RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01155
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated by the Informal Physical Evaluation Board (PEB) for “right shoulder arthritis” and “left femur impairment,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The applicant contends he was not give the correct information for appealing the PEB adjudication.  Additionally, the CI’s back and knees were overlooked by the PEB.  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 based upon a 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 - 20091022	VARD - 20110825	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Right (Non-Dominant) Shoulder Arthritis
	5010	10%	Arthritis Right Shoulder (Dominant) due to Trauma	5201-5019	10%	20110511	
			Surgical Scar, Right Anterior Shoulder	7805	0%		
Left Femur Impairment	5299-5255	10%	Post Traumatic Fracture of Left Superior and Inferior Pubic Ramus	5255	10%	20110526	
Low Back Pain	Not Unfitting	Lumbar Strain w/Pars Interarticularis Defect	5237-5243	10%	20110511	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY: 

Right (Non-Dominant) Shoulder Arthritis.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right shoulder surgery in May 2009, after a motor vehicle accident (MVA).  Despite post-operative physical therapy (PT), the right shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic right shoulder pain due to residual of healed mid clavicular fracture” for PEB adjudication.  At an Internal Medicine visit in September 2009, 2 months prior to separation, the CI endorsed daily right shoulder pain with flare-ups upon exertion or overhead lifting.  His physical examination (PE) revealed right shoulder and collar bone tenderness as well as painful motion.  There was no muscle spasm, instability, or weakness about the right shoulder.  The MEB NARSUM written in September 2009 used this internal medicine visit for its narrative and range of motion (ROM) measurements of flexion at 150 degrees (normal 180) and abduction at 140 (normal 180) from a PT visit on 16 September 2009.  The CI failed to report for his initial VA Compensation and Pension (C&P) examination; however, his subsequent examination occurred in May 2011, 16 months after separation. 

The Board directed attention to its rating recommendation based on the above evidence.  Although using different but similar codes, both the PEB and VA rated the right shoulder condition at 10% citing arthritis and or functional loss due to pain.  The VASRD §4.71a threshold for a rating for ROM impairment (5201) is “at shoulder level” (approximately 90 degrees from the side), and the ROM revealed in this case was well above this level.  Although there was no limitation of motion to support a rating under 5201, 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.

Left Femur Impairment.  Pursuant to the same MVA previously described, the CI underwent surgical fixation of a pelvic fracture with hip pinning in late July 2009.  At the corresponding MEB examination, 2 months prior to separation, the CI reported daily pelvic pain with flare-ups when walking, prolonged standing, or maneuvering stairs.  His PE revealed a left-sided antalgic gait.  There was decreased and painful motion of the left hip.  Tenderness was present.  There was no guarding, muscle spasms, or evidence of surrounding ligament instability.  At the 16 month remote post-separation VA C&P examination, the CI reported similar flare-ups as previously described and stated, “During flare-ups [the CI] experiences neither functional impairment nor any limitation of motion of the joint.”  His PE revealed a normal gait.  Both hips had normal ROM without any identified abnormalities. 

The Board directed attention to its rating recommendation based on the above evidence.  Although the PEB and VA titled the diagnosis differently, they both utilized the same primary VASRD code of 5255 (femur, impairment) and rated 10%, citing painful motion.  Board members first agreed that the VA examination was well past the usual 12 month timeframe of consideration and therefore was essentially void of probative value in rendering a rating impairment rating.  Although there was no ROM limitation in support of a positive rating, all Board members agreed that the pre-separation encounter clearly documented pain-limiting motion and therefore, in support of VASRD §4.59.  Absent persistent fracture without nonunion or malunion and or the presence of hip disability greater than ‘slight’, there is no route to an impairment rating higher than the PEB’s 10% under any applicable code and no coexistent pathology which would merit additional rating for the hip condition under any other separate code.  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 femur/hip condition.  

Contended PEB Condition. The Board’s main charge is to assess the fairness of the PEB’s determination that the low back pain was not unfitting.  The back condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The condition was reviewed and considered by the Board.  There was no performance-based evidence from the record that the back condition significantly interfered with satisfactory duty performance.  After due deliberation, and 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 condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left femur impairment condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended back condition, 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 20140228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160010631 (PD201401155)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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