying the analogous VASRD code of 5099-5003 and rated it 0% with specified application of the USAPDA pain policy.  The VA applied the analogous VASRD code of 8599-8519, paralysis of the long thoracic nerve, and granted a 10% rating citing, “… medical evidence showing subjective complains of painful motion with objective evidence of right shoulder pain.” And, “…a 10 percent is assigned for incomplete paralysis of arm movements which is moderate.”  The analogous use of code 8519 for rating the CI’s condition is suboptimal as there was no injury, pathology or functional deficit related to that nerve’s anatomic distribution.  The ROM evidence does not support the minimum rating under the single limitation of motion code for the shoulder (5201).  There was no clinical evidence of ankylosis of the shoulder girdle and no history of recurrent shoulder dislocation.  There was a surgical excision of the distal clavicle that can be rated analogously under VASRD 5203, impairment of the clavicle or scapula.  There was no dislocation or non-union with loose movement as required for the 20% disability rating; therefore, a 10% rating for non-union without loose movement is appropriate.  The right shoulder MRI did reveal degenerative arthritis that was treated with surgical resection of the diseased clavicle and can be rated under VASRD code 5003, degenerative arthritis (hypertrophic or osteoarthritis).  Application of VASRD §4.59 (painful motion) was supported by the service treatment records to achieve a minimum rating (10%) under code 5003.  No code under VASRD §4.71a would yield a rating greater than 10%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right shoulder pain condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that left ankle pain 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.  Although the left ankle pain was profiled and implicated in the commander’s statement, it was not judged to fail retention standards.  It was reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance.  The CI was able to pass his physical fitness tests and there was no indication the he could not meet his MOS specific duties due to left ankle pain.  Additionally, the NARSUM specifically stated that the CI “…has done well since with his permanent 2 profile for his lower extremities.”  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 contended left ankle pain 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 chronic right shoulder pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic right shoulder pain condition, the Board unanimously recommends a disability rating of 10%, coded 5203 IAW VASRD §4.71a.  In the matter of the contended left ankle pain 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Right Shoulder Pain	5203	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130325, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB),

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130018748 (PD201300131)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA