RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01801
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (General Construction Equipment Operator) medically separated by the Informal Physical Evaluation Board “left shoulder pain”, rated 10%.

CI CONTENTION:  The applicant’s condition continues to worsen and negatively impacts his daily activities.  The applicant’s complete submission is at Exhibit A.  

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 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 -  20030119	VA - 20030423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Shoulder Pain…	5099-5003	10%	Residuals, Left Shoulder Surgery Rotator Cuff Reconstruction	5201	20%	20030319	
			Scar, Left Shoulder Surgery Associated with Residuals, Left Shoulder Surgery, Rotator Cuff Reconstruction	7805	0%		
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	
.  

ANALYSIS SUMMARY:  

Left Shoulder Pain.  According to service treatment records and the MEB narrative summary (NARSUM), the left hand dominant CI injured his left shoulder in August 1999 while lifting a beam.  Ongoing pain led to open shoulder reconstruction (labrum repair) in March 2001.  Surgery and physical therapy failed to adequately improve the condition.  

At the time of the orthopedic clinic appointment on 19 June 2002, 7 months before separation, the CI reported that he was not able to get back to 100%, but could do his job.  On examination he was noted to have full ROM with tenderness around the shoulder joint and chronic pain.  At the physical therapy clinic appointment on 21 June 2002, the CI reported that he was unable to fire a weapon.  The examiner noted that he had reached a plateau with therapy and had chronic pain with activity.  

The CI’s shoulder condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and so he was referred for a Medical Evaluation Board (MEB).  At the MEB examination (recorded on DD Form 2807 and 2808) dated 9 September 2002, 4 months prior to separation, the CI reported that he could not qualify on his weapon due to his painful shoulder.  Physical exam showed a well-healed surgical scar, but was otherwise silent in regards to his shoulder condition. 

At the time of the orthopedic clinic appointment on 30 September 2002, 4 months before separation, the CI reported that he had trouble holding his son or lifting anything.  The examiner noted that he had full ROM.  

According to the MEB NARSUM evaluation on 30 September 2002, 4 months prior to separation, the examiner noted that although the CI did well in rehabilitating his shoulder after surgery, he was unable to return to duty to perform the lifting tasks required of his military specialty or perform push-ups.  Shoulder dislocations were not reported.  Physical examination showed a well healed scar.  There was no evidence of instability, but showed that he did have pain with anterior apprehension.  The examiner stated “he has full ROM of his shoulder.”  

At the VA Compensation and Pension (C&P) examination on 19 March 2003, 2 months after separation, the CI reported having stiffness in his left shoulder and no symptoms related to his surgery scar.  Physical exam showed left shoulder ROM for flexion was 80 degrees (normal 180 degrees) and abduction was 160 degrees (normal 180 degrees).  After describing the right shoulder and right knee the examiner summarized that there was “no limitation of movement of both the left shoulder and the right knee.  There is no painful motion, edema, effusion, instability, weakness of the left shoulder or the right knee.  Tenderness on the anterior joint compartment of the left shoulder and guarding of the movement of the left shoulder.”  Skin exam documented that there was no limitation of shoulder motion because of the scar.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis), citing the USAPDA Pain Policy (derived from AR 635-40).  The VA assigned a 20% rating using the 5201 code (arm limitation of motion) for limitation of motion using the post-separation VA exam.  The VA also assigned a separate 0% rating using code 7805 (scars, other) for his surgical scar.  

The Board discussed the probative value of the NARSUM and VA exams as the ROMs were significantly different.  The VA exam was closer to the date of separation, and provided specific degrees for ROM, but had some internal inconsistency or typos when referring to the CI’s left (affected) or right (normal) shoulder in summary statements.  The MEB exam did not detail degrees of ROM.  The service treatment record had two notes indicating full ROM and two notes indicating full active ROM in the year prior to separation.  The Board adjudged that the NARSUM exam aligned with the preponderance of the evidence in the record and therefore had the highest probative value for rating at separation.  There was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a minimum rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence prior to separation demonstrated motion above this level which did not support a minimum rating under 5201.  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 any rating higher than 10% under the 5203 code (clavicle or scapula, impairment of).  The Board does not recommend separation rating for scars unless their presence imposes a direct limitation on fitness.  The Board reviewed service treatment records and did not find evidence that a tender or painful scar separately interfered with duty and therefore a separate rating was not recommended.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder condition.

BOARD FINDINGS:  In the matter of the left shoulder condition and IAW VASRD §4.71a, the Board majority 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 20140417, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

'06 JUL 2015

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 XXXXXXXXXX, AR20160003400 (PD201401801)

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