RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	 	CASE:  PD-2014-00999
BRANCH OF SERVICE: Army	SEPARATION DATE:  20080915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Patriot Operator/Maintainer, medically separated for “limitation of motion of left (non-dominant) shoulder,” with a disability rating of 20%.  

CI CONTENTION:  His conditions continue to worsen.   The applicant’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 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:  

SERVICE PEB - Dated 20080814	VARD - 20090413	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain	5201	20%	Left Shoulder Rotator Cuff Repair, SLAP, Biceps Tenotomy & Clavicle Resection	5201-5020	10%	20090413	

Hearing Loss
	Not Unfitting	Right Ear Hearing Loss	6100	NSC	20090706	
		Left Ear Hearing Loss	6100	NSC	20090706	
Hyperlipidemia	Not Unfitting	Hyperlipidemia	7099-7005	NSC	20090706	
Joint Pain, Left Index Finger	Not Unfitting	No VA Placement	
Flat Feet	Not Unfitting	Bilateral Foot Pes Planus	5276	NSC	20090706	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Shoulder Condition.  The CI originally injured his left shoulder while doing push-ups in 2007.  Eventually, he underwent an arthroscopic surgical repair of a left rotator cuff and labrum tear.  After rehabilitation (14 weeks after surgery, 4 months prior to separation), the CI significantly improved with less pain and better range-of-motion (ROM).  Despite overall improvement, the persistence of joint pain resulted in the CI being referred to a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARSUM) examination (07 July 2008 2 months prior to separation), the CI’s chief complaint was “left shoulder pain.”  The physical examination (PE) revealed painful and limited motion of the left shoulder with further reduction after repetitive use.  The left shoulder was “somewhat weaker” to right side comparison.  Sensory and motor parameters were normal.  The diagnosis remained left shoulder pain.  His permanent profile listed the same diagnosis and the commander’s statement noted his inability to perform duties due to his physical condition.  At the VA Compensation and Pension (C&P) examination (05 September 2008, 10 days prior to separation), the CI’s clinical history was chronologically summarized without additional complaints.  His PE revealed normal but painful ROM as well as crepitus, stiffness, and weakness about the left shoulder.  The examiner also estimated that the CI “will have mild to moderate functional loss limited to 150 degrees of forward flexion and will have mild physical impairment during flare-ups.”  There were no neurologic deficits present.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the left shoulder at 20% coded 5201 (limitation of arm motion), citing repetitive motion decline to 90 degrees of abduction.  The VA rated the left shoulder at 10% coded 5201-5020 (limited motion-synovitis) citing painful motion.  Board members first looked at examination time reference to the date of service separation and concluded that the VA examination being just 10 days from separation held near exclusive probative value (PV) in this case and therefore equates to a rating of 10% for painful motion under VASRD §4.59.  However, having no other coding options available that would equate to a VASRD impairment rating higher than the PEB’s current 20% and IAW DoDI 6040.44, the Board may not recommend a rating lower than that received prior to application.  Therefore, all evidence considered, there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s 20% rating decision for the left shoulder condition. 

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the conditions of hyperlipidemia, left index finger joint pain, flat feet, and hearing loss 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.  None of the conditions were implicated in the commander’s statement nor judged to fail retention standards and only left-sided hearing loss was profiled.  All conditions were reviewed and considered by the Board.  Although the Audiologist noted a “mild conductive hearing loss” in the left ear, Board members concluded that the mild degree of hearing impairment as well as the other contended conditions did not significantly interfered with satisfactory military duty performance.  Therefore, after due deliberation in consideration of the preponderance of the evidence, all members concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination for the any of the above listed conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the contended hyperlipidemia, left index finger joint pain, flat feet, and hearing loss 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 20140225, with attachments
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 XXXXXXXXXXXXXXXXXX, AR20160005836 (PD201400999)

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