RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02176
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “chronic left shoulder pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that the ratings for his shoulder and ankle should be changed.  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 - 20040114	VARD - 20040624	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Shoulder Pain	5099-5003	10%	Chronic Left Shoulder Pain…	5299-5201	20%	20040518	
Chronic Right Ankle Pain	Not Unfitting	Residuals, Right Ankle Sprain	5299-5271	0%	20040518	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Shoulder Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI started complaining of left shoulder pain in March 2003 without inciting incident or injury.  Left shoulder X-ray was interpreted as negative.  There was no surgical indication and despite 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 MEB.  

The range of motion (ROM) evaluations in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Left Shoulder ROM
(Degrees)	PT ~3 Mo. Pre-Sep	MEB ~2 Mo. Pre-Sep	VA ~3 Mo. Post-Sep	
Flexion (180 Normal)	Full	180	180	
Abduction (180)	Full	180	90	
Comments	Painful motion	Painful motion	-	
§4.71a Rating	10%	10%	20%	

At the 9 December 2003 physical therapy examination, 3 months prior to separation, the examiner noted that the CI had full active ROM with pain at the end range of flexion and abduction.  Testing for impingement signs (equivalent to painful motion) was positive.  The CI also had tenderness to palpation of the left anterior shoulder.  

The 15 December 2003 MEB NARSUM examination, 2 months prior to separation, the CI complained of left shoulder problems.  Shoulder dislocations were not reported.  Physical examination showed left shoulder flexion was 180 degrees (normal 180) and abduction was 180 degrees (normal 180).  There was no swelling, effusion, or atrophy noted, but the CI did “complain of discomfort with abduction…as well as [with] full internal rotation.”  Instability was not addressed.  

At the 18 May 2004 VA Compensation and Pension (C&P) examination, performed 3 months after separation, the CI reported constant pain in the left shoulder area that was tender to the touch.  He also complained of “constant numbness in [his] left hand associated with pins-and-needles sensation in the tips of [his] fingers of the left hand [and] weakness of grasp…things slip out of his hands.”  Focused physical examination of the left shoulder showed “tenderness in the bicipital area of the left shoulder region.”  In regards to his ROM, forward flexion was 180 degrees and abduction was 90 degrees.  He was also noted to have normal strength, sensation, and reflexes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency Pain Policy for pain that was slight and frequent.  The VA assigned a 20% rating under code 5299-5201 (analogous to limitation of arm motion), based on the C&P examination 3 months after separation, citing limitation of abduction to 90 degrees.  

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 physical therapy and MEB examinations more proximate, and prior to, separation, demonstrated motion above this level.  The VA examination showed limitation of abduction at this level (90 degrees), but this post-separation finding was an outlier and conflicted with other examinations proximate to separation.  The panel agreed that the NARSUM and physical therapy examinations proximate to separation held more probative value than the post-separation VA examination.  Although there was no limitation of motion to support a rating under the 5201 code, 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 left shoulder condition.

Contended PEB Condition:  Chronic Right Ankle Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Although the contended condition was profiled and implicated in the commander’s statement, it was not judged to fail retention standards by the MEB.  The 9 December 2003 physical therapy clinic visit showed that the CI could still run a half mile.  On examination the CI’s gait was noted to be non-antalgic and his active right ankle ROM was within normal limits.  The 15 December 2003 NARSUM examination showed a normal gait and stable right ankle.  Radiographic studies were negative.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

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.  In the matter of the contended right ankle condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150807, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170010117, 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,