RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00359
BRANCH OF SERVICE:  Army	BOARD DATE:  20150528
Separation Date:  20050801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Cryptologic Linguist) medically separated for a chronic left shoulder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “left shoulder instability” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic pain/instability, left shoulder” as unfitting, rated 10% citing the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI contends that he should have been rated higher for his condition.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

IPEB – Dated 20050615	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain/Instability, Left Shoulder	5009-5003	10%	Postoperative Residuals, Left Shoulder, Sub acromial Decompression with Ligament Instability, Osteoarthritis and Supraspinatus Tendonitis (Non-dominant)	5003	10%	20051017	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 4	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060125 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Pain/Instability, Left Shoulder Condition.  The CI developed left shoulder popping and a feeling of instability with overhead activities in 2002.  The physical therapist documented left shoulder pain rated at 4/10 constantly and 8/10 with minimal lifting.  There were physical exam findings of positive cross arm testing, positive Hawkins (impingement) testing, tenderness to palpation (TTP) with weakness on internal rotation, TTP with liftoff, extreme TTP in the anterior shoulder and strength 4/5 with flexion.  The Orthopedist noted that the CI was limited to 10 push-ups because he would lose shoulder strength.  The Emergency Room provider noted left shoulder TTP and decreased range-of-motion (ROM).  A left shoulder MRI demonstrated a small amount of fluid in the subchoracoid space, and a small subchondrial cyst in the greater tuberosity of the left humerous.  The Orthopedics memo for record noted physical exam findings of TTP along the inferior border of the AC joint and a mild limitation with abduction on the left arm without atrophy or other significant limitations.  Left shoulder X-rays showed a borderline increase of the left acromioclavicular distance and slight bursa abnormalities and the CI underwent a left shoulder arthrogram for better visualization of the labrum to rule out a tear.  Based on the results of the arthrogram, the Orthopedist performed left shoulder arthroscopic surgery that tightened up some of the structures in the shoulder.  The left shoulder X-ray showed post-operative changes.  The MEB narrative summary (NARSUM) exam, approximately 3 months prior to separation, documented that the left shoulder surgery did not alleviate the CI’s pain and feeling of instability.  The MEB NARSUM physical exam findings are summarized in the chart below.

The VA Compensation and Pension (C&P) exam, approximately 2 months after separation, documented that the CI reported some left shoulder joint morning stiffness, lack of endurance and weakness.  The CI also reported that activities and conditions made his shoulder pain worse such as overhead activities.  The VA C&P physical exam findings are summarized in the chart below.

There were ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Left Shoulder ROM
(Degrees)	NARSUM~3 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
Flexion (180 Normal)	Restricted motion to external rotation; weak internal rotation, external rotation abduction; +apprehension to abduction with external rotation; instability in anterior plane with sense of subluxation during laxity testing	180	
Abduction (180)		180	
Comments:  
Right Handed		Discomfort on motion; tenderness; signs of mild instability with mild downward movement; reflexes and strength normal.  
Well healed surgical scars with mild elevation 	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the left shoulder condition as 5099 analogous to 5003 [arthritis, degenerative (hypertrophic or osteoarthritis)] and rated at 10% with application of the USAPDA pain policy.  The VA coded the left shoulder (non-dominant) condition as 5003 and rated at 10%.  The Board adjudged that the evidence proximate to separation documented painful shoulder motion.  VASRD §4.71a specifies for 5003 that “satisfactory evidence of painful motion” constitutes limitation of motion and specifies application of a 10% rating “for each such major joint or group of minor joints affected by limitation of motion” and VASRD §4.59 (painful motion) provides an alternate justification for a 10% rating.  There was slight instability documented with insufficient evidence of loose movement of the clavicle or scapula, or shoulder ROM limitations approximating the shoulder level (90 degrees) or episodes of guarding of movement at shoulder level to warrant any rating over 10% using alternative coding.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder 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 the left shoulder condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the “chronic pain/instability, left shoulder” condition and IAW VASRD §4.71a, 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140103, 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 XXXXXXXXXXXXXXXX, AR20160000440 (PD201400359)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA