RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03439
BRANCH OF SERVICE:  Army  	Date of separation: 20070213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Apache Attack Helicopter Repairer, medically separated for “chronic pain, right shoulder due to supraspinatus tear,” rated at 10%.

CI CONTENTION:  The applicant makes no specific contentions.  Her 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 - 20061214	VARD - 20070614 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder, due to Supraspinatus Tear	5099-5003	10%	Supraspinatus Tear and Strain, Right Shoulder	5201-5024	10%	20070614	
RATING:  10%	RATING:  60%	

ANALYSIS SUMMARY:  

Right Shoulder Condition.  The narrative summary (NARSUM) noted the CI injured her dominant right shoulder in November 2005 while deployed.  She lost her footing while working on an aircraft and the arm was pulled upward and she felt a “pop.”  Primary care visits in November 2005 and January 2006 noted the injury may have occurred from a dislocation with spontaneous relocation of the shoulder, but noted full range-of-motion (ROM) and no instability of the shoulder was noted on examination.  After returning from deployment, electrodiagnostic studies were performed on 25 May 2006 to evaluate possible cervical spine causes of right upper extremity (RUE) symptoms of pain and mild weakness and showed no evidence of peripheral nerve injury (cervical radiculopathy).  Magnetic resonance imaging of the shoulder on 11 July 2006 noted a partial tear of a rotator cuff tendon and no evidence of injury due to dislocation.  At an orthopedic evaluation on 15 August 2006 the CI reported constant right shoulder pain and “slipping” and neck pain with radiation to the right upper back, which occurred together.  The examination noted diffuse tenderness and limited shoulder ROM, with no gross instability.  The shoulder and cervical spine examinations were noted to be limited by shoulder pain.  The CI was offered shoulder injection by an orthopedic specialist, but she declined and requested a Medical Evaluation Board (MEB).

The DD Form 2808, Report of Medical Examination, dated 8 September 2006, 5 months before separation, noted anterior right shoulder pain with full ROM.  At the MEB examination on 24 November 2006, 3 months before separation, the CI reported right shoulder and neck pain aggravated by activities such as lifting and carrying weights of more than 15 pounds.  The MEB physical examination cited a physical therapy evaluation dated 6 October 2006.  The therapist noted mild RC weakness with “multiple joint laxity.”  Shoulder abduction and external rotation caused an audible painful click.  Strength of the right upper extremity was decreased due to pain, graded 4+/5, and sensation was normal.  Shoulder ROM was flexion 160 degrees (normal 180) and abduction 180 degrees (normal 180).  Neck ROM was reduced and painful, with TTP of the lower neck and between the shoulder blades.  According to the NARSUM cervical MRI in August 2006 was normal.  

At the VA Compensation and Pension (C&P) examination on 14 June 2007, 4 months after separation, the CI reported she tore her right rotator cuff in 2005.  She reported constant pain and grinding in her shoulder aggravated by activity including overhead work.  The CI also reported neck pain which began with her shoulder injury and radiated to her right shoulder and arm.  She reported pain medications were helpful.  There was normal RUE reflexes and strength, without muscle atrophy.  The examiner noted sensation as “hypersensitive to the right arm.”  Shoulder ROM was flexion 180 and abduction 100 and neck ROM was painful and decreased.  Shoulder and cervical spine X-rays were normal.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition 10%, coded 5099-5003 (analogous to degenerative arthritis) and cited the USAPDA pain policy.  The VA rated it 10%, coded 5201-5024 (tenosynovitis with limited arm motion).  The Board noted that the MEB referred shoulder pain and neck pain secondary to the left shoulder condition as separate conditions and the PEB adjudicated the shoulder condition and neck pain as a single unfitting condition.  The Board reviewed the evidence and agreed that it supports that the neck pain was related to the shoulder injury and they are the same disability and cannot be provided individual disability ratings IAW VASRD 4.14 (Avoidance of pyramiding).  The Board therefore deliberated the rating of the shoulder condition and agreed that the evidence in record supports a 10% rating at separation coded as 5024 (according to 5003 rating criteria) for tenosynovitis of a single joint with limited motion or coded as 5299-5203 (analogous to clavicle-scapula impairment), an analogous code for rotator cuff injury, or coded as 5299-5201 IAW VASRD 4.59 (Painful motion).  The Board reviewed to see if a higher rating was supported with any applicable coding approach.  A 10% rating is the highest rating available for a single joint coded according to 5003 criteria and there was no evidence of arm motion limited “at shoulder level”, taken by Board practice to be 90 degrees of flexion or abduction, for a 20% rating coded as 5201.  Although, after the initial injury, there was speculation that dislocation with spontaneous relocation may have occurred, there were no recurrent dislocations documented in record, there was no MRI evidence of injury due to dislocation, and despite global joint laxity noted by the Service physical therapist, no instability was noted at two primary care visits or the orthopedic evaluation noted above.  The Board therefore concluded that coding as 5202 (impairment of the humerus) for recurrent dislocations was not warranted.  The Board also considered if there was evidence in record of functional loss equivalent to limitation of arm motion at shoulder level at the time of separation sufficient to warrant a 20% rating due to the single notation of abduction of 100 degrees at the C&P exam.  However, the commander’s statement referenced many limitations due to the shoulder condition, but did not mention difficulty with overhead work; the permanent profile did not prohibit or limit overhead activities; and, guarding of shoulder movements at shoulder level was not noted at any exam in record.  Additionally, there was no evidence of impairment of the clavicle/scapula with loose movement or shoulder ankylosis to support a higher rating.  Thus, the Board determined that the evidence supports a 10% rating for the shoulder condition and no higher.  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 for the shoulder condition.

BOARD FINDINGS:  In the matter of the 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.  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 20140715, 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 XXXXXXXXXXXXXXXXXX, AR20160006095 (PD201403439)

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