RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00685
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Chemical, Biological, Radiological, and Nuclear Specialist, medically separated for “right shoulder pain,” with a disability rating of 10%.

CI CONTENTION:  The VA rated his PTSD, sleep apnea, hypertension, bilateral knee pain conditions higher and his right shoulder pain the same.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based on 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:  

SERVICE PEB - 20070911	VARD - 20080331	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	10%	Right Shoulder Acromioclavicular Separation	5203	10%	20071101	
Bilateral Knee Pain	Not Unfitting	Right Knee Chondromalacia	5024	0%		
		Left Knee Fibrous Growth	5024	0%		
Hypertension		Hypertension	7101	0%		
Insomnia		Sleep Apnea Status Post Uvulopalopharyngoplasty	6847	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder Pain.  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI injured his right shoulder after falling on it in October 2005.  Diagnostic imaging (X-ray) studies of the shoulder in July 2006 showed widening of the right acromioclavicular joint.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right shoulder pain” for PEB adjudication.  At an orthopedic evaluation on 23 April 2007 (6 months prior to separation) the CI reported worse pain with movement above shoulder level.  Shoulder instability was denied.  Examination showed painful right shoulder motion and tenderness.  Active motion was “normal.”  There was no instability.  The orthopedist rendered a diagnosis of right shoulder separation.  During the MEB NARSUM examination on 24 August 2007 (3 months prior to separation) the CI reported significant pain which limited his ability to perform his military specialty and basic soldier skills.  The pain was described as sharp, rated 5/10 in severity but increased to 9/10 when carrying weights, attempting to throw, or positioning at parade rest.  Physical examination showed tenderness over the right acromioclavicular joint and painful motion.  Abduction was 170 degrees (normal 180 degrees) and flexion was 170 degrees (normal 180 degrees).  There was no instability.

At the 1 November 2007 VA Compensation and Pension (C&P) examination, performed at the time of separation, the CI reported daily right shoulder pain.  Physical examination showed tenderness at the right acromioclavicular joint.  Right shoulder abduction was 180 degrees and flexion was also 180 degrees.  There was no additional limitation with repetitive motion.
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating coded analogously to 5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA also assigned a 10% rating using the analogous 5203 code (clavicle or scapula, impairment of) for joint tenderness and painful motion.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under the 5201 code, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  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 right shoulder condition. 

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that bilateral knee pain, hypertension and insomnia were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  

Bilateral Knee Pain. The CI developed bilateral knee pain after falling in basic training in 2002 and he was assigned temporary L2 profiles in 2005.  An orthopedic evaluation in March 2007 (8 months prior to separation) recorded a complaint of left greater than right knee pain that had worsened since July 2004.  A permanent L2 profile for bilateral knee pain was signed by the orthopedist in March 2007.  However in July 2007 a permanent L3 profile was signed by the NARSUM orthopedist and included restrictions against forced formation running and no repetitive jumping or squatting.  The permanent profile allowed alternate physical fitness testing (swimming, biking); and lower body weight training, running, walking, biking and swimming at own pace and distance.  The commander’s statement on 27 July 2007 (3 months prior to separation) reported that the CI could not perform his duties due to profile restrictions that included bilateral knee pain, and concurred with a recommendation for an MEB because returning to a deployable physical condition was unlikely.  The NARSUM orthopedist on 24 August 2007 indicated that the bilateral knee pain condition had been temporarily profiled and met retention standards.  Turning its attention to a fitness recommendation, the Board noted that although there was a permanent L3 profile, the specific restrictions did not preclude alternate fitness testing or exercise participation; and the commander’s assessment regarding impairment was based on the profile.  The NARSUM orthopedist and MEB concluded that the condition met retention standards.  The Board therefore concluded there was not a preponderance of evidence that bilateral knee pain separately interfered with performance of duty.   After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the bilateral knee pain condition and so no additional disability ratings are recommended.

Hypertension and Insomnia. The hypertension and insomnia conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  Both were reviewed and considered by the Board.  There was no performance-based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the hypertension and insomnia conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the right shoulder pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral knee pain, hypertension and insomnia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  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 20140121, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR2016001 0620 (PD201400685)

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