RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02100
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050520

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard or National Guard E4, Personnel Services Specialist, medically separated for “chronic pain, right [sic] left shoulder” with a disability rating of 10%.  

CI CONTENTION:  Contends foot, scars, hypertension, hyperlipidemia, IBS, PTSD, GERD, and spine conditions.  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 - 20050429	VARD - 20041027	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right [sic] Left Shoulder	5299-5003	10%	Status Post Arthroscopic Superior Labrum…	5201	20%	STR	
Bilateral Foot Pain	Not Unfitting	Left 5th Hammer Toe 	5282	0%	20050908	
		Right 5th Hammer Toe	5282	0%		
Plantar Warts [Bilateral]		Left Foot, Plantar Warts	7899-7806	NSC		
		Right Foot, Plantar Warts	7899-7806	0%		
Hyperlipidemia		Hyperlipidemia	7799-7700	NSC	STR	
GERD		GERD	7307-7346	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Shoulder.  The panel determined the PEB made an administrative error documenting a “right” shoulder condition on the DA Form 199 Form when the “left” shoulder was forwarded for adjudication and is consistent with the service treatment record (STR).  
According to the STR and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the non-dominate left shoulder condition began in September 2003 after moving equipment.  The CI underwent arthroscopic surgery on 12 May 2004 for a superior labrum anterior and posterior lesion tears.  A 5 January 2005 physical therapy examination, 5 months prior to separation, noted complaints of left shoulder pain.  The physical examination revealed ROM for flexion and abduction each 90 degrees (both normal to 180); painful motion was not addressed.  During the 12 January 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months before separation, the physical examination showed ROM of flexion 45 degrees and abduction 80 degrees; painful motion was not addressed.  

The 20 January 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of left shoulder pain.  The physical examination revealed 4/5 motor strength of his infraspinatus and supraspinatus muscle groups, while subscapularis had 5-/5 motor strength.  The goniometric-ROM for flexion was 113 degrees and abduction was 90 (both normal at 180); passive ROM was noted with painful motion.  There was not VA Compensation and Pension examination performed proximate to separation, the VA rated the left shoulder based on the CI’s STR.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the shoulder condition 10%, analogously coded 5003 (degenerative arthritis) citing the US Army Physical Disability Agency pain policy for slight/constant pain.  The VA rated the left shoulder condition 20%, coded 5201 (arm, limitation of motion) based on the CI’s STR, citing limited motion at shoulder level.  

The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level”.  The Board agreed that the STR examinations in evidence demonstrated motion at shoulder level to support a 20% rating for the non-dominate arm, but no higher under 5201.  There was no malunion with marked deformity or frequent episodes of recurrent dislocation of the humerus to justify a higher rating under the 5202 code (humerus, other impairment), and no higher rating available under the 5203 code (clavicle or scapula, impairment).  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 left shoulder condition, coded 5201.  

Contended PEB Conditions:  Bilateral Foot Pain, Plantar Warts, and Gastroesophageal Reflux Disease (GERD).  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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.  

Bilateral Foot Pain, Plantar Warts.  Notes in STR and MEB addendum indicated the CI was undergoing active treatment for plantar warts of both feet.  A VA outpatient orthopedic note 19 December 2004 indicated the CI had hammertoes, bilateral heel pain and plantar warts and needed extra deep boots to accommodate orthotics.  VA outpatient podiatry notes from December 2004 on indicated the CI had and was given new prescription orthotics.  The MEB forwarded two conditions of the feet as medically unacceptable – bilateral foot pain and plantar warts.  The MEB Foot addendum listed one condition of the feet characterized as “bilateral foot pain related to recurrent warts.”  The 5 April 2005 permanent profile was U3L3 and listed bilateral foot pain with noted physical limitations of special shoes authorized and unable to march or stand for prolonged periods of time.  The commander’s statement dated 18 January 2005 did not implicate the bilateral foot conditions as impairing the CI’s performance of his duties.  The commander noted that the physical profile for the CI’s MOS was P3U2L3E2E2S2.  Given the MOS physical requirements of L3, there was no performance-based evidence from the record that these foot conditions 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 the contended bilateral foot pain, plantar warts and GERD conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic pain, left shoulder condition, the panel unanimously recommends a disability rating of 20%, coded 5201 IAW VASRD §4.71a.  In the matter of the contended bilateral foot pain, plantar warts, and GERD 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, Right [sic] Left Shoulder	5201	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150729, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011082, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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