RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01418
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071227

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

CI CONTENTION:  The CI requests review of all conditions.  The CI’s 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 - 20071001	VARD - 20090702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Shoulder	5099-5003	10%	Left Shoulder Strain w/impingement Symptoms	5299-5201	0%	20090529	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Shoulder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right hand dominant CI’s left shoulder pain condition began in June 2005 without specific injury.  Radiographic studies on 6 September 2006 showed no significant joint or bone abnormality.  Evaluation by physical therapy (PT) showed full active range of motion (FAROM) of the left shoulder and a normal examination.  The examiner recommended NSAID’s and activity modification for pain relief.  There was no surgical indication, and conservative treatment (physical therapy, trigger point injections, medication) did not result in improvement sufficient to allow unrestricted duty.  

The MEB NARSUM examination on 28 August 2007, 4 months prior to separation, noted continued complaints of shoulder pain.  The CI stated he gave up “sports, rock climbing and swimming” due to his shoulder pain.  Physical examination showed the left shoulder range of motion (ROM) following repetitive movement at flexion of 140 degrees (normal 180 degrees) and abduction of 85 degrees (normal 180 degrees).  The ROM was restricted by pain.  The examiner noted “significant audible crepitus” during manipulation.  All radiographic studies were normal.  The CI could not perform the duties or physical requirements of his MOS.  

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left shoulder condition 10%, coded analogously 5099-5003 (Arthritis, degenerative), citing, pain limited motion, rated as slight/constant, using the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left shoulder condition 0% coded analogously 5299-5201 (Arm, limitation of motion), based on the Compensation and Pension (C&P) examination 17 months after separation, citing  normal forward flexion and normal appearing left shoulder.  Probative value for rating is placed on the NARSUM examination as the C&P examination is remote from separation.  

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.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).   There was no malunion or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  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 condition.  

BOARD FINDINGS:  In the matter of the left shoulder condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20150618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008453, XXXXXXXXXXXXXXXXXX 

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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.

A copy of this decision has been provided to the counsel you listed on your application, Pennsylvania Department of Military and Veterans Affairs, XXXXXXXXXXXXXXXXXX.

Sincerely,					       
						      					
Enclosure