RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX                                                                	 CASE:  PD-2014-04069
BRANCH OF SERVICE: Army                                                                   SEPARATION DATE:  20070318

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Infantryman) medically separated for a shoulder condition.  The shoulder could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The “right shoulder pain secondary to tendonitis,” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (right knee pain) as medically acceptable for PEB adjudication.  The Informal PEB adjudicated “chronic right shoulder pain,” as unfitting, rated 0%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION: He was given a higher rating for his conditions by the VA.  His complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the 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/Naval 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: 

IPEB – Dated 20070206	VA* - (~1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Shoulder Pain	5009-5003	0%	Anterior Labral Tear, R/Shoulder	5299-5201	10%	20070423	
Right Knee Pain	Not Unfitting	Right Knee Condition	5260	NSC	20070423	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1	
RATING:  0%	COMBINED RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070801 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right Shoulder Pain.  The narrative summary (NARSUM) notes the CI developed pain during a field exercise when he fell on his dominant right shoulder and felt a “pop”.  The CI was treated conservatively with anti-inflammatory medications, physical therapy (PT) and a temporary profile.  He was subsequently deployed and when he returned from deployment he was evaluated by orthopedics for increased shoulder pain.  Magnetic resonance imaging (MRI) 31 October 2005 noted a “tiny” bone cyst of the humerus, but no significant pathology of the joint or rotator cuff (RC); and additional imaging, including X-rays and an arthrogram (MRI with contrast dye), were interpreted as normal.  Orthopedic evaluation 7 December 2005 noted tenderness to palpation (TTP) of the anterior shoulder, no instability, and flexion of 110 degrees (normal 180), with pain and positive tests for impingement.  Despite additional PT there was no improvement in the shoulder pain and no surgery was recommended.  The CI was given a permanent profile and an MEB was initiated.  

The DD Form 2808, Report of Medical Examination, 23 October 2006, noted TTP of the shoulder with painful abduction at 100 degrees (normal 180).  At the MEB exam 19 December 2006, 3 months before separation, the CI reported chronic shoulder pain aggravated by lifting or working overhead.  The MEB physical exam noted PT-measured range-of-motion (ROM) was flexion 140, 145, and 145 degrees and abduction 135, 140, and 135 degrees, and the therapist noted ROM was limited by pain.

At the VA Compensation and Pension (C&P) exam 30 April 2007, performed 1 month after separation, the CI reported constant right shoulder pain, aggravated by activity without instability or dislocations.  He reported increased symptoms with lifting, carrying and working overhead, but denied use of medications or flare-ups.  The exam noted no TTP.  Shoulder ROM was flexion and abduction of 180 degrees, without pain, and there was no additional loss of ROM with repetition.  Shoulder MRI 30 April 2007 noted an anterior labral (joint cartilage) tear and mild degenerative changes of the RC, without tears.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder 0%, coded 5099-5003 (analogous to degenerative arthritis), and cited the USAPDA pain policy.  The VA rated the shoulder condition 10%, coded 5299-5201, despite normal, painless ROM at the VA exam dated 23 April 2007, noting the abnormal MRI findings.  The Board agreed the evidence in record supports a 10% rating coded as either 5299-5201 IAW VASRD §4.59 (painful motion) for painful limited motion, or 5299-5203 (analogous to clavicle/scapular impairment) as an analogous code for RC injury, or coded 5024 (tenosynovitis) according to 5003 rating criteria for imaging evidence of degenerative tendonitis of a single major joint.  The Board reviewed to see if the evidence supports a higher evaluation with any applicable code.  There was no evidence of arm motion limited “at shoulder level” (by Board practice taken to be 90 degrees of flexion and abduction) for a 20% rating coded 5201.  A 10% rating is the highest available rating under 5003 criteria for a single joint and there was no evidence of dislocation of the clavicle/scapula or nonunion with loose movement, impairment of the humerus, or ankylosis for a higher rating with any other VASRD shoulder code.  The Board thus determined that the evidence supports a 10% rating for the shoulder condition and no higher, including consideration of functional loss. The Board chose to code the condition as 5299-5201.  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 shoulder condition.  

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the right knee condition was 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.  

Right knee pain.  A primary care visit 10 November 2005 noted right knee pain.  Knee X-rays were ordered and the CI was referred for PT and orthopedic consult.  An orthopedic evaluation in December 2005 indicated only shoulder pain.  No other notes were found in the available service treatment record regarding knee pain.  The NARSUM noted knee X-rays in 2005 showed early degenerative arthritis and the CI was diagnosed with retropatellar pain syndrome and took anti-inflammatory medication on an ‘as needed’ basis.  The right 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 the right knee condition significantly interfered with satisfactory duty performance.  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 right knee condition and so no additional disability ratings are recommended.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy for rating the shoulder condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5201 IAW VASRD §4.71a.  In the matter of the contended right knee condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Right Shoulder Pain Condition	5299-5201	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140925, 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-D0), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20160004456 (PD201404069)

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 rating to 10%
without 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.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
()DVA