RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00720
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070709

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

CI CONTENTION:  The CI contends his condition continues to worsen and impact his daily activities.  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 based upon a 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 - 20070405	VARD - 20070807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Shoulder	5099-5003	10%	Left Shoulder Strain with Scar [and Surgical Residuals]	5299-5203	10%	20070404	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Pain Left Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced an atraumatic onset of left (non-dominant) shoulder pain in March 2002 during basic training.  A labral tear (the labrum is the attachment for the joint capsule at the rim of the socket) was suspected, but arthroscopy in December 2003 identified only some labral fraying which was debrided.  Four months later, however (with no interim history of injury or other explanation in the STR), labral and ligamental tears were identified; and, a second surgical intervention ensued (Mumford procedure with distal clavicular excision).  This was complicated by post-operative infection requiring surgical drainage and debridement.  The CI did well, but subsequently developed signs of joint impingement requiring a final surgical intervention (subacromial decompression) in March 2005 (27 months before separation).  An orthopedic follow-up entry (19 months before separation) documented favorable surgical results with “full function” and the absence of instability or signs of impingement by physical examination.  The remaining outpatient STR evidence probative to functional impairment, range of motion (ROM), instability, and other VASRD rating criteria was consistent with that from the formal examinations which follow.  There was no STR documentation of incapacitating episodes unrelated to surgical recovery.  Further surgery was not indicated; a protracted trial of conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “persistent left shoulder pain status post multiple surgical procedures” to the PEB.

Formal ROM measurements for the MEB by physical therapy (PT) were conducted on 12 February 2007 (5 months before separation) and recorded forward flexion to 120 degrees (normal 180, 90 for minimum 20%) and abduction to 105 degrees (same parameters), specifying painful motion.  The MEB’s DD Form 2808, Report of Medical Examination, was conducted a day after the above PT evaluation and also provided ROM measurements.  That examiner recorded forward flexion to 165 degrees and abduction to 135 degrees.  The NARSUM examination on 8 March 2007 (4 months before separation) documented persistent pain rated “slight [and] occasional” precipitated by “anything that requires pushing, pulling, or lifting.”  The physical examination recorded some positive signs of impingement but no instability.  The NARSUM duplicated the PT ROM measurements (omitting abduction).  

A VA Compensation and Pension (C&P) examination on 4 April 2007 (3 months before separation) documented “recurrent” shoulder pain (unquantified) with “actions above the level of his head.”  The physical examination recorded the absence of joint tenderness or instability.  The ROM measurements were forward flexion to 155 degrees and abduction to 135 degrees, specifying pain at end-ranges that was increased with repetition (no ROM degradation).
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5099-5003 (analogous to degenerative arthritis) cited the US Army Physical Disability Agency (USAPDA) Pain Policy, but was compliant with VASRD §4.71a criteria for the service ROM and other ratable evidence.  The VA assigned a 10% rating under the analogous code 5299-5203 (clavicle or scapula, impairment of), citing the ROM and pain with repetition from the C&P examination.  There was no ROM limitation in evidence which would achieve a rating higher than 10%; and, there was no ankylosis, fracture (nonunion/malunion) or subluxation/instability that would support a higher rating via any other applicable code available under §4.71a.  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 of the left shoulder condition.  

BOARD FINDINGS:  In the matter of the left 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 20150603, 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, AR20170000068 (PD201500720)

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