RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00257
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “left (dominant) shoulder pain,” with a disability rating of 10%. 

CI CONTENTION:  The CI made a lengthy contention. The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical conditions at the time of separation.  The panel 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 panel 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 - 20070730	VARD - 20080808	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left (Dominant) Shoulder Pain	5099-5003	10%	Left Shoulder, SLAP (Superior Labral Anterior Posterior) Repair	5299-5201	10%	20080630	
Temporomandibular Joint (TMJ) Arthralgia	Not Unfitting	TMJ 	9999-9905	NSC	20080625	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left (Dominant) Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left shoulder surgery in 1999, 2002, and 2003 for a torn cartilage of the shoulder.  Radiographic imaging in July and December 2006 confirmed a recurrent labral tear.  Following these surgeries, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “shoulder sprain anterior glenoid labrum” for PEB adjudication.  

At a 30 May 2007 physical therapy clinic examination, 3 months prior to separation, ranges of motion (ROM) were recorded as flexion of 144 degrees (normal 180) and abduction to 153 degrees (normal 180), limited by painful motion.  There were no additional decrements in ROM after repetition.  

According to the 9 July 2007 MEB NARSUM evaluation, 2 months prior to separation, the CI reported “numerous dislocations” and constant pain causing difficulty picking up his children, inability to lift or wear body armor, running limited to a half mile (due to shoulder pain), and driving limited to short distances (2 miles to and from work).  The physical examination showed “full ROM” with pain at the limits of motion and no evidence of instability.  

At the 30 June 2008 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported pain that did not limit activities of daily living or his post-discharge civilian job.  He reported an inability to run more than one quarter mile or exercise as desired, and that he could not lift his children.  The physical examination showed flexion to 160 degrees and abduction to 130 degrees.  There was evidence of painful motion with no change after repetition and no evidence of instability.  
 
The panel directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also rated 10% for the shoulder, using analogous code 5299-5201 (arm, limitation of motion) based on evidence of painful motion.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  While there were prior dislocations, both the NARSUM and VA C&P examinations indicated no evidence of instability, so the next higher rating of 20% was not justified under the 5202 code (humerus, other impairment of).  There was no STR documentation of nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left shoulder pain.  

Contended PEB Condition:  TMJ Arthralgia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

PANEL FINDINGS:  In the matter of the left (dominant) shoulder pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended TMJ arthralgia, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150406, w/attachments
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 XXXXXXXXXXXXXXXXXXXXX, AR20170003455 (PD201500257)

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