RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01313
BRANCH OF SERVICE:  Army	BOARD DATE:  20150327
SEPARATION DATE:  20061115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Combat Engineer) medically separated for left shoulder pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards, but was authorized to perform an alternate physical fitness test (per PROFILE).  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The chronic left shoulder pain was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic Left shoulder pain secondary to impingement syndrome caused by repetitive strain injuries to the shoulder, status post arthroscopic debridement” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Partial loss of mobility of left arm was not evaluated in the overall rating, in addition PTSD was not evaluated during the board proceedings at time of discharge.”

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 20061026	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	0%	Left Shoulder Status Post Rotator Cuff Repair	5201-5019	10%	20070102	
Other x 0 (Not In Scope)	Other x 3	
RATING:  0%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070222 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Shoulder.  The narrative summary (NARSUM) notes the CI experienced left shoulder pain while working on an armored vehicle during deployment in March 2004.  The CI continued to have pain despite conservative treatment and when he returned from deployment left shoulder X-rays on 3 November 2004 were normal.  Notes in the service treatment record indicated he was initially diagnosed with impingement syndrome and according to the NARSUM, the pain continued despite several courses of physical therapy (PT).  A magnetic resonance arthrogram on 22 December 2005 suggested a labral (joint cartilage) tear and a diagnostic arthroscopy was performed on 24 January 2006.  A partial thickness rotator cuff (RC) tear was debrided and no other abnormalities were noted.  At an orthopedic evaluation on 17 March 2003 the CI reported continued left shoulder and arm pain, graded 2/10 at rest and increased to 4-5/10 with activities, without numbness/tingling of the upper extremity (UE).  The exam noted range-of-motion (ROM) of flexion and abduction of 180 degrees (normal for both 180), with intact pulses and sensation of the UE.  The examiner noted mild shoulder pain with good ROM post-operatively and recommended return to duty with a P2 profile for no push-ups.  The NARSUM noted that despite additional PT, the CI continued to report shoulder pain and a MEB was initiated.

At the MEB examination on 12 September 2006, 2 months prior to separation, the CI reported constant shoulder pain, increased by activities, especially overhead lifting.  The MEB physical exam noted abduction of 150 degrees and difficulty putting the left arm behind the back, with normal sensation and “slightly less” strength on the left than the right.  Physical therapy ROM for the MEB on 11 September 2006 was flexion of 170 degrees times three, and abduction of 155, 160, and 160 degrees, with pain at end ROM.  The MEB examiner noted that he and the orthopedic specialist had a difference of opinion regarding the evaluation of the CI.  The orthopedic examiner left the evaluation of pain to others such as the MEB examiner, because it is not an orthopedic condition, and this accounted for their differing profile recommendations for the shoulder condition.

At the VA Compensation and Pension examination on 2 January 2007, 2 months after separation, the CI reported constant shoulder pain graded 3-4/10, increased with activity, and an occasional “popping” sensation, without dislocations or subluxations.  On exam the CI was noted to be right hand dominant.  There was tenderness to palpation of the RC and no muscle atrophy was noted.  Strength and reflexes of the UE were normal.  Shoulder ROM was flexion of 170 degrees and abduction of 150 degrees, with pain at end ROM and no additional loss of ROM with repetition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition 0%, coded 5099-5003 (analogous to degenerative arthritis) and the VA rated it 10%, coded 5201-5019 (bursitis with limited arm motion).  Members agreed that the evidence in record supports a 10% rating coded analogously to 5201 IAW VASRD §4.59 (painful motion) for painful limited arm motion.  The Board reviewed to see if a higher rating was achieved with any coding approach.  There was no evidence of the involvement of two or more major joints for 20% rating according to 5003 rating criteria.  There was no evidence of limitation of motion that met the threshold criteria for a 5201 rating based on ROM alone, specified as limitation of arm motion “at shoulder level.”  Board practice when rating with 5201 has considered 90 degrees of abduction or flexion “at shoulder level.”  Additionally, there was no evidence of ankylosis, impairment of the humerus, or impairment of the clavicle or scapula with loose movement.  Member consensus was that the evidence supports a 10% rating and no higher with any applicable code IAW VASRD 4.71a.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59, the Board recommends a disability rating of 10% for the left shoulder condition, code 5299-5201.

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 left shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5201 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Left Shoulder Pain	5299-5201	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140112, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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, AR20150013436 (PD201401313)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA