RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00962
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070423

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E5, Cryptologic Linguist, medically separated for “chronic pain, left (non-dominant) shoulder” with a disability rating of 0%.

CI CONTENTION:  He was rated higher by the VA.  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 condition(s) 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 - 20070313	VARD - 20070912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left (Non-Dominant) Shoulder	5099-5003	0%	Left Shoulder Impingement	5201	20%	20070622	
Left Hip Pain	Not Unfitting	Left Hip Bursitis	5252-5019	10%		
Right Elbow Pain	Not Unfitting	Right Elbow Strain	5206-5024	10%		
Right Wrist Pain	Not Unfitting	Right Wrist Strain	5215-5024	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Pain, Left (Non-Dominant) Shoulder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI had a 7 year history of left shoulder pain since early 2003 after taking a PT test.  The symptoms became worse in October 2005 with overhead lifting activities.  The CI denied any specific trauma or injury.  Diagnostic imaging studies (X-ray) 3 October 2005 showed mild degenerative changes of the left distal clavicle.  
The CI was diagnosed with left shoulder impingement and a left shoulder arthroscopic sub-acromial decompression was performed 3 April 2006.  After several months of physical therapy and a sub-acromial steroid injection there was little or no improvement in his complaint of pain.  Diagnostic imaging studies (X-ray) on 23 October 2006 indicated a normal left shoulder impingement series.  Diagnostic imaging studies (MRI arthrogram) on 8 November 2006 revealed a complex tear with degenerative changes of the inferior labrum and a partial tear or high-grade sprain of the middle glenohumeral ligament that extended into the superior glenohumeral ligament.  Further treatment did not result in improvement sufficient to allow unrestricted duty.  

The 17 January 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of left trapezial (posterior) shoulder pain which had been getting worse despite activity modification and working with physical therapy and physical medicine and rehabilitation.  The CI complained of difficulty with driving and sitting at a computer.  Physical examination showed passive range of motion (ROM) to 100 degrees flexion (180 normal) and abduction to 80 degrees (180 normal) with guarding.  There was diffuse tenderness to palpation about the shoulder.  There were no impingement signs present.  

At the 22 June 2007 VA Compensation and Pension (C&P) examination, performed 2 months after separation, the CI reported constant left shoulder pain, rated 7/10 in intensity.  The pain was aggravated by physical activity, stress, and sleeping positions.  The pain was relieved by medication (Motrin).  Physical examination showed no edema, effusion, weakness, tenderness, redness, heat, abnormal movement, guarding or subluxation.  The ROM was reported as forward flexion 60 degrees limited by pain (180 normal) and abduction 60 degrees limited by pain (180 normal). 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under code 5003 (arthritis, degenerative [hypertrophic or osteoarthritis]), citing the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA assigned a 20% rating using code 5201 (arm, limitation of motion of) for painful limitation of forward flexion.  The VA additionally rated the left shoulder surgical scar at 0% under code 7801 (scar due to other causes, not of the head, face, or neck that are deep and nonlinear).

There was evidence of forward flexion and abduction to “at shoulder level” (approximately 90 degrees from the side) to justify a 20% rating for the non-dominant arm in both the MEB NARSUM and VA C&P examination code 5201.  There was no evidence of non-dominant shoulder limitation of 25 degrees from the side to justify the next higher rating under the same code.  There was no history of fracture with fibrous union or nonunion of the humerus to justify a higher rating under code 5202 (humerus, other impairment of), and no higher rating available under code 5203 (clavicle or scapula, impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic left shoulder pain condition.

Contended PEB Conditions:  

Right Elbow Pain, and Right Wrist Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The right elbow pain and right wrist pain were not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the right elbow pain and right wrist pain 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 any of the contended conditions and so no additional disability ratings are recommended.

Left Hip Pain.  Although, the left hip pain was profiled and mentioned in the commander’s statement, diagnostic imaging studies revealed a normal appearing hip and the PEB judged the condition did not fail retention standards.  The panel additionally noted that the CI was able to take and pass the walk aerobic test and sit-ups portions of the APFT which would both put significant stress on the hips.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the left hip pain and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic pain, left (non-dominant) shoulder condition, the panel unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the contended left hip pain, right elbow pain, and right wrist pain conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain, Left (Non-Dominant) Shoulder	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, with attachments.
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007893, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure