RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02783
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Military Intelligence Systems Maintainer/Integrator) medically separated for lumbar and right shoulder conditions.  These could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent U3/L3 profile and referred for a Medical Evaluation Board (MEB).  Shoulder pain, probably secondary to residual labral tear, postoperative Bankart repair and low back pain (mechanical) were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted.  The Informal PEB adjudicated the chronic low back pain and right shoulder pain as unfitting, rated 10% each with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  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 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 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 20040908	VA* - (~2 Mos. Pre -Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5237	10%	Residuals of Low Back Injury	5237	10%	20041028	
Right Shoulder Pain…	5099-5003	10%	Residuals Right Shoulder Injury	5299-5203	10%	20041028	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1	
RATING:  20%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20050302 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Lumbar Condition.  The service treatment record (STR) corroborates the history in the MEB narrative summary (NARSUM) of an atraumatic onset of low back pain early in service in 2000 (4+ years pre-separation).  There were intermittent complaints of back pain (normal X-ray), but no temporary profiles.  There was no STR documentation of radicular symptoms; normal neurological exams (5/5 strength) were documented; and, surgery was not indicated.  A physical therapy entry from March 2004 (9 months pre-separation) recorded normal thoracolumbar range-of-motion (ROM) in all planes except for a 25% reduction of extension, annotating painful motion.  There is no STR evidence for more significant ROM limitation, abnormal gait or spinal contour, neurological deficits, or incapacitating episodes

The MEB NARSUM was conducted 30 July 2004 (4 months pre-separation) and documented “continued chronic low back pain which was intermittent [no mention of radicular symptoms] ...causing difficulty with prolonged sitting, prolonged standing ... [and] ... running ....”  The MEB NARSUM physical examination recorded right sided paraspinal spasm and painful motion, without comment regarding gait, spinal contour, or ROM; and, noted normal neurologic findings.

A VA Compensation and Pension (C&P) examination was conducted 28 October 2004 (2 months pre-separation) and documented constant pain rated 3/10 with exacerbations to 6-7/10 “after prolonged sitting or heavy lifting....”  The VA examiner noted right lower extremity radiation (the only comment to that effect in the record), further stating that the “right leg occasionally buckles momentarily but she has no paresthesias.”  The VA physical examination recorded normal gait and spinal contour, spinal tenderness, and normal motor and sensory testing.  The VA measured ROM was normal in all planes, but specified painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5237 (Lumbar strain) cited the VASRD §4.71a criteria of spasm and painful motion (from the MEB NARSUM), and did not cite specific ROM measurements.  The VA’s 10% rating under the same code cited the C&P ROM measurements and conceded painful motion (VASRD §4.59) for the minimum compensable rating.  There is no ROM evidence supporting a rating higher than 10%, no evidence of gait or spinal contour abnormality in support of a 20% rating, no evidence of additionally ratable peripheral nerve impairment, and no documentation of incapacitating episodes which would provide for a higher rating under that formula.  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 of the lumbar condition.

Right Shoulder Condition. The CI experienced an atraumatic onset of right shoulder pain in 2000, in the same period as for the back pain.  She was diagnosed with a labral (rim of joint socket) tear and underwent arthroscopic repair (Bankart procedure) in October 2002 (2 years pre-separation).  Despite conservative measures and temporary profiles her pain persisted, and imaging (MRI) revealed a new labral tear and degenerative changes (normal alignment).  Further surgical intervention was reasonably declined, and an MEB was initiated.  There are STR entries confirming restoration of normal ROM after surgery (with persistent painful motion), normal strength, and the absence of mechanical impingement or instability; all of these being specifically documented in the final orthopedic clinical entry (with comprehensively detailed physical findings) of 31 March 2004 (9 months pre-separation).  There are separate STR entries from the MEB period documenting measured forward flexion to 170 degrees (normal 180), and a normal electrodiagnostic study (EMG) of the right upper extremity.  There are no STR entries conflicting with the above evidence or documenting periods of incapacitation.

The MEB NARSUM documented persistent pain (unquantified), especially with overhead work, and did not mention subjective instability or impingement.  The physical exam noted tenderness, the absence of atrophy, and summarized the findings as “essentially within normal limits.”  The NARSUM ROM measurements were 170 degrees of forward flexion and abduction (for both, normal 180, minimum compensable 90), specifying painful motion.

The pre-separation VA C&P (same as for lumbar) documented persistent pain (“says her shoulder is currently no better than it was before her surgery”) interfering with push-ups, “heavy lifting,” and “overhead work.”  Subjective complaints of weakness and occasional upper arm numbness were also noted.  The physical exam recorded joint tenderness and normal neurological findings (5/5 strength) without comment regarding stability or impingement.  The VA ROM measurements were normal (forward flexion and abduction to 180), specifying painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (Degenerative arthritis) conceded painful motion for a §4.71a compliant rating based on the Service evidence.  The VA’s 10% rating analogous to 5203 (Clavicle or scapula, impairment of) satisfied the 10% criterion of “no loose movement” under that code; although, the decision confusingly invoked “functional limitations” and “pain with motion” as the rationale.  The ROM evidence does not support the minimum compensable rating, except by application of §4.59.  There was no clinical evidence of ankylosis, bone damage, or nonunion/malunion of any component of the shoulder girdle that would support a higher rating under any other joint code; and, there was no history of dislocations or findings of instability that would support a higher rating under 5202 (Humerus, other impairment of).  After due deliberation, considering all evidence and with deference to reasonable doubt, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the right 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.  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 lumbar condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right shoulder condition and IAW VASRD §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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXX, AR20160003898 (PD201402783)

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