RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00759
BRANCH OF SERVICE:  Army	BOARD DATE:  20150429
SEPARATION DATE:  20050801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-3 (Infantry Officer) medically separated for chronic right shoulder pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “degenerative joint disease of (his) glenohumeral joint” and “cubital tunnel syndrome of (his) right upper extremity” to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic right shoulder pain” as unfitting, rated 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  The Board reviewed the CI’s lengthy contention as documented in blocks 3, 12 and 15 of his DD 294 application.  In addition to the CI’s unfit condition, he contended for PTSD (assumed: posttraumatic stress disorder), bilateral hands, and his neck.

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 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 20050614	VA* - (~2 Wks. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5003	10%	Right Shoulder DJD	5201-5010	10%	20050813	
Cubital Tunnel Syndrome	Not Unfitting	Right Cubital Tunnel Syndrome	8516	10%	20050813	
Other x0	Other x9	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20060506 (most proximate to date of separation)

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the 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.  The CI suffered several injuries of his right shoulder with the two most significant being while at the US Military Academy and the other while deployed to Afghanistan.  In November 1998, he underwent an open repair of a right labrum tear to treat his recurrent instability.  His post-operative rehabilitation went well, he was able to return to competitive sports, and had no problems for a 5-year period.  While deployed in late 2003, the CI suffered another injury to his right shoulder when he fell off of a military vehicle.  There was no dislocation but the pain and sensation of instability returned.  Pre-operative evaluation with magnetic resonance imaging (MRI) did not reveal any rotator cuff tear.  Additionally, pre-operative physical exam was consistent with some moderate apprehension but no frank instability.  In August 2004 (a year prior to separation) the CI underwent examination under anesthesia with subsequent arthroscopic rotator cuff tear.  The operative findings were significant for no subluxation of the humeral head and significant wear of the articular cartilage of the humeral head.  The CI completed post-operative rehabilitation and orthopedic evaluation 8 months prior to separation revealed painful motion but no instability.  The narrative summary prepared 3 months prior to separation noted the CI was not able to get back to where he could function in the military, he continued to have chronic shoulder pain and an MEB would be in the CI’s best interest.  The examiner stated, “I reviewed the pictures of his surgery and it shows indeed he does have osteoarthritis of his glenohumeral joint.  He also has osteoarthritis that was shown on the MRI of his shoulder back in June of 2004.”  The examiner, an orthopedic surgeon, also stated, “He has good stability of his shoulders.  I do not appreciate a positive subluxation glide in the anterior or posterior directions of his right shoulder.  He does have a negative sulcus at this time, but he does have more what I think is the pain coming from the arthritic changes that he has in the shoulder.”  At the VA Compensation and Pension exam performed 2 weeks after separation, the CI reported continued chronic discomfort and increased pain with certain range of motion positions.  The pertinent physical exam findings are summarized below.

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Shoulder ROM (Degrees)	DD 2808 ~5 Mo. Pre-Sep	PT for MEB ~3 Mo. Pre-Sep	VA C&P ~2 Wks. Post-Sep	
Flexion (180 Normal)	-	155	120	
Abduction (180)	95	160	110	
Comments: Right Hand Dominant 	Neg. apprehension	Pos. mechanical limitation of internal rotation	Pos. painful motion; Pos. Deluca decrease of 5 degrees in all motions; Normal strength; no instability	
§4.71a Rating	10%	0% (PEB 10%)	10% (VA 10%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic right shoulder pain condition by applying VASRD code 5003 (degenerative arthritis) and rated it 10%.  The VA applied the combination code of 5201 (limitation of arm motion) with 5010 (arthritis due to trauma) and also rated it 10%.  The Board considered alternative coding and rating schemes that may be of benefit to the CI.  There was no post-operative instability that would allow for the application of any shoulder specific VASRD code.  Additionally, there was no evidence of incapacitation that would allow for a 20% evaluation under code 5003.  There is no appropriate coding scheme that would result in a rating greater than 10% for the right shoulder pain condition.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), Board members agreed that the disability rating of 10% for the chronic right shoulder pain condition was appropriately recommended in this case.

Contended Right Cubital Tunnel Syndrome Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that the right cubital tunnel syndrome was 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.  The right cubital tunnel syndrome condition was profiled and was judged to fail retention standards.  It was implicated in the commander’s statement by the following statement, “This injury coupled with his previous shoulder injury directly affects CPT Nash's ability to function in his current MOS….”  All service treatment record (STR) entries were reviewed and considered by the Board.  There is electro diagnostic evidence supporting the diagnoses of a right cubital tunnel syndrome.  This is a condition of ulnar nerve entrapment at the elbow, not a formal elbow joint condition and his right elbow ROM was normal.  The spectrum of disability from cubital tunnel syndrome ranges from numbness and tingling (paraesthesias) only to weakness and atrophy of the intrinsic muscles of the hand.  At the time of separation, the CI only manifested paraesthesias of the right hand, with no hand weakness noted, and those sensory changes had no functional implications.  Although the condition was forwarded by the MEB as separately failing retention standards, the Board could find no evidence in the STR of objective performance based criteria for concluding that the condition was independently unfitting.  Additionally, the CI’s profile allowed for carrying and firing a weapon, and construction of an individual fighting position, tasks that would be significantly impaired if the cubital tunnel syndrome was unfitting.  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 right cubital tunnel syndrome condition and so no additional disability rating is recommended.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chronic 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 right cubital tunnel syndrome 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, 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 20140201, 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 XXXXXXXXXXXXXXX, AR20150013203 (PD201400759)

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