RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01450
BRANCH OF SERVICE:  ARMY	BOARD DATE:  20141113
SEPARATION DATE:  20041001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard SGT/E-5 (63W/Wheeled Vehicle Repair) medically separated for chronic left shoulder pain. The condition did not improve adequately to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3 profile and underwent a Medical Evaluation Board (MEB).  The left shoulder condition, characterized as “left shoulder osteoarthritis with shoulder impingement” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic pain left shoulder” as unfitting, rated 10% IAW the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was found unfit for duty, due to a damaged, left shoulder rotator cuff.  I feel the rating should be changed because my rotator cuff is totally gone in my left shoulder.”

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 left shoulder condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 20040624	VA – based on Service Treatment Record (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Shoulder	5099-5003	10%	Osteoarthritis	5003	10%	STR	
Combined:  10%	Combined:  10%	
                   Derived from VA Rating Decision (VARD) dated 20051024 (most proximate to date of separation)

ANALYSIS SUMMARY:

Left Shoulder Pain.  In October 2001, the CI was in Afghanistan, and he injured his left shoulder while driving nails at a construction project.  He was able to complete his tour of duty in Afghanistan, and he returned to Fort Polk, Louisiana.  The CI’s shoulder condition was treated with corticosteroid injections and physical therapy (PT).  However, the shoulder pain persisted and an MEB was initiated.  The MEB physical examination (PE) was on 7 June 2004.  At that exam there was some tenderness in the left upper back region between the scapula and the spine.  There was no muscle atrophy.  Deep tendon reflexes were 1+ in both arms.  Left shoulder range-of-motion (ROM) was measured by PT, and is summarized below.

The CI was separated from service on 1 October 2004.  Fourteen months later, on 29 November 2005, he was seen at a VA Medical Center.  He reported that the left shoulder pain was aggravated by lifting his left arm, and working over his head.  PE of the left shoulder revealed no tenderness to palpation over the bicipital tendon.  With ROM testing, forward flexion was painful at approximately 140 to 150 degrees.  Lateral abduction was painful at 120 degrees.  The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Left Shoulder ROM
(Degrees)	MEB ~ 4 mos. Pre-Sep
(20040607)	VAMC ~ 14 mos. Post-Sep
(20051129)	
Flexion (180 Normal)	110	Pain starts at 140-150	
Abduction (180)	120	Pain starts at 120	
Comments	Pain with motion	Painful motion	
§4.71a Rating	10%*	10%*	
                                     *10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion)

The Board carefully examined all available evidence and directs attention to its rating recommendation.  The Army PEB and the VA both assigned a disability rating of 10%.  The Board determined that the painful shoulder condition was essentially non-compensable based on the VA Schedule for Rating Disabilities (VASRD) §4.71a diagnostic codes for the shoulder and arm (5200 through 5203).  However; IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  There was no path to a higher rating for the left shoulder since there was no evidence of a significantly disabling joint abnormality that would warrant a higher rating.  After due deliberation, the Board determined that a disability rating of 10% was appropriate.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the chronic unfitting left shoulder pain.

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 noted above, PEB reliance on the USAPDA pain policy was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic left shoulder pain and IAW VASRD §4.40, §4.45, and §4.59, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXX, AR20150006468 (PD201301450)

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