RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02061
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Cryptologic Linguist, medically separated for “chronic pain, left shoulder” with a disability rating of 10%.

CI CONTENTION:  The CI contended “decreased range of motion on effected shoulder” and “difficulty in sleeping due to regurgitation while asleep from hernia.”  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 panel 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 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 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 - 20061005	VARD - 20070625	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Shoulder	5009-5003	10%	Left Shoulder Tear of Superior Anterior Glenoid Labrum	5201	10%	20070302	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Shoulder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic pain, left shoulder condition began in March 2005 after a 20K road march.  A 15 December 2005 MRI showed findings consistent with a small tear of the superior anterior glenoid labrum (SLAP tear) and a small degenerative cyst in the posterior lateral humeral head.  At a follow-up orthopedic clinic appointment on 9 January 2006, the CI was instructed to make an appointment for evaluation for arthroscopic repair of the SLAP lesion.  At the next orthopedic clinic appointment on 20 April 2006, a decision was made to delay surgery while awaiting resolution of a separate skin lesion issue.  At a physical therapy clinic appointment on 6 June 2006, the CI reported pain all the time, normally 5/10; and increasing to 6-7/10 and lasting several hours, with certain shoulder motions.  On physical exam, the range of motion (ROM) was flexion 145 (normal 180) and abduction 140 (normally 180).  Strength was 5/5 with pain with resistance all motions and tenderness to palpation over the A/C joint and supraspinatus insertion.  An MRI on 19 June 2006 identified tendinosis lateral upper rotator cuff, possibly with a small partial tear in the undersurface (no complete tear was seen).  There was a slightly inferiorly angulated and down-sloping acromion with some narrowing between the humeral head and the acromion identified, and small cystic changes at the humeral head rotator cuff insertion site, suggesting chronic changes.  An MRI with gadolinium post arthrogram injection on 25 June 2006 revealed findings consistent with a small tear of the superior anterior glenoid labrum and a small degenerative cyst in the posterior lateral humeral head.  At an Orthopedic appointment on 16 August 2006, the CI reported continued pain at the site and, after deliberation, decided not to proceed with surgery.  The physical exam showed normal active ROM for both flexion and abduction, with normal strength and no decreased response to tactile stimulation.  The shoulder was tender on palpation at insertion of the supraspinatus.  There was positive cross arm, SULCUS and Hawkin’s.  After treatment, the left shoulder condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.  At the 22 September 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported pain and instability in the left shoulder, impingement of the A/C joint and left arm numbness with use.  Physical examination showed pain upon testing of the left shoulder.  The 22 September 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of slight/constant pain rated at 6/10, increasing to 8/10 with aggravation.  The shoulder did not bother his sleep, but the CI gave up running and martial arts due to the pain.  Medications included ibuprofen and acetaminophen daily for pain.  Physical examination referred to physical therapy ROMs dated 11 September 2006 with flexion of 145 degrees (180 normal), with pain at 7/10; and abduction of 140 degrees (180), with pain rated 7/10.  There was no edema, the CI was neurologically intact and the left shoulder strength 4+/5 secondary to pain.  At the 2 March 2007 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported limited motion with pain, popping and cracking.  There were cold weather flare-ups of moderate intensity, usually twice weekly, lasting 1-2 days, with no additional functional impairment.  There was also numbness of the inner aspect of the left arm and entire hand.  Physical exam showed mild atrophy of the left bicep with some pain on motion, but overall normal bilateral shoulders.  ROM was 180 degrees of flexion (with discomfort at the endpoint) and 175 degrees for abduction (with discomfort at the endpoint).  There was no evidence of motor or sensory loss and deep tendon reflexes were all 2+.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “chronic pain, left shoulder” condition 10%, coded 5099-5003 (Analogous to Arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the “left shoulder tear of superior anterior glenoid labrum” condition 10% coded 5201 (arm, limitation of motion), based on the VA C&P examination 4 months after separation, citing pain with range of 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.  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 to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  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 “chronic pain, left shoulder” condition.  

BOARD FINDINGS:  In the matter of the “chronic pain, left shoulder” condition and IAW VASRD §4.59, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150727, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010042, 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,					      
						      					
Enclosure