RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01079
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard O3, Infantry Officer, medically separated  for “chronic pain, left (non-dominant) shoulder,” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  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 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 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 - 20040220	VARD - 20041104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Shoulder	5099-5003	20%	Residuals L Shoulder…Surgery	5299-5201	30%	20040916	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Shoulder.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI underwent three surgical interventions of the left shoulder during 2001 and 2002; an arthroscopic rotator cuff repair and two subsequent manipulations under anesthesia (MUA) with clavicular decompression.  Despite surgical treatment, the left shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left shoulder pain and weakness status-post surgical intervention times 3” for PEB adjudication.

The MEB NARSUM examination of 16 April 2003, 15 months prior to separation, indicated that the CI was unable to do any overhead work or simple tasks of daily living such as lifting a glass to his mouth or opening a jar due to constant left shoulder pain.  He was taking narcotic pain medicine three times per day.  His physical examination (PE) revealed significantly decreased range of motion (ROM) of the left shoulder.  Flexion was 30 degrees (normal 180) and abduction was 10 degrees (normal 180).  There was no comment as to the presence of painful motion nor evidence of surrounding muscular atrophy.  Comparative strength revealed weakness of the left upper extremity.  

An Occupational Therapy (OT) encounter dated 20 November 2003, 8 months prior to separation, indicated painful left shoulder ROM of 20 degrees flexion and 35 degrees abduction.  Shoulder dislocations were not reported.  

A VA primary care encounter dated 6 August 2004, 3 weeks after separation, revealed the CI as “guarding ROM of the left shoulder and arm due to pain.”  Additionally, the provider documented the following statement:  “This appears to be [hypersensitivity/overreaction] response as {the CI’s} arm is grossly normal in appearance, aside from old surgery scarring.  {The CI} reports unable to use/move arm for years, yet no muscle atrophy is noted in fact, {CI’s} muscle mass is equal to the other arm.”  

At the 16 September 2004 VA Compensation and Pension (C&P) examination, performed 2 months after separation, the CI reported severe shoulder pain that resulted in basically a frozen shoulder.  He also reported his physician had instructed him to avoid driving or performing any strenuous activities with his left arm, but was able to slowly accomplish all activities of daily living.  The pain was still being treated with narcotic medication.  His left shoulder ROM was recorded as 0 degrees for both flexion and abduction.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under code 5099-5003 (analogous to degenerative arthritis), citing application of the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA assigned a 30% rating, coded 5201 (analogous to limitation of arm motion) for “ankylosis of the scapulohumeral articulation limiting abduction to 25 degrees from the side.”  

The Board members first acknowledged the clinical inconsistencies in both pre- and post-separation examinations; whereby the CI’s shoulder motion was severely limited, prior to separation versus no motion at all after separation.  Additional inconsistencies of the absence of surrounding muscular atrophy when one presents with the inability to move arm “for years” coupled with the ability to “accomplish all of his activities of daily living by himself (slowly with pain)” did not appear medically or physically plausible.  Given such stated inconsistencies, all Board members agreed to place a preponderance of examination probative value to the STR notes and the pre-separation evaluations to include the MEB NARSUM and rehabilitation notes.  The VASRD §4.71a threshold for rating a non-dominant arm ROM impairment under code 5201 is 20% equating to criteria of, “at shoulder level” (approximately 90 degrees from the side) or “midway between side and shoulder level” (approximately 45 degrees from the side).  The next higher 30% rating for the non-dominant arm requires motion limited to “25° from (body) side.”  The nearest probative clinical encounter in this case revealed painful abduction to 35 degrees; equating to an impairment level below that if the ROM was measured only to 25 degrees.  The 35 degree of abduction clearly supports an impairment level of 20%; the same as the PEB.    Therefore, 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 for the chronic left shoulder pain.

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 modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011803, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.
Sincerely,