RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-03502		
BRANCH OF SERVICE:  Army	Separation Date:  20080215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Interior Electrician, medically separated for a left shoulder condition, with a disability rating of 20%.

CI CONTENTION:  The CI requests the Board consider all conditions.  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 - 20090303	VARD 20071219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arm, Limitation of Motion Secondary to Chronic Left Shoulder and Neck Pain	5003-5201	20%	Acromioclavicular Joint and Humeral Head Degeneration, Left Shoulder and Spondylotic Changes Cervical Spine	5003	10%	20071219	
			Upper Back Condition	5237	Not Service Connected (NSC)	20071219	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY: 

Left Shoulder Condition.  During basic training the CI’s left shoulder gave out while performing push-ups and overhead hand claps; however, she was able to graduate from both basic training and AIT.  A left shoulder magnetic resonance imaging study (MRI) performed in February 2006 showed bursitis, mild acromioclavicular degeneration, mild supraspinatus muscle tendinosis, and mild degenerative change of the humeral head.  The CI was treated with a steroid injection for chronic left shoulder pain and limited active range-of-motion (ROM).  Despite chiropractic treatments, physical therapy (PT), and pain and muscle relaxing medications, the CI’s pain limited ROM did not resolve.  An electromyogram/nerve conduction velocity study (April 2007) and arthrogram (May 2007) were normal.  The Medical Evaluation Board (MEB) narrative summary (NARSUM) examination, approximately 9 months prior to separation, documented reports of chronic left shoulder pain.  The left shoulder pain was aggravated by lifting and overhead movements.  The CI reported that she would awaken with pain rated at 4/10.  The physical examination demonstrated focal tenderness of the shoulder soft tissues bilaterally (left greater than right) and over the left acromioclavicular joint, sub acromial bursa, and supraspinatus muscle.  The VA Compensation and Pension (C&P) examination, approximately 2 months prior to separation, documented reports of weakness, stiffness, swelling, giving way and pain.  The pain was described as constant, aching and sharp; rated at 6-8/10; worsened with activity; and relived by rest and medication.  The VA C&P physical examination demonstrated full active range of motion (ROM) (flexion: 180 degrees, abduction: 180 degrees), normal upper extremity strength bilaterally and no evidence of painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the arm limitation of motion secondary to chronic left shoulder and neck pain 5003-5201 (arthritis, degenerative-arm, and limitation of motion of), rated 20%.  The VA coded the acromioclavicular joint and humeral head degeneration, left shoulder, and spondylotic changes cervical spine condition as 5003, rated 10%.  Service treatment records evidenced painful motion for the application of VASRD §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic left shoulder condition.  

Neck Condition:  The CI developed burning sensations during ruck marching.  A cervical spine X-ray performed in January 2007 showed slight narrowing of the disc spaces in the lower cervical spine (C5-6 and C6-7).  A cervical spine MRI performed in April 2007 showed mild spondylotic changes at C4-5 with minimal bilateral stenosis The CI was treated conservatively without resolution of the neck pain.  The MEB NARSUM examination documented that the neck pain was aggravated by neck positioning and strenuous activity.  The MEB NARSUM physical examination demonstrated tenderness to palpation over the trapezius, scalene, and para-cervical muscles.  PT documented decreased lateral flexion and rotation bilaterally with normal cervical spine flexion and extension.  At the VA C&P examination the CI reported constant neck stiffness and sharp, aching pain; rated at 6-8/10.  The physical examination demonstrated full active cervical ROM without evidence of radiation of pain on motion, muscle spasm, or tenderness.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB subsumed the neck pain in the rating of the arm limitation of motion.  The VA rated the cervical spine condition as part of the shoulder condition.  Board members agreed that the cervical neck pain condition could be reasonably justified as separately unfitting and therefore; eligible for a separate service disability rating.  Multiple service treatment notes documented reports of neck pain with objective radiographic and examination findings of cervical pathology.  The Board agreed that the evidence supports a VASRD rating for localized tenderness not resulting in abnormal gait or abnormal spinal contour.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the neck condition.  

BOARD FINDINGS:  In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  In the matter of the neck condition, the Board unanimously recommends a disability rating of 10%, coded 5237 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 her prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Left Shoulder Pain	5003	10%	
Chronic Neck Pain	5237	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140711w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMA-RB
.JUL 1 4 2016
MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA   22202-3557

SUBJECT:   Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXX, AR20160008178  (PD201403502)

1.	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, accept the Board's recommendation to modify the individual's disability description without modification of the combined rating or re-characterization of the individual's separation. This decision is final.

2.	I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3.	I  request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.
CF:
( ) DoD PDBR ( ) OVA