RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02840
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Combat Engineer, medically separated for “chronic left shoulder pain…” with a disability rating of 10%.

CI CONTENTION:  “Review all records.”  The CI’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 - 20051213	VARD - 20060411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Status Post Impingement Syndrome, Residuals of Decreased Painful Range of Motion	5203	20%	20060320	
Mild Hypercholesterolemia	Not Unfitting	No VA Placement	
Smoking	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  #0%	

ANALYSIS SUMMARY:

Chronic Left Shoulder Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left-handed CI underwent left shoulder arthroscopic surgery in March 2005 for a partial rotator cuff tear and impingement.  Despite steroid injections, surgery and physical therapy (PT) treatment, the left shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “chronic left shoulder pain/chondral defect/arthritis” for PEB adjudication.

According to the MEB orthopedic evaluation on 20 September 2005, 4 months before separation, the CI complained of shoulder pain that caused an inability to perform sit-ups, overhead activities, an inability to wear his body armor, and an inability to carry or fire his M16.  Shoulder dislocations were not reported.  The examination showed left shoulder tenderness and painful motion.  Flexion was 170 degrees (normal 180 degrees) and abduction was 170 degrees (normal 180 degrees).  Tests for shoulder instability were negative.  The MEB NARSUM examination on 28 November 2005, 1 month before separation, recorded a chief complaint of left shoulder pain rated 4-6/10 in severity that worsened to 10/10 with certain activities.  Shoulder dislocations were not reported.

At the VA Compensation and Pension (C&P) examination in March 2006, 3 months after separation, the CI reported weakness, stiffness, dislocations and partial dislocations.  Pain severity was rated 8/10.  The examination showed left shoulder tenderness and painful motion.  Flexion was 160 degrees and abduction was 150 degrees.  Repetitive motion was reported to cause additional limitation via “weakness, lack of endurance and pain” but the examiner stated that a determination of additional loss of degrees of motion was not possible without resorting to speculation.  There was no documentation of instability or of loose shoulder movement.  Left shoulder X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating analogously coded 5003 (degenerative arthritis), citing residual pain.  The VA assigned a 20% rating coded 5203 (clavicle or scapula, impairment) based on the VA C&P examination approximately 3 months after separation, citing shoulder dislocation.  The VASRD §4.71a code 5201 (arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (approximately 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 code 5202 (humerus, other impairment); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under code 5203 (clavicle or scapula, impairment).  After due deliberation, and in consideration of all 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.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that mild hypercholesterolemia and smoking conditions were not unfitting.  The smoking condition is a condition not constituting a physical disability, IAW DoDI 1332.38.  The mild hypercholesterolemia condition, as an asymptomatic laboratory finding, had no impact on fitness and is not a VASRD-ratable condition.  The Board therefore has no basis for recommending either of these conditions as unfitting.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the mild hypercholesterolemia and smoking contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended mild hypercholesteremia and smoking conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140529, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 1 9 2016

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, AR20160008648 (PD201402840)

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