RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03271
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Medical Logistics Specialist, medically separated for “chronic neck pain” and “chronic left shoulder pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  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 - 20060119	VARD - 20070123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5237	10%	Chronic Cervical Strain with Radiculopathy	5237	10%	20060601	
Chronic Left Shoulder	5099-5003	0%	Residuals, Dislocation of Left Shoulder	5201	20%	20060601	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic neck pain began in September 2003 after falling from a vehicle.  Diagnostic imaging done in October 2004 revealed herniated spinal discs at C5-6 with nerve root impingement.  Physical examination (PE) parameters in December 2005 (Spurling’s test) indicated a possible left-sided cervical radiculopathy.  There was no surgical indication.  Despite conservative treatment to include epidural steroid injections of her left cervical spine, she did not improve sufficiently to allow unrestricted duty.  The MEB forwarded “chronic cervical pain, left side spasm and left radiculopathy,” for PEB adjudication.  At the MEB examination dated 29 November 2005, 5 months prior to separation, the CI reported chronic left neck pain rated 7/10 with spasm.  She was unable to carry and fire an individual weapon, move with a fighting load at least 2 miles, and construct an individual fighting position.  She could not run, do pull-ups, or jump.  Her PE revealed moderate/severe muscle spasm and tenderness of the left-sided neck muscle.  Cervical range of motion (ROM) was full, but painful.  The MEB examiner also referred to physical therapy (PT) ROM measurements conducted 2 weeks later which indicated worsening motion limitation resulting in a combined ROM of 165 degrees as compared to the MEB’s notation of “full ROM” representing a combined ROM of 340 degrees.  

At the VA Compensation and Pension (C&P) examination on 1 June 2006, performed 2 months after separation, the CI reported a daily occurrence of sharp 7/10 neck pain extending into her left arm and fingertips.  Her PE revealed tenderness all through the cervical spine as well as in her left deltoid muscle.  There was no abnormal spinal contour, no surrounding muscle spasms, and her gait and posture was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic neck pain 10% under the analogous 5299-5237 code (cervical spine strain), citing tenderness to palpation.  The VA also assigned a 10% rating coded 5237 citing limited combined ROM.  The Board deliberated on the probative value of the examinations in evidence as well as the totality of the record.  The documented combined sum of motion at the PT examination was the single piece of evidential data in the record that reached the 20% impairment criteria.  However, after extensive deliberation, all Board members agreed that the consistency of the complete record favored near normal but painful ROM and therefore, in consideration of all the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended no change in the PEB’s rating for the chronic neck pain condition.  

Chronic Left Shoulder Pain.  Subsequent to the same mechanism of injury as described under the CI’s neck condition, the CI developed chronic left shoulder pain.  Serial diagnostic imaging studies revealed degenerative changes, bursitis, as well as a bone spur about the left shoulder.  Additionally, a Hill-Sacks deformity (humeral head indentation indicating a prior shoulder dislocation) was noted.  The surrounding shoulder ligaments were intact.  There was no evidence of a bone fracture, dislocation, or a rotator cuff tear.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left shoulder chronic irritability, Hill-Sach’s deformity” for PEB adjudication.  At the MEB specialty examination the CI reported continuous pain in her left shoulder with numbness extending into her left arm and tingling in her fingers.  Her PE was brief and revealed tenderness and spasms about the left shoulder.  There was full ROM of both shoulders.  Although provocative testing indicated anterior instability of the left shoulder, the examiner specifically stated, “I couldn't appreciate any instability of the shoulder in this examination.”  Distal upper extremity strength and reflexes were normal.  

At the VA C&P examination on 1 June 2006, performed 3 months after separation, the CI reported daily 7-8/10 left shoulder pain associated with constant weakness and stiffness in the morning.  The pain affected her daily activities such as exercising, overhead pushing, and lifting her daughter.  “She describes increase in pain with any type of overhead movement.”  Her PE was extensive and revealed tenderness about the lateral aspect of the left shoulder.  Shoulder ROM was painful and decreased noting flexion to 120 degrees and abduction to 90 degrees.  There was no evidence of shoulder deformity, stiffness, erythema, atrophy, or warmth upon palpation.   
   
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the analogous 5099-5003 code (arthritis, degenerative), citing slight and occasional pain per the U.S. Army Pain policy.  The VA assigned a 20% rating coded 5201 (limitation of arm motion) for limitation of abduction of 90 degrees.  The VASRD §4.71a code 5201 threshold for a rating for ROM impairment is “at shoulder level” (approximately 90 degrees from the side), and the ROM in evidence from the VA C&P examination demonstrated shoulder abduction to this level of impairment.  

Although both the MEB and VA examinations were well within the time frame for rating under VASRD rules, Board members agreed that the VA examination was more comprehensive and detailed and therefore placed greater probative value on the VA evaluation.  Although the VA abduction ROM was listed as 90 degrees, the evaluation comments of pain with “overhead pushing” and “overhead movements” clearly makes reference of an ability to achieve greater than 90 degrees of abduction.  Therefore, all Board members agreed that the evidence of painful motion supported the maximum rating of 10% IAW VASRD §4.59.  There was no malunion or recurrent dislocation of the humerus and no dislocation or nonunion of the collar bone or shoulder blade to justify a higher rating under the 5202 (humerus impairment) or 5203 (collar bone or shoulder blade impairment) codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the left shoulder condition.   

BOARD FINDINGS:  In the matter of the chronic neck pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the chronic left shoulder pain, the Board unanimously recommends a disability rating of 10%, coded 5299-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5299-5237	10%	
Left Shoulder Pain	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140714, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160008657, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.   I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and Iaccept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical
Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final. Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,

Enclosure