RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01715
BRANCH OF SERVICE:  ARMY	BOARD DATE:  20140828
SEPARATION DATE:  20031225

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (71L/Administrative Specialist) medically separated for a left shoulder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or to satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The left shoulder condition, characterized as “status post left shoulder sub-acromial decompression and distal clavicle resection with persistent postoperative pain,” by the MEB was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic pain left shoulder status post sub-acromial decompression and distal clavicle resection,” as unfitting and rated at 10% citing the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left shoulder condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20031030	VA – unable to locate Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Shoulder… 	5099-5003	10%	Left Shoulder Condition	5203	Not Service Connected	
Other x 0 (Not in Scope)	Other x 0 (Not in Scope)	
Combined:  10%	Combined:  No Rating 	
Derived from VA Rating Decision (VARD) dated 20050802 (most proximate to date of separation)

ANALYSIS SUMMARY:  The Board acknowledges the impairment with which the CI’s service-connected condition may burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

Left Shoulder Condition.  Review of the STR reveals that the CI was well until 14 July 2002, when he fell down a flight of stairs at work, striking his left shoulder. The injury was well documented by a line of duty determination dated 2 months prior to separation.  Clinic records note that he was evaluated on the day after the accident, noting left shoulder pain (6/10), with tenderness to palpation over the left shoulder and a decreased range-of-motion (ROM) secondary to pain.  A permanent profile (U3) (dated 3 months prior to separation), documents the diagnosis of left “sub-acromial decompression” and “distal clavicle resection” and limits lifting to 20 pounds, with no push-ups or sit-ups.  The commander’s memorandum to the PEB documents that the CI’s duty performance is excellent” but that his “physical impairments prevent him from fulfilling the requirements” within his MOS.

At the MEB exam, the CI reported a painful shoulder.  The MEB physical exam (DD Form 2808) noted 3/5 strength in the left shoulder with “ROM intact” and with “pain in the left shoulder.”  The MEB examination also later noted decreased “ROM with pain.”  As primary clinical documents, including surgical records and radiology reports, were not included in the evidence provided for this Board to review, the most complete source of evidence of this injury is contained in the MEB narrative summary (NARSUM), dated 2 months prior to separation.  The NARSUM notes the history of the injury, and documents referral to orthopedics which resulted in the diagnosis of “left shoulder impingement syndrome” and subsequent arthroscopic surgery; namely, sub-acromial decompression and distal clavicle resection.  Pain persisted after surgery, especially with lifting and with activities over the shoulder and was insufficiently relieved with either physical therapy or medications to permit return to full duty.  Upon examination, the acromioclavicular joint was non-tender; there was full abduction to 180 degrees.  Provocative testing, performed to uncover left shoulder impingement, instability or rotator cuff injury was negative.  The NARSUM diagnosis was persistent post-operative pain, moderate and frequent status post left shoulder sub-acromial decompression and distal clavicle resection.  The MEB was performed 2 months prior to separation, recommended that this condition was medically unacceptable.  The Informal PEB performed less than 2 months prior to separation, found the left shoulder condition unfit, with pain noted as moderate and frequent.

The Board directed attention to its rating recommendation based on the above evidence, which provides minimal documentation of the medical history and treatment provided, but does provide sufficient detail for rating determination at separation IAW to the Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The Board notes that shoulder conditions can be coded and rated for ROM under code 5201, for instability using code 5202, for rotator cuff injury analogously to 5203 and with consideration of painful motion and functional loss, IAW VASRD §4.59 and §4.40.  The Informal PEB originally rated this condition at 10%, for moderate and frequent pain, IAW the USAPDA Policy/Guidance memorandum, under code 5099-5003.

The shoulder ROM measurements, taken specifically for the MEB (2 months prior to separation), revealed full abduction (180 degrees), albeit with pain and decreased strength; therefore, the rating for this condition cannot be raised above 10% under VASRD code 5201 for limitation of motion.  Noting that shoulder disability can also be rated based upon instability, the Board noted that the NARSUM determined that there was no instability in the dominant shoulder; as a result, VASRD code 5202 would not be indicated.  Additionally, as the provocative testing documented in the NARSUM did not note weakness in the rotator cuff, VASRD code 5203 (to which injury of the rotor cuff is analogously assigned) would also not be appropriate.  VASRD code 5003 is often applied when ROM is decreased, but is insufficiently decreased to be compensable under appropriate diagnostic codes and the presence of degenerative joint disease must be verified by radiographs, which are not in evidence in this case.  The Board carefully examined the remaining codes applicable to shoulder injury, and did not find another rating code, for which the criteria would allow any ratings higher than 10%.  
Since the USAPDA is no longer applicable, the Board elected to rate this condition at 10%, under VASRD code 5099-5003,  analogously as an unlisted shoulder condition, with pain on motion and functional loss, with decreased shoulder strength due to pain.  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 shoulder condition.

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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the left shoulder condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the left shoulder pain condition and IAW VASRD §4.40, 4.59 and 4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140410, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20150008231 (PD201401715)

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						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA