RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03377
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20061020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, M1 Armor Crewman, medically separated for “chronic right shoulder pain,” with a 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 – 20060927	VARD - 20070119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Shoulder Pain	5099-5003	10%	Right Shoulder Injury Status Post Decompression Surgery	5201-5010	10%	20060504	
Migraine and Tension Headaches	Not Unfitting	Migraines	8100	30%	20060504	
Post-Traumatic Stress Disorder	Not Unfitting	Post-Traumatic Stress Disorder, to include claim for Insomnia	9411	10%	20060504	
Low Back Pain	Not Unfitting	Scoliosis with Thoracolumbar Strain	5237	10%	20060504	
Bilateral Knee Pain	Not Unfitting	Right Knee Tendonitis	5024	10%	20060504	
		Left Knee Tendonitis	5024	10%	20060504	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Chronic Right Shoulder Pain.  The service treatment records and the Medical Evaluation Board (MEB) orthopedic narrative summary (NARSUM) indicated the CI sustained an injury to his right shoulder while deployed to Iraq, December 2003.  An orthopedic physician diagnosed right shoulder impingement syndrome.  The CI underwent two decompression surgeries and was treated with physical therapy and medication without significant improvement.  Radiographs in November 2005 demonstrated mild degenerative changes of the acromioclavicular joint and no evidence of fracture or dislocation.  A magnetic resonance imaging of the right shoulder 2 weeks prior to the second surgery demonstrated the presence of impingement and partial tear with minimal fluid in the acromioclavicular (AC) joint.  The MEB NARSUM dated 21 February 2006, 9 months before separation, noted that the CI had not responded to treatment and continued to have pain.  His U3 profile prohibited all functional activities.  The CI reported pain with abduction range of motion (ROM) and was not taking pain medication.  The physical examination recorded pain-limited ROM:  flexion 116 degrees (180 normal) and abduction 123 (180 normal) degrees.  Evidence of instability, weakness, and sensory deficit was absent.

At the VA Compensation and Pension (C&P) exam, 6 months before separation, the CI reported right shoulder weakness with constant pain.  Physical examination documented right shoulder flexion 180 degrees and abduction 160 degrees with painful motion.  There was no instability, weakness, or sensory deficit.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder 10% with codes 5099-5003 (analogous for degenerative arthritis).  The VA rated the right shoulder 10% with codes 5201-5010 (limitation of motion with arthritis, due to trauma).  The Board considered a higher rating with diagnostic codes:  5003 (degenerative arthritis), 5201 (arm, limitation of motion), 5202, (humerus, other impairment), and 5203 (dislocation of clavicle or scapula), but agree there was no evidence to support a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient evidence to recommend a change from the PEB’s adjudication of the right shoulder condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that migraine/tension headaches, post-traumatic stress disorder (PTSD), low back pain and bilateral knee pain were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  All conditions were reviewed and considered by the Board as noted below.

Migraine Headache.  The CI reported a 7-year history of recurrent headaches of varying character, frequency and intensity.  He was evaluated by neurology while in the MEB process, and noted at the time, he was taking headache prevention medication and an abortive medication.   The neurologist assessed him with chronic daily headache, and recommended medication changes.  The MEB NARSUM reported missing a few days of work every month secondary to headaches and had missed 24 days over a 1-year period.  However, the examiner noted there was no record of visits to the emergency room related to headaches.  The commander’s performance statement did not mention headache diagnosis or specify any limitations attributable to headaches; specifically, there was no mention of work loss due to headaches.  Although the migraine headache condition was profiled P3, there was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance.

PTSD.  The MEB NARSUM psychiatric addendum noted the CI had only recently presented to mental health with complaint of poor sleep, nightmares, anxiety, social isolation from friends, and hypervigilance.  His nightmares consisted of dreams where he either saw himself dead or he saw bodies of dead Americans.  His mental status examination was normal.  It was noted that the CI was taking psychotropic medication to assist with sleep issue.  The psychiatrist assessed PTSD, chronic, in partial remission and noted that there was mild impairment in social and occupational functioning; however, his condition met retention standards.  This condition was not profiled or implicated by the commander’s statement.  There was no performance based evidence from the record that the PTSD condition significantly interfered with satisfactory duty performance.

Low Back Pain (LBP).  During the MEB NARSUM orthopedic addendum the CI reported LBP with sitting or standing.  It was recommended that he undergo treatment with physical therapy and take Ibuprofen.  LBP was not profiled or implicated by the commander’s statement.  LBP was not judged to fail retention standards.  There was no performance based evidence from the record that the LBP condition significantly interfered with satisfactory duty performance.

Bilateral Knees.  The MEB NARSUM orthopedic addendum noted full bilateral knee ROM with absence of painful motion and no joint inflammation.  The CI reported right knee pain without any specific injury.  The examiner diagnosed bilateral knee pain with minimal degenerative joint disease.  The bilateral knee condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance.

After due deliberation 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 migraine/tension headaches, PTSD, low back pain, and bilateral knee pain and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic right shoulder pain and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine/tension headaches, PTSD, low back pain, and bilateral knee pain 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 20140718, 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 XXXXXXXXXXXXXXXXXXXX, AR20160008002 (PD201403377)

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