RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01399
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E5, Automated Logistics Specialist, medically separated for “right shoulder pain” rated at 10%, and “hearing loss” determined to be EPTS [existed prior to service] without service aggravation, with a combined disability rating of 10%.  

CI CONTENTION: The CI contends not unfitting hearing loss and PTSD conditions have worsened.  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 - 20040511	VARD - 20051014	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5099-5003	10%	Residuals, Right Shoulder Rotator Cuff Repair	5299-5203	10%	20050802	
Hearing Loss	6100	---%	Hearing Loss	6100	NSC	20050726	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Shoulder Pain. According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right (dominant) shoulder surgery in October 2003 for right shoulder impingement, acromioclavicular joint degenerative joint disease, and rotator cuff tear.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right shoulder pain, status post right shoulder arthroscopic subacromial decompression and distal clavicle excision with mini open rotator cuff repair, glenohumeral joint degenerative changes” for PEB adjudication.  At the time of the orthopedic clinic appointment on 17 February 2004, 5 months post-surgery and 6 months prior to separation, the CI reported pain with range of motion (ROM), flexion at 170 degrees (normal 180), and abduction at 165 degrees (normal 180).  According to the NARSUM addendum written for the shoulder in March 2004, 5 months prior to separation, the CI reported persistent pain, particularly with lifting-type activities.  Physical examination showed pain with forward flexion.  There was no tenderness over his shoulder and a negative cross-arm adduction test.  Motor function was 4+/5 for his rotator cuff muscles.  At the VA Compensation and Pension (C&P) examination in August 2005, performed 12 months after separation, the examiner noted no lost time from work due to with any of his problems.  Physical examination identified pain and fatigue with movement and full ROM. The examiner opined that the joint was not the problem; the soreness in the muscles and tendons resulted in function al impairment. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (degenerative arthritis), citing the US Army Physical Disability Agency Pain Policy.  The VA also assigned a 10% rating using an analogous 5299-5203 code (clavicle or scapula, impairment of) based on the VA C&P examination 12 months after separation, citing pain on motion.  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was insufficient 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.  

Hearing Loss.  According to service treatment records and the MEB NARSUM, the CI reported a history of bilateral hearing loss dated to his return from Vietnam in 1971.  An audiology treatment not dated 09 April 2003 noted that the CI did not work around noise and reports of tinnitus (ringing sound in the ear).  At an ENT [ear, nose, and throat) evaluation dated 19 February 2004, the CI reported a history of tinnitus since 1991 and slow, progressive hearing loss.  A diagnosis of moderate to severe hearing loss was rendered and the CI was referred to the MEB.  At the VA C&P examination in August 2005, performed 12 months after separation, the examiner referenced a hearing examination from 1987 which documented “significant hearing loss bilaterally.”  The CI reported difficulty “listening to soft spoken people, program speakers, and on [the] telephone” and tinnitus.    The examiner referenced audiogram results of 80% speech recognition at 80dB bilaterally, moderate to moderately severe loss from 1000 to 8000Hz, and bone conduction scores which confirmed sensorineural hearing loss.  The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the hearing loss as unfitting, but EPTS and not permanently service aggravated.  Board members agreed based on the CI reports there is compelling evidence to support a finding that the hearing loss condition existed prior to service (EPTS) and was not permanently aggravated beyond natural progression and is therefore; not eligible for a disability rating.  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 hearing loss condition.

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 bilateral hearing loss condition, the Board unanimously recommends no change in the PEB adjudication.  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 20140315, 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 AR20160010057 (PD201401399)

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